Labral tear test

Key takeaways

A labral tear test is a physical examination maneuver that screens for a torn labrum before you order imaging.

No single special test is accurate enough on its own. Combining two or more tests with clinical reasoning raises accuracy to 80-90%.

A positive test reproduces the patient’s pain or clicking, which points toward MRI or MR arthrogram. A negative test does not rule a tear out.

The FADIR test is the exception worth knowing: it is sensitive rather than specific, so a negative result is the informative one.

Practice management software like Pabau captures each test result in a structured digital form, so your documentation stays audit-ready.

Labral tears in the shoulder and hip are common in athletes, manual workers, and patients whose sport involves repetitive overhead or rotational movement. Clinicians use a battery of special tests to screen for these injuries before ordering imaging. This guide covers the step-by-step procedure for each of the useful tests and what a positive result means. It also covers their diagnostic accuracy and how to record findings in a structured assessment.

What is a labral tear test?

A labral tear test is a physical examination maneuver that provokes symptoms in the shoulder or hip joint. Those symptoms are usually pain, clicking, or clunking. The labrum is a ring of cartilage that deepens the joint socket and stabilizes the ball-and-socket joint. When it tears, from trauma or from overuse, specific movement patterns trigger the symptom, which is what makes these tests useful screening tools.

These tests are not diagnostic on their own. Imaging, either MRI or MR arthrogram, is required for definitive diagnosis. What the tests do is help you prioritize further investigation and explain your reasoning to the patient and the specialist.

• Shoulder labral tear tests: O’Brien test (active compression test), crank test, Speed’s test, Biceps Load II test
• Hip labral tear tests: FABER test (Flexion, ABduction, External Rotation), FADIR test (Flexion, ADduction, Internal Rotation), Fitzgerald test (anterior hip labral provocation)

Clinicians use several tests together because any single positive result carries only moderate weight. A physical therapy EMR that structures your clinical assessment keeps every result in one place. It also flags the findings that warrant an imaging referral.

Shoulder special tests: O’Brien test and the alternatives

The O’Brien test, also called the active compression test, is the most commonly cited shoulder test for labral tears and acromioclavicular (AC) joint pathology. It has moderate sensitivity (72%) and specificity (60%) for SLAP lesions, which are superior labral anterior-posterior tears.

O’Brien test (active compression test): Procedure and interpretation

1. Patient position: Patient seated or standing, shoulder forward-flexed to 90°, elbow extended, thumb pointing downward (internal rotation).
2. Examiner placement: Stand beside the patient. Place one hand on the superior aspect of the humerus and the other on the extended arm.
3. Downward pressure: Apply firm downward pressure on the arm, as if pushing it toward the floor. The patient resists and holds 90° of forward flexion.
4. Repeat with supination: Repeat the same maneuver with the arm in external rotation (thumb up). This position tests the AC joint rather than the labrum.
5. Interpret: A positive test is shoulder pain in step 1 that improves or resolves in step 4. Pain only in step 4 suggests AC joint pathology instead.

Clinical interpretation: Pain with internal rotation that improves with external rotation suggests a labral tear or SLAP lesion. Combine it with at least one other test before you refer for imaging.

Crank test: Procedure and interpretation

1. Patient position: Patient supine or seated, shoulder abducted to 90°, elbow flexed to 90°.
2. Axial compression: The examiner applies a compressive force along the long axis of the humerus, pushing the humeral head toward the glenoid.
3. Rotation under load: Holding that compression, the examiner grasps the wrist and rotates the shoulder internally, then externally.
4. Patient response: Ask the patient to report pain, clicking, or clunking during the movement.
5. Interpret: A positive test reproduces the patient’s pain or mechanical symptoms, most often during internal rotation.

The crank test has sensitivity around 73% for SLAP lesions. The compression is what earns it a place in an overhead athlete’s assessment. It shears the labrum rather than simply moving the joint through range.

