Examination of the Hip

Introduction

  • Introduce self and gain consent
  • Hand hygiene
  • Ask for pain, commence the exam on the unaffected side. Tell patient to voice any discomfort during exam
  • Adequately expose patient’s legs
  • Position patient standing

Look

  • Mobility aids, prescription meds
  • Any clinical signs suggestive of generalised disease
  • General inspection from anterior, lateral and posterior views 
Anterior– Skin, scars, swelling, dystrophic changes
– Coronal plane deformity- knees, feet
– Wasting- quadriceps
– Pelvis
LateralTurn affected side towards you
– Skin, scars
– Deformity- lumbar lordosis, flexion attitude of hip, flexion attitude of knee- may be 2° to hip
– Is stance symmetrical?- flexed knees, ankle equinus
– Lumbar spine- forward flexion- ‘there is normal unrolling of lumbar spine’
Posterior– Spine- scoliosis, skin changes (cutaneous manifestations of spine disease)
– Is pelvis level?
– Wasting – glutes (look from above), popliteal creases, heels
– Leg length assessment if appropriate (see section below)
— Tip: Comment

Trendelenburg’s test:

  • Get patient to stand upright
  • Place your fingers on each pelvis at the iliac crest
  • Ask the patient to lift one foot off the ground
  • Observe if the pelvis drops on the side of the raised leg. This suggests contralateral hip abductor weakness
    • (Sound side sags)
  • If pt is unbalanced, perform Modified Trendelenburg’s test
    • Stand in front of pt. Ask pt to place hands on your hands. Pt performs test.
    • +ve test is when there is more pressure on one hand than the other

3 reasons for +ve Trendelenburg’s test:

  1. Pain- painful disorder of hip
  2. Pivot
    • Dislocation or subluxation of the hip
    • Shortening of femoral neck
  3. Power
    • Weak hip abductors

Gait (find video)

Get patient to walk to the door and back, assess gait.

Tip: Observe pt walking towards you, away from you and from the side

Types of gait abnormalities:

  • Antalgic- short stance on affected limb due to pain
  • Trendelenburg gait or lurch
  • Short- shoulder drops and lurch on ipsilateral side
  • Stiff knee
  • Thrusting gait (varus thrust)- bowing out of knee *Look from back
  • Decreased ROM
  • Supratentorial (CNS)

Tip: Describe gait and foot-thigh progression to examiner

Lay patient supine.

  • Have closer look for any surgical scars. Comment on pt’s posture while supine

Feel

  • Tip: Look at patient’s face while palpating, communicate to examiner the specific structures you are palpating
  • Palpate greater trochanter (trochanteric bursitis)
  • Other structures
    • Palpate along line of inguinal ligament from medial to lateral 
      • Feel for dislocated femoral head, hernias, aneurysms, lymph nodes
    • Palpate for tenderness (LFCN)

Move

  • Patient remains supine
  • Assess and compare movements on each hip, start on the unaffected side first.

Special test: Thomas test- tests for fixed flexion deformity (loss of full extension) 

+ve: when one knee is flexed, contralateral leg raises off bed (contralateral leg has a FFD)

Tip: If pt has FFD knee, place pt at edge of couch

  • Place hand under lumbar spine. *Do not remove hand throughout test
  • Ask patient to actively flex unaffected hip and knee to chest
  • Gently passively maximise flexion
  • Ask patient to clutch knee to chest
  • Comment
    • ‘Lumbar lordosis eliminated’
    • ‘Contralateral flexion range of x°’
  • Gently extend affected hip passively
  • Stop when painful comment of FFD. Note x°
  • Repeat on other side

Active movements:

  1. Active hip flexion (120°)
  2. Active hip extension (180°)

Passive movements:

  1. Rotation in flexion
    • Tests for internal rotation, external rotation
    • Flex hip and knee at 90°
    • Rotate leg laterally/medially
    • Assess pelvic movement with other hand
  2. Abduction/adduction in extension
    • Tests for hip abduction (45°), adduction (30°)
    • Ask patient to fully straighten legs on bed
    • Fix contralateral pelvis, abduct/adduct hip by moving patient’s ankle
    • Tip: Need to check for pelvic movement either by stabilising pelvis with forearm or placing contralateral leg over bed to lock pelvis
  3. Passive hip extension (10-20°)
    • Lay patient prone
    • Place hand on pelvis, use other hand to lift one leg at a time

