Hip Orthopaedic Test: Fitzgerald Test

The Fitzgerald Test is a hip special test used to provoke symptoms associated with anterior or posterior acetabular labral involvement. It uses combined hip movements to move the femoral head and neck through positions that may stress the acetabular labrum.

A positive finding may include reproduction of familiar hip or groin pain, sharp pain, catching, clicking or symptom reproduction during the test arc. However, the Fitzgerald Test does not confirm a labral tear on its own. It should be interpreted alongside history, mechanical symptoms, hip range of motion, other special tests, imaging if relevant and professional judgement.

Introduction

The Fitzgerald Test is a hip special test used in assessment reasoning for suspected acetabular labral involvement. It includes manoeuvres for both anterior and posterior labral symptom provocation.

The test was described in the context of acetabular labral tears, where mechanical hip pain and clicking were commonly reported features. Since then, hip labral testing has become part of many hip and groin assessment frameworks.

The Fitzgerald Test is clinically useful because it combines end-range hip positions and symptom provocation. However, hip symptoms can overlap between labral, femoroacetabular, capsular, muscular, tendon, lumbar, pelvic and other sources. Because of this, a positive Fitzgerald Test should not be treated as proof of a labral tear.

Systematic review evidence suggests the Fitzgerald Test may have high sensitivity in limited studies, but specificity is not well established. This means a negative result may sometimes be useful in reducing suspicion when the broader assessment is also reassuring, but a positive result should be interpreted cautiously.

Quick Summary

Test name: Fitzgerald Test
Region: Hip and groin
Primary purpose: Support assessment reasoning for anterior or posterior acetabular labral involvement
Test variations: Anterior labral manoeuvre and posterior labral manoeuvre
Positive finding: Familiar hip/groin pain, sharp pain, clicking, catching or symptom reproduction
Negative finding: No familiar pain, no relevant mechanical symptoms and similar response to the opposite side
Main limitation: Specificity is not well established; the test does not confirm labral pathology.

What Is the Fitzgerald Test?

The Fitzgerald Test is a passive hip movement test used to provoke symptoms that may be associated with acetabular labral involvement.

It includes two main variations:

Anterior Fitzgerald Test
The hip is moved from flexion, abduction and external rotation toward extension, adduction and internal rotation.

Posterior Fitzgerald Test
The hip is moved from flexion, adduction and internal rotation toward extension, abduction and external rotation.

The test is considered positive when it reproduces familiar pain, sharp hip pain, clicking, catching or the client’s typical mechanical symptoms.

Why It Is Used

The Fitzgerald Test may be used to support assessment reasoning around:

• Suspected acetabular labral involvement
• Anterior hip or groin pain
• Posterior hip symptoms
• Mechanical hip symptoms
• Clicking, catching or locking sensations
• Femoroacetabular impingement-type presentations
• Hip pain during pivoting, twisting or deep flexion
• Sport-related hip and groin symptoms
• Whether further assessment may be appropriate

It is most useful when combined with history, symptom behaviour, hip range of motion and other hip special tests.

What It Assesses

The Fitzgerald Test assesses symptom response during combined hip movement arcs.

It may provide information about:

• Anterior hip or groin symptom provocation
• Posterior hip symptom provocation
• Mechanical symptom reproduction
• Painful hip arc
• Side-to-side difference
• Hip irritability
• End-range tolerance
• Possible intra-articular hip contribution

It does not directly assess:

• Labral integrity with certainty
• FAI morphology with certainty
• Cartilage status
• Imaging findings
• Hip strength
• Pelvic control
• Lumbar contribution
• Gait mechanics
• Readiness for sport or work
• Treatment needs

Who It Is Useful For

The Fitzgerald Test may be useful for clients with:

• Hip or groin pain
• Mechanical hip symptoms
• Clicking, catching, locking or giving-way sensations
• Pain with pivoting or twisting
• Pain with deep hip flexion
• Sport-related hip symptoms
• Suspected intra-articular hip contribution
• Symptoms that require clearer baseline documentation

It may also be useful for professionals learning how to assess hip symptom response using combined movement tests.

