Trendelenburg Test

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 Trendelenburg Test


What is the Trendelenburg Test?

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.

The Trendelenburg sign indicates weakness of the gluteus medius muscle during unilateral weight-bearing.

See Also: Pelvic Anatomy

How do you do the Trendelenburg Test?

This position produces a strong contraction of the gluteus medius, which is powerfully assisted by the gluteus minimus and Tensor Fascia Latae, in order to keep the pelvis horizontal. For example, when the body weight is supported by the left foot, the left hip abductors contract both isometrically and eccentrically to prevent the right side of the pelvis from being pulled downward by gravity.

Trendelenburg Test
Trendelenburg Test

What does a positive Trendelenburg test mean?

Several dysfunctions can produce a positive Trendelenburg Test:

  1. Weakness of gluteus medius muscle.
  2. Hip instability and subluxation.
  3. Hip osteoarthritis.
  4. Initially post Total Hip Replacement.
  5. Superior Gluteal Nerve Palsy.
  6. Lower back pain.
  7. Legg-Calvé-Perthes Disease.
  8. Congenital hip dislocation.

A Trendelenburg gait can also be observed caused by abductor insufficiency and is characterized by:

  1. Pelvic drop in swing phase.
  2. Trunk side flexion towards the stance limb.
  3. Hip adduction during stance phase.
See Also: Gait Cycle

Trendelenburg Test Accuracy

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:

Notes

Grading of the Trendelenburg sign:

NegativePatient can lift the pelvis on the non–weight-bearing side
Weakly positivePatient can maintain the position of the pelvis on the non–weight bearing side but not lift it
PositivePelvis on the non–weight-bearing side drops visibly
Grading of the Trendelenburg sign (from Hoppenfeld 1982)

Related Anatomy

Hip abductors consists of 3 muscle: Gluteus medius, Gluteus minimus and Tensor fasciae latae (tensor fasciae femoris).

MuscleOriginInsertionInnervation
Gluteus mediusIlium between posterior and anterior gluteal linesGreater trochanterSuperior gluteal
Gluteus minimusIlium between anterior and inferior gluteal linesAnterior border of greater trochanterSuperior gluteal
Tensor fasciae latae (tensor fasciae femoris)Anterior iliac crestIliotibial bandSuperior gluteal
Hip abductors
Hip abductors

Reference

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Clinical Tests for the Musculoskeletal System, Third Edition book.
  6. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
  7. Campbel’s Operative Orthopaedics 13th Edition Book.



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