SLAP tear special tests: Biceps Load II and Speed’s test

Speed’s test and the Biceps Load II test both target the biceps anchor at the superior labrum. They are usually run alongside the O’Brien and crank tests, since two agreeing results are worth far more than one.

1. Speed’s test: Shoulder flexed to 90°, elbow extended, forearm supinated (thumb up). The patient resists downward pressure. Positive on reproduction of anterior shoulder or biceps pain.
2. Biceps Load II test: Patient seated, shoulder abducted to 120°, elbow flexed to 90°, forearm supinated. The examiner presses down on the arm while the patient resists. Positive on pain at the superior shoulder or anterior joint line.

Research shows that combining the O’Brien, crank, Speed’s, and Biceps Load II tests improves sensitivity to 80-90% when at least two of them are positive. Relying on a single test risks a false negative.

Hip special tests: FABER, FADIR, and Fitzgerald

Hip labral tears are common in dancers, soccer players, and patients with hip dysplasia or femoroacetabular impingement. The three main tests differ in patient positioning and direction of movement, which lets you load different regions of the labrum.

FABER test (Flexion, ABduction, External Rotation)

1. Patient position: Patient supine, hip and knee flexed, ankle resting on the opposite knee (figure-4 position).
2. Examiner placement: Stand beside the patient. Apply gentle downward pressure on the inside of the flexed knee, stretching the hip into flexion, abduction, and external rotation.
3. Patient response: Ask the patient to report pain in the hip or groin, or any clicking sensation.
4. Interpret: A positive test is pain in the groin or hip during the stretch, which suggests anterior-inferior labral pathology or iliopsoas tightness.

FADIR test (Flexion, ADduction, Internal Rotation)

1. Patient position: Patient supine. The examiner passively flexes the hip to 90°, then moves it into adduction and internal rotation.
2. Examiner action: Apply gentle overpressure at the end of the combined movement.
3. Patient response: Ask the patient to report anterior hip or groin pain, catching, or clicking.
4. Interpret: A positive test suggests femoroacetabular impingement or labral pathology, especially where the pain is sharp and anterior.

The FADIR test has high sensitivity and low specificity for hip labral pathology. That combination makes the negative result the informative one. If a properly performed FADIR test does not reproduce the patient’s pain, impingement and labral involvement both become much less likely. A positive result, taken alone, confirms very little.

Fitzgerald test

1. Patient position: Patient supine, hip flexed to 90°, knee flexed to 90°.
2. Examiner action: Apply downward pressure on the knee while the patient resists, creating compression and internal rotation of the hip.
3. Patient response: Ask the patient to report sharp anterior hip pain, clicking, or any reproduction of symptoms.
4. Interpret: Anterior hip pain with compression and internal rotation suggests an anterior-superior labral injury.

Across both joints, the position you put the patient in decides what a positive finding can tell you. The panel below sets the seven tests side by side.

Diagnostic accuracy: How reliable are labral tear tests?

No single physical examination test is accurate enough on its own to diagnose a labral tear. Published figures also vary widely between studies, so read the numbers below as a guide to each test’s character rather than a fixed value. You still have to combine the tests with the patient’s history, the mechanism of injury, and imaging.

Two positive tests beat any single test, and by a wide margin. A patient with a positive O’Brien test and a positive crank test has a high probability of a labral tear and warrants an imaging referral. One positive test on its own calls for follow-up and a second assessment first.

Read the two hip tests as a pair. FADIR is the screening test, since a negative result makes impingement and labral pathology unlikely. FABER is the more specific of the two, so a positive FABER test carries more weight in the referral letter.

