Hip Exam



Walking aid


Footwear - shoe raises



- Overall alignment of Lower Limb



- lumbar lordosis

- flexed attitude of hip / knee

- scars



- lumbar spine

- buttock wasting

- popliteal creases

- examine ROM

- try to differentiate spine and hip


Functional Leg Length


Attain symmetrical stance

- knees extended

- feet flat on ground

- check levels of ASIS

- comment on


A.  Pelvis is level / not level

B.  Stance is symmetrical

C.  Coronal plane deformity - Knee is flexed, ankle is in equinus 




A.  Pelvis is level with symmetrical stance

- no LLD


B.  Pelvis is not level with symmetrical stance

- uncompensated LLD


C.  Pelvis is level with asymmetrical stance

- compensated LLD


D.  Pelvis is not level with asymmetrical stance

- partially compensated LLD

- contractures



- if pelvis not level

- to assess functional leg length discrepancy





- assess if patient's abductors can elevate ASIS on affected side

- without using trunk



- visualise ASIS or PSIS

- stand on good leg

- opposite ASIS should rise

- stand on bad leg

- cannot raise opposite ASIS
- either fall or have to lean trunk over


False negative test

- able to maintain abduction with no abductor function

- fixed abduction contracture

- arthrodesed hip in abduction


Invalid if

- poor balance

- generalised weakness

- lack of co-ordination or understanding

- costo-pelvic impingement




1. Pain

- painful disorder of hip

- centre over hip to decrease abductor pull

- decrease joint reaction forces  


2. Pivot

- dislocation or subluxation of hip

- shortening of femoral neck 

- abductors cannot work correctly


3. Power 

- weakness of abductors







- shoulder drops on ipsilateral side

- head up and down



- abductor lurch


Rigid / Stiff

- hip

- knee



- shortened stance phase



- back knee gait

- foot drop


Supratentorial (CNS)


Supine on Examination Bed




Along line of inguinal ligament from medial to lateral

- masses (dislocated femoral head, hernias, aneurysms, lymph nodes)

- tenderness (LCFN)


Along posterior greater trochanter

- tenderness (trochanteric bursitis)




Exclude FFD of knee

- allows assessment of leg length (correct with pillow)

- allows assessment of FFD of hip (must put knee over bed)


Valgus knee

- difficulty measuring LL

- will be unable to put other leg in same position

- must measure components




Normal ROM

- Flexion / extension 140o

- adduction / abduction 400

- IR / ER


Thomas' Test


Angle through which thigh is raised from couch is angle of fixed flexion


Fixed flexion deformity of knee

- place patient at edge of couch

- when assessing FFD, move heel over edge of couch

- lower heel below level of couch

- to eliminate effect of knee FFD



- passively flex both knees to 45o

- place hand behind back and

- ask patient to clutch unaffected knee to chest

- ensure lumbar lordosis eliminated

- this fixes pelvis



- gently extend affected hip passively

- lift heel off bed

- stop when painful

- fixed flexion deformity of (x)o



- ask patient to actively flex affected hip

- gently passively maximise flexion

- comment

- flexes to (y)o

- flexion arc of (x)o FFD to (y)o


Abduction / Adduction in Extension



- hip and knee extended

- fix pelvis by abducting unaffected hip so that leg dangles over edge of couch

- palpate ipsilateral ASIS

- abduction / adduction both sides

- know at extremes of limit when ASIS / Pelvis begins to move


Internal and External Rotation in Flexion



- hip flexed to 90o

- hold leg with one hand

- hand in popliteal fossa

- leg resting on forearm

- assess pelvis movement with other hand

- palpate contralateral ASIS

- internal rotation, turn foot out

- external rotation, turn foot in

- examine contralateral side 


Leg Length


Make pelvis square with bed

- attempt to make legs square with pelvis and straight

- ensure buttocks not in dip in bed

- ensure normal heel height

- ensure no asymmetrical buttock wasting


Apparent LL 

- leg length measured without correcting for sagittal or coronal plane deformity

- from umbilicus to medial malleolus

- tape measure


True LL 

- leg length measured once coronal & sagittal plane deformity corrected for 

- sum of intercalated segments

- ASIS to medial malleolus


Correct for 


1.  Abduction contracture

- comment on contracture

- unable to place legs perpendicular to pelvis because of abduction contracture

- must place other leg in same position

- abduct unaffected hip same degree

- measure leg length


2.  Adduction contracture

- comment on contracture

- unable to place legs perpendicular to pelvis because of adduction contracture

- must place other leg in same position

- measure leg lengths sequentially

- cross one leg and measure

- cross other leg and measure


3.  FFD Hip or Knee

- correct with pillows


4.  Equinus foot

- look below medial malleolus

- difference in effective heel height because of equinus contracture


5. Coronal plane deformity knees

- cannot correct for 

- must measure intercalated segments


Galeazzi's sign


Identify level of leg length discrepancy


Flex knees to 90o with hips and ankles at 45o

- put malleoli at same level

- any hindfoot asymmetry makes test inaccurate


Femurs parallel

- tibias same height

- discrepancy above knee


Tibias parallel

- femurs same length

- discrepancy in tibia

- knees at different levels


LLD above GT


1.  Bryant's triangle

- identify ASIS with thumb & tip of greater trochanter with forefinger

- drop imaginary lines down to floor

- distance between the lines

- difference in distance between ASIS and GT suggests discrepancy proximal to GT

- assess perpendicular distance between points with fingers of other hand

- perpendicular distance between points is different by (x) fingerwidths


2.  Schoemaker's line 

- line from greater trochanter thru ASIS

- projection from each side should cross proximal to umbilicus

- if shortening above gr trochanter then the lines will cross below the umbilicus


3.  Nelaton's line 

- ischial tuberosity to ASIS

- with patient lying on the side

- the greater trochanter should lie on the line