A patient with hip TB has the earliest clinical sign of hip involvement as:

• A Shortening of the limb
• B Antalgic gait with Trendelenburg sign
• C Fixed flexion abduction external rotation deformity
• D Limitation of medial rotation with hip in flexion (earliest) ✓

Explanation

In hip TB, the earliest sign is loss of medial (internal) rotation when the hip is flexed to 90° — because synovitis and joint effusion first restrict the motion that has the least available range. As disease progresses, the hip assumes the 'position of ease': flexion, abduction, and external rotation (to maximise joint volume). With worsening, the position shifts to the 'position of deformity': flexion, adduction, and medial rotation — a pattern due to fibrosis and capsular contracture. The earliest radiological sign is periarticular osteoporosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.