Leg length assessment

  • Must do once coronal and sagittal plane deformity known
    • If deformity present, match both legs with pillows
  • Make pelvis square with bed, legs square with pelvis
  • Keep legs straight
  • Apparent leg length: umbilicus to tip of medial malleolus (difference suggests tilted pelvis)
  • True leg length: ASIS to tip of medial malleolus (difference suggests OA on shorter leg)
  • Segmental measurement: if deformity cannot be made symmetrical, measure femur and tibia separately
  1. Are the leg lengths equal?
  2. Where is the discrepancy? (Galeazzi test, Bryant’s triangle)
    • Above or below knee
    • If in femur- above or below GT?
  • Galeazzi test/Allis test: assess if leg length discrepancy is in femur or tibia; seen in DDH in infants)
    • Flex knees to 90°
    • Observe parallelism of femur and tibia
    • +ve if unequal knee heights
  • Nelaton’s line: from ASIS to ischial tuberosity
    • Greater trochanter usually lies in this line.
    • However, in hip dislocation and NOF, GT is felt above the line
  • Bryant’s triangle test (if positive Galeazzi test): assess if discrepancy is above or below GT
    • Identify ASIS with thumb and tip of greater trochanter with forefinger
    • Difference between ASIS and GT suggests discrepancy proximal to GT
    • Comment ‘when Bryant’s triangle is constructed, distance between ASIS and GT is diff by (x) fingerwidths/ x cm’
    • If reduced, construct Roser-Nelaton’s line

Thank patient and perform hand hygiene

Suggest further tests

  • Examine spine and knees
  • Perform full neurovascular LL exam
  • Suggest appropriate further imaging

Special tests

  • FADIR test: tests for hip femoral acetabular impingement or labral tear
    • Lay patient supine
    • Flex knee to 90
    • Adduct and internally rotate hip
    • +ve: groin pain
    • Tip: Make note of internal rotation range to suggest degree of impingement
  • FABER test (Flexion, Abduction and External Rotation): test for SI joint stability
    • Lay patient supine
    • Get patient to place foot on opposite above knee
    • Fix contralateral hip, lower test leg towards table
    • +ve: test leg remains above opposite leg
  • Ober’s test: tests TFL/ITB for contracture
    • Lay patient on side with affected side up
    • Flex knees and hip for stability
    • Abduct and extend pt’s upper leg, fix pelvis with other hand
    • Lower leg to table (adduct)
    • +ve: if leg remains abducted (in the air)
  • Sciatica straight leg raise test/Lasegue test: tests for sciatica
    • Lay patient supine
    • Holding the ankle, raise leg while keeping knee straight. This passively flexes the hip
    • Dorsiflex the foot (Bragard’s sign)
    • Maximally flex the neck (Neri’s sign)
    • +ve: if patient feels pain in lower back/posterior thigh/buttock
  • Kendall test/Rectus femoris contracture test
    • Lay pt supine
    • Place one leg over end of bed
    • Keep other flexed to chest
    • +ve if hanging knee extends and cannot remain at 90° flexion
  • Hamstring test: tests for proximal hamstring tendinopathy
    • Lay patient supine
    • Maximally flex hip and knee
    • Extend knee slowly until resistance is felt
    • +ve: sharp or deep hip/buttock pain

Other tests

  • Lateral on couch
    • Assess abductor power
  • Prone on couch
    • Assess gluteal bulk
    • Perform rotation in extension
    • Fix pelvis, place hand across SI joints
    • Flex knee to 90°

Others

  • Circulation- feel distal pulses
  • Concealed- groin and perineum
  • Cephalad joint

References

Dr Lewis Potter·Clinical Examination·Last updated:November 12, 2021. (2021, November 12). Hip examination – OSCE guide. Geeky Medics. Retrieved March 1, 2022, from https://geekymedics.com/hip-examination/

Author

Julia Liew, Western Health Intern 2022

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.