When to refer for imaging after a positive result

Positive physical examination findings alone do not confirm a labral tear. MRI or MR arthrogram gives you the definitive diagnosis. Refer for imaging when:

• At least two special tests are positive in a symptomatic patient
• One test is positive, the mechanism of injury fits (trauma or an overuse pattern), and symptoms have persisted beyond four weeks
• The patient is an athlete or a manual worker, where an early diagnosis changes the treatment plan
• Clinical examination rules out the alternatives (rotator cuff tear, AC joint arthritis, cervical radiculopathy)
• Conservative treatment (rest, physical therapy, anti-inflammatories) has not improved symptoms after two to four weeks

MRI is the standard imaging modality. An MR arthrogram, which injects contrast into the joint, raises sensitivity for small labral tears. Documenting your clinical findings in a structured clinical record lets you pass those reasoning steps straight to the radiologist and the specialist. Nobody has to reconstruct them from memory.

How to complete the assessment form in clinical practice

The downloadable form walks you through documenting findings, interpreting the pattern, and flagging patients who warrant an imaging referral. Here is how to fill it out during a consultation:

1. Patient demographics and history: Record age, mechanism of injury, duration of symptoms, previous episodes, and the sports or work tasks that aggravate the symptoms.
2. Special tests section: For each test, mark it positive, negative, or not performed. Note which movement or position provoked the symptom, and whether it was pain or a click.
3. Positive test summary: Count the positives. Two or more moves the patient into the imaging referral conversation.
4. Differential diagnoses: Note what the results still leave open. For the shoulder that means rotator cuff pathology, AC joint arthritis, and impingement syndrome. For the hip it means dysplasia, impingement, and psoas tightness.
5. Clinical impression and next steps: Say whether you recommend conservative management, imaging, or a specialist opinion. Add the physical therapy plan where one applies, including the range-of-motion and strengthening phases.

Storing completed forms in a system that links assessment findings to automated follow-up workflows means a patient with imaging-indicated findings gets chased rather than forgotten. You can set reminders for post-imaging communication, or for checking where a specialist referral has got to.

Why clinicians use special tests: Clinical context and limitations

Special tests are screening maneuvers rather than diagnostic tools. They do three jobs in an assessment:

• Point you at the investigation worth prioritizing
• Give you the words to explain your reasoning to the patient
• Set the pace from first assessment through imaging to treatment

Labral tears also travel with company. In the shoulder that often means a rotator cuff tear, impingement, or AC joint arthritis, and in the hip it means dysplasia or impingement. Working through the tests in a fixed order is what stops a second finding going unnoticed. Managing patient care systematically from intake to post-imaging follow-up is what keeps outcomes consistent.

How Pabau keeps special test findings in the patient record

A paper exam sheet works fine until the findings have to travel. The detail thins out when somebody retypes a summary into the record hours later, and the negative tests are usually the first to drop off. Those are the results that rule alternatives out, so losing them costs the referral its reasoning.

Practice management software like Pabau replaces that sheet with a digital form you design once. Each test gets its own field, positive or negative, with room to name the movement that provoked the symptom. The completed form sits in the patient record, so an imaging referral can quote the exam instead of paraphrasing it.

The follow-up then runs on its own. Pabau can trigger a reminder when an MRI result is due back, or when a patient on conservative management reaches the four-week review. Nobody has to hold a mental list of who is waiting on what.

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Pabau’s digital forms and clinical records help you document special test findings, track outcomes, and automate referral follow-up in one practice management platform.

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Conclusion

Special tests earn their place by changing what you do next, not by naming the diagnosis. Two positive tests in a patient whose mechanism of injury fits is enough to move to imaging. One positive test usually buys another appointment and a second look, and that is the right call.

The harder discipline is writing the findings down in a form another clinician can read. A referral built on a documented pattern of positive and negative tests gets taken seriously. One built on a remembered click does not. Book a demo to see how Pabau keeps assessment findings and referral follow-up in one place.

Continue your research

Need guidance on structuring clinical assessments? Safer clinical notes best practices teach you how to document findings systematically so your special test results are audit-ready and defensible.

Want to automate post-assessment follow-up? Automated clinical workflows help you schedule imaging referrals, patient education, and specialist consultations without manual tracking.

Looking for sports medicine context? Sports medicine practice management covers the full workflow from injury assessment through return-to-sport protocols.

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