When to Use This Test

Consider using the Fitzgerald Test when:

• Labral involvement is part of the assessment reasoning
• The client reports mechanical hip symptoms
• Hip or groin pain is reproduced by rotation, pivoting or deep flexion
• You need to compare anterior and posterior hip symptom response
• Other hip tests such as FADIR, FABER or Scour are relevant
• You are building a broader hip assessment profile

The test should be used after screening for irritability and range tolerance.

When Not to Use or When to Be Cautious

Use caution or avoid the test when:

• The hip is acutely irritable
• There is suspected fracture or major trauma
• The client cannot tolerate passive hip movement
• Recent surgery makes end-range movement inappropriate
• Severe pain is present before testing
• Neurological symptoms require further assessment
• The professional cannot control the hip movement safely
• The test position is outside the client’s comfortable range

Stop the test if sharp pain increases, the client asks to stop, or the hip cannot be moved safely.

Equipment Required

The Fitzgerald Test usually requires no special equipment.

Optional equipment includes:

• Measurz app
• Pain rating scale
• Plinth or firm testing surface
• Notes field for test variation, movement arc and symptoms
• Video recording for education or comparison if appropriate
• Goniometer or inclinometer if range is measured separately

Step-by-Step Protocol / Practice

Setup

Ask the client to lie supine on a plinth or firm surface.

Explain that the hip will be moved through a controlled arc and that they should report any familiar pain, clicking, catching or symptoms.

Test the less symptomatic side first if appropriate.

Client position

The client lies supine with the pelvis relaxed and the tested leg supported by the professional.

The hip and knee are moved passively by the professional.

Examiner/professional position

The professional stands beside the tested hip.

One hand supports the knee or distal thigh. The other controls the lower leg, ankle or hip position depending on the variation.

Hand placement

Support the client’s leg so the hip can be moved smoothly through the required arc.

Avoid gripping painfully or forcing end-range movement.

Stabilisation

Monitor pelvic movement. Excessive pelvic rotation can reduce test consistency.

The pelvis does not need to be fixed rigidly, but the movement should come mainly from the hip.

Movement or force direction

For the anterior labral variation:

1. Start with the hip in flexion, abduction and external rotation.
2. Move the hip toward extension.
3. Add internal rotation and adduction through the movement arc.
4. Observe for anterior hip or groin pain, clicking or familiar symptoms.

For the posterior labral variation:

1. Start with the hip in flexion, adduction and internal rotation.
2. Move the hip toward extension.
3. Add abduction and external rotation through the movement arc.
4. Observe for posterior hip pain, clicking or familiar symptoms.

Movements should be slow, controlled and within tolerance.

Instructions

Tell the client:

“Stay relaxed and let me move your hip. Tell me if this reproduces your familiar symptoms, where you feel it and whether you notice clicking, catching or sharp pain.”

Positive finding

A positive finding may include:

• Familiar anterior hip or groin pain
• Familiar posterior hip pain
• Sharp pain during the movement arc
• Clicking with familiar pain
• Catching or locking sensation
• Reproduction of the client’s typical mechanical symptoms
• Clear side-to-side difference

Record which variation was positive.

Negative finding

A negative finding may include:

• No familiar pain
• No mechanical symptoms
• No meaningful side-to-side difference
• Smooth movement through the test arc
• No relevant symptom reproduction

A negative finding does not fully exclude labral involvement.

Stopping criteria

Stop the test if:

• Sharp pain increases
• The client asks to stop
• The hip cannot be moved safely
• The client guards strongly
• Symptoms become concerning
• The test is not meaningful due to irritability

Safety notes

The Fitzgerald Test uses end-range combined hip positions. Avoid forcing movement, especially in irritable hips.

