• Patient standing in shorts or underwear, back and knees exposed.
• Access is required to the groin, thighs and gluteal region.
• Asymmetry of spine
• Gait: antalgic, short leg, Trendelenburg gait
• Walking aids
• Trendelenburg's test
Tape: leg length
• Apparent leg length (xiphisternum to medial malleolus)
• True leg length (ASIS to medial malleolus)
• scars, erythema, ecchymosis
• sinuses and alignment of skin creases
• psoas abscess draining in sub gluteal fold
• Soft tissues: swelling or wasting of glutei and quadriceps.
• deformity or asymmetry: shortening of leg; external or internal rotation of hip
• pelvic tilt
• valgus or varus knee, lordosis, kyphosis, scoliosis
• Skin: temperature, tenderness, sensation.
• Soft tissues:
• adductor tenderness, bursitis
• pulses, capillary refill time
• sensation and movement
• greater trochanter
• midpoint of inguinal ligament (hip joint)
• pubic bone and symphysis
• femoral shaft
• tenderness or mobility
• Active and passive:
• flexion/fixed flexion
• internal rotation (foot moves outwards)
• external rotation (foot moves inwards)
• extension (press thigh onto bed)
• abduction/adduction whilst stabilising pelvis (palpating contralateral ASIS)
Special tests (* = essential tests)
• Thomas's test*
• Impingement sign*
• Straight leg raise*
• FABER test
• Sciatic nerve stretch test
• Ober's test
To complete the examination…
• Examine the joint above (back and sacroiliac joint) and the joint below (knee).
• Check full neurovascular status of the lower limb.
• Order appropriate radiographs and further imaging.
What do you look for during gait and initial observations?
• Look for an antalgic gait or the use of any walking aids.
• Inspect the soles of the shoes for the pattern of wear.
• In the setting of possible neck of femur fracture, gait and weight-bearing activities should not be examined.