First get the patient to walk and note the gait (usually antalgic). Ask them to squat (partly a functional test to see if they can get up off the toilet). Then get them to do the Trendelenburg test remembering “the sound side sags”. Causes of a positive test include weak abductors, coxa vara (decreased angel between the neck and shaft of the femur), hip dislocation, femoral neck fracture and pain from any inflammatory condition).
Then get the patient to lie down an look at the hip
Feel the muscle bulk, usually by putting your thumbs on the ASIS and middle finger on the greater trochanter. Then measure the real (measured from the ASIS to the medial malleolus) vs apparent (measured from the xiphisternum) length. If there is a discrepancy try and locate the shortening, (i.e. above or below the knee / above or below the greater trocanter?) by getting the patient to line up the toes and flex the knees
Now move – first do Thomas’s test. The sound hip (if you know which one it is) is flexed until the lumber lordosis is obliterated - if the affected leg raises then they have a fixed flexion deformity.
Then get them to do active then passive movements including flexion, abduction, adduction, and internal and external rotation.
Finally lie them prone and look, feel (sacroiliac disease) and move (extension).