Trendelenburg Test is used to identify weakness of the hip abductors. It also can be used to assess other mechanical, neurological or spinal disorders, such as the Congenital dislocation of the hip or hip subluxation.
A Trendelenburg gait can also be observed caused by abductor insufficiency and is characterized by:
Pelvic drop in swing phase.
Trunk side flexion towards the stance limb.
Hip adduction during stance phase.
Sensitivity & Specificity
A Systematic Review for diagnostic validity of the physical examination maneuvers for hip pathology, the Trendelenburg test demonstrated some evidence for use in a clinical setting in diagnosing gluteal tendon pathology:
Sensitivity= 0.23-0.73 %
In the single leg stance, the pelvic and trochanteric musculature (gluteus medius and gluteus minimus) on the weight-bearing side contract and elevate the pelvis on the unsupported side, holding it nearly horizontal. This process allows uniform gait.
Where the gluteal muscles are compromised (weakened as a result of a hip dislocation, due to paralysis, or following multiple hip operations) with functional deficits, they are no longer able to support the pelvis on the weight-bearing side. The pelvis then drops down on the normal, non–weight-bearing side (positive Trendelenburg sign).
If the Trendelenburg test is present bilaterally it produces typical waddling gait (duck walking).
The drop in the pelvis toward the unaffected side also shifts the body’s center of gravity in that direction. Patients usually compensate by shifting the body toward the weight-bearing leg.
Grading of the Trendelenburg test:
Patient can lift the pelvis on the non–weight-bearing side
Patient can maintain the position of the pelvis on the non–weight bearing side but not lift it
Pelvis on the non–weight-bearing side drops visibly
Grading of the Trendelenburg sign (from Hoppenfeld 1982)
Hip abductors consists of 3 muscle: Gluteus medius, Gluteus minimus and Tensor fasciae latae (tensor fasciae femoris).
Ilium between posterior and anterior gluteal lines
Ilium between anterior and inferior gluteal lines
Anterior border of greater trochanter
Tensor fasciae latae (tensor fasciae femoris)
Anterior iliac crest
Youdas JW, Madson TJ, Hollman JH (2010) Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis. Physiother Theory Pract 26: 184-194. PMID: 20331375.
Pasic, Nick; Bryant, Dianne; Naudie, Douglas; and Willits, Kevin, “Diagnostic Validity of the Physical Examination Maneuvers for Hip Pathology: A Systematic Review” (2014). Kinesiology Publications. 12.
Woodley SJ, Nicholson HD, Livingstone V, et al. Lateral hip pain: findings from magnetic resonance imaging and clinical examination. J Orthop Sports Phys Ther. 2008;38:313-328.
Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44:2138-2145.
Clinical Tests for the Musculoskeletal System, Third Edition book.
Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.