Positive and Negative Test Interpretation

A positive Fitzgerald Test may increase suspicion that intra-articular hip structures, including the acetabular labrum, are relevant to the client’s symptoms. This is more meaningful when the test reproduces the client’s familiar hip or groin pain with mechanical symptoms such as clicking, catching or locking.

The anterior variation may be more relevant when symptoms are felt in the anterior hip or groin. The posterior variation may be more relevant when symptoms are felt posteriorly.

However, a positive Fitzgerald Test does not confirm a labral tear. Hip impingement, capsular irritation, muscular guarding, tendon-related symptoms, lumbar referral, pelvic contribution and other hip conditions may produce similar responses.

A negative Fitzgerald Test may decrease suspicion of labral involvement, particularly if the test has high sensitivity in the relevant population and other hip special tests are also negative. However, a negative test does not fully exclude labral pathology or intra-articular hip contribution.

The finding is more meaningful when interpreted with:

• Mechanism of onset
• Mechanical symptoms
• Pain location
• Symptom behaviour
• Hip range of motion
• FADIR
• FABER
• Scour Test
• Log Roll Test
• Gait
• Functional tests
• Imaging where relevant

Sensitivity, Specificity and Diagnostic Accuracy

Evidence for the Fitzgerald Test is limited and should be interpreted cautiously.

Systematic review summaries have reported high sensitivity for the Fitzgerald Test, approximately 0.98 to 1.00, for hip labral lesions in limited available studies. Specificity is not well established, which means a positive test may not strongly confirm the condition.

Condition or presentation: Suspected acetabular labral lesion
Population: Hip pain populations in older diagnostic accuracy studies
Test variation: Fitzgerald anterior and/or posterior labral manoeuvre
Reference standard: Imaging, arthroscopy or surgical findings depending on study
Sensitivity: Approximately 0.98–1.00 in limited evidence
Specificity: Not clearly established
Positive likelihood ratio: Not clearly available
Negative likelihood ratio: Potentially useful when sensitivity is high, but exact values are limited
Key limitations: Small or older studies, variable reference standards, limited specificity reporting and overlap with other hip conditions.

Plain-language interpretation:

• A negative Fitzgerald Test may reduce suspicion when the broader assessment is also reassuring.
• A positive Fitzgerald Test may support further assessment reasoning but does not confirm a labral tear.
• Lack of specificity limits rule-in value.
• The result is stronger when combined with history, mechanical symptoms, other hip tests and imaging where relevant.

Reliability and Validity

Reliability depends on how consistently the professional positions the hip, controls the movement arc and defines a positive finding.

Reliability may improve when the professional records:

• Anterior or posterior variation
• Start and end positions
• Pain location
• Pain score
• Mechanical symptoms
• Whether the symptoms were familiar
• Side-to-side comparison
• Movement speed
• Range limitation
• Client irritability

Validity is limited as a stand-alone diagnostic test. The Fitzgerald Test may be valid as a symptom provocation manoeuvre for intra-articular hip reasoning, but it does not directly verify labral structure.

Common Errors and Limitations

Common errors include:

• Moving too quickly
• Forcing end range
• Not identifying anterior versus posterior variation
• Not recording pain location
• Treating any click as positive even if painless and unfamiliar
• Ignoring symptom familiarity
• Not comparing sides
• Not combining with other hip tests
• Calling the test diagnostic
• Overlooking lumbar or pelvic contribution

Limitations include:

• Specificity is not well established
• Mechanical symptoms are not unique to labral tears
• Hip morphology and imaging findings may be present without symptoms
• Pain can arise from multiple structures
• Test technique varies between professionals
• Acute irritability can reduce usefulness
• A single positive test should not guide decisions alone

Practical Applications

The Fitzgerald Test may be useful for:

• Hip and groin assessment
• Labral assessment reasoning
• Mechanical symptom documentation
• Anterior versus posterior symptom provocation
• Side-to-side comparison
• Baseline and retest records
• Client education
• Deciding whether further assessment may be appropriate

In Measurz, Fitzgerald Test findings can be recorded alongside FADIR, FABER, Scour Test, Log Roll Test, hip range of motion, hip strength, squat assessment, gait and sport-specific movement tests.

