Inspection (Look):

• With patient standing check for any muscle wasting (gluteal muscle bulk), scars
• With the patient lying supine look for any flexion deformity of hip or any leg length disparity (In fracture neck of femur leg is shortened and externally rotated). Any leg length disparity needs to be confirmed by measuring true leg length (measure from ASIS to the medial malleolus on the same side)

Palpation (feel):

• Palpate over the greater trochanter for tenderness and also the position. These should be at the same level. If there is any discrepancy the higher side is likely to be the abnormal one.

Move:

• Move the hip joint passively.
• Check flexion (flex the patient’s knee to 90 degrees and move the thigh towards the chest). Assess any fixed flexion deformity by performing the Thomas’ test.
• With the hip and knee flexed at 90 degrees assess internal and external rotation of the hip
• Check adduction and abduction of the hip. The right hand grasps the heel of the right leg while the left hand is placed over the ASIS to steady the pelvis. The leg is then moved outwards, or inwards.
• Ask patient to roll over on to the stomach. Extension is tested by placing one hand over the sacroiliac joint while the other elevates the leg.

Function:

• Watch the patient and note the gait, is it painful (antalgic gait causing a limp).

Special tests:

Trendelenberg test: Ask the patient to stand first on one leg and then on the other. In a normal test the non-weight bearing hip remains level or even rises (normal). In an abnormal test the non-weight bearing pelvis will drop (proximal myopathy or hip joint disease). The Tredelenberg test has been studied for a variety of hip pathologies with varying sensitivity and specificity. It has been best validated in greater trochanteric pain syndrome with a sensitivity of 73% and specificty of 77%