hip joint lies deep inside the body and cannot normally be directly palpated. To assess for pelvic fracture one should palpate the: Iliac spines Superior and inferior pubic rami Movement Internal rotation – with knee and hip both flexed at 90 degrees the ankle is abducted. External rotation – with knee and hip both flexed at 90 degrees the ankle is adducted. (also done with the Patrick's test / FABER test) Flexion (also known as the Gaenslen's test) Extension – done with the patient on their side. Alignment should be assessed by palpation of the ASIS, PSIS and greater trochanter. Abduction – assessed whilst palpating the contralateral ASIS. Adduction – assessed whilst palpating the ipsilateral ASIS. Assessment for a hidden flexion contracture of the hip – hip flexion contractures may be occult, due to compensation by the back. They are assessed by: Placing a hand behind the lumbar region of back Getting the patient to fully flex the contralateral hip. The hand in the lumbar region is used to confirm the back is straightened (flexed relative to the anatomic position). If there is a flexion contracture in the ipsilateral hip it should be evident, as the hip will appear flexed. Normal range of motion Internal rotation – 40° External rotation – 45° Flexion – 125° Extension – 10–40° Abduction – 45° Adduction – 30° Special maneuvers Trendelenburg test/sign: Make sure pelvis is horizontal by palpating ASIS. Ask patient to stand on one leg and then on the other. Assess any pelvic tilt by keeping an index finger on each ASIS. Normal (Trendelenburg negative): In the one-legged stance, the unsupported side of the pelvis remains at the same level as the side the patient is standing or even rise a little, because of powerful contraction of hip abductors on the stance leg. Abnormal (Trendelenburg positive): In the one-legged stance, the unsupported side of the pelvis drops below the level as the side the patient isstanding on. This is because of (abnormal) weakness of hip abductors on the stance leg. The latter hip joint may therefore be abnormal. Assisted Trendlenburg test If balance is a problem, face the patient and ask them to place their hands on yours to support him/her as he/she does alternate one-legged stance. Increased asymmetrical pressure on one hand indicates a positive Trendelenburg test, on the side of the abnormal hip A ‘delayed’ Trendelenburg has also been described,