How to Record This in Measurz

Record:

• Test name: Fitzgerald Test
• Variation: anterior or posterior
• Side tested
• Result: positive, negative, unclear or unable to test
• Pain score
• Symptom location
• Symptom quality
• Familiar symptom reproduction
• Clicking, catching or locking
• Painful arc point
• Range limitation
• Movement direction
• Comparison side
• Irritability
• Guarding or compensations
• Reason for stopping if relevant
• Related findings
• Confidence in result
• Further assessment notes if appropriate
• Retest date if relevant

Recording these details improves repeatability, communication, client education, assessment reasoning, monitoring over time, team consistency and reporting quality.

Related Tests / Internal Links

• FADIR Test
• FABER Test
• Scour Test
• Log Roll Test
• Hip range of motion
• Hip internal rotation
• Hip flexion
• Hip strength testing
• Single-leg squat
• Gait assessment
• Toe Touch Test

FAQs

What is the Fitzgerald Test used for?

It is used to support assessment reasoning around possible hip labral involvement by reproducing hip or groin symptoms during combined movement arcs.

Are there anterior and posterior versions?

Yes. The anterior variation stresses the anterior labral region, while the posterior variation is used for posterior labral symptom provocation.

What is a positive Fitzgerald Test?

A positive finding may include familiar pain, sharp hip or groin pain, clicking, catching or reproduction of the client’s typical symptoms.

Does a positive Fitzgerald Test diagnose a labral tear?

No. It may increase suspicion, but it does not confirm a labral tear.

Does a negative Fitzgerald Test exclude labral pathology?

No. A negative result may reduce suspicion in some contexts, but it does not fully exclude labral involvement.

Is clicking always positive?

No. Clicking is more meaningful when it is familiar, painful or associated with the client’s typical symptoms.

Should this test be painful?

It should not be forced into pain. Familiar symptom reproduction should be recorded, but the test should remain controlled and safe.

What should it be combined with?

History, mechanical symptoms, FADIR, FABER, Scour, Log Roll, hip range of motion, strength testing and functional assessment.

Key Takeaways

The Fitzgerald Test is a hip special test used for anterior and posterior labral assessment reasoning.

A positive finding may include familiar hip or groin pain, clicking, catching or mechanical symptom reproduction.

Sensitivity has been reported as high in limited studies, but specificity is not well established.

A positive result does not confirm a labral tear.

A negative result does not fully exclude labral involvement.

Measurz recording should include variation, side, pain location, mechanical symptoms, movement arc and comparison side.

References

Burgess, R. M., Rushton, A., Wright, C., & Daborn, C. (2011). The validity and accuracy of clinical diagnostic tests used to detect labral pathology of the hip: A systematic review. Manual Therapy, 16(4), 318–326. https://doi.org/10.1016/j.math.2011.01.004

Fitzgerald, R. H. (1995). Acetabular labrum tears: Diagnosis and treatment. Clinical Orthopaedics and Related Research, 311, 60–68. PMID: 7634592

Leibold, M. R., Huijbregts, P. A., & Jensen, R. (2008). Concurrent criterion-related validity of physical examination tests for hip labral lesions: A systematic review. Journal of Manual & Manipulative Therapy, 16(2), E24–E41. https://doi.org/10.1179/jmt.2008.16.2.24E

Reiman, M. P., Goode, A. P., Hegedus, E. J., Cook, C. E., & Wright, A. A. (2013). Diagnostic accuracy of clinical tests of the hip: A systematic review with meta-analysis. British Journal of Sports Medicine, 47(14), 893–902. https://doi.org/10.1136/bjsports-2012-091035

Reiman, M. P., Goode, A. P., Cook, C. E., Hölmich, P., & Thorborg, K. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 811. https://doi.org/10.1136/bjsports-2014-094302