Trendelenburg Test

Contents

Definition

A physical examination finding associated with various hip abnormalities (those associated with abduction muscle weakness or hip pain or congenital hip dislocation, hip rheumatic arthritis, osteoarthritis) in which the pelvis sags on the side opposite the affected side during single leg stance on the affected side; during gait, compensation occurs by leaning the torso toward the involved side during stance phase on the affected extremity[1]


Description

There are two important elements that maintain the stability of the hip in the standing position.
First the strength of the surrounding muscles(m. gluteus medius, m. Tensor facia latae, m. gluteus maximus, m. gluteus minimus, m. piriformis, m. obturatorus internus), and second the lever system of the femoral neck and head in the hip joint . When those two elements are clinically normal, you can notice that when a person is standing on one foot, the abductors on the same side are contracting powerfully. This maintains the fixation hip joints and the stability of the whole hip.
When a patient is athletic, they are able to compensate and they can keep their pelvis in a neutral position. The lower leg adducts and rotates internally.
If the patient has no disorder, he will be able to stand on one foot without his hip dropping down or backwards. It's the gluteus medius muscle on the supported side that will generate a reverse action.
If there is a disorder the patient who stands on the affected leg will have the other side of the hip dropping out or backwards.
A positive test can indicate an unstable hip on the unsupported side or a weak gluteus medius muscle of the standing leg .
People who have a positive trentelenburg test mostly walks with 'dipping gate'

Another function of the trendelenburg test is to test the function of the lesser saphenous vain and perforating vains.
[2]

http://stemcelldoc.wordpress.com/2009/03/10/trendelenburg-test/

Clinically Relevant Anatomy

http://www.prohealthsys.com/anatomy/grays/arthrology/hipjoint.php

[1]
hip abductors : m. gluteus medius = stabilize the pelvis dynamically
                         m. Tensor facia latae
                         m. gluteus maximus
                         m. gluteus minimus
                         m. piriformis
                         m. obturatorus internus
                         ==> keeps the hip from dropping down or backwards
femoral neck
femoral head
hip joint
pelvis

[3]


Purpose

The purpose of the Trendelenburg Test is to identify weakness of the gluteus medius muscle.

Beside the identification of a weakness in the gluteus medius muscles from the standing leg, the trendelenburg test can be used to discover or to help discover in combination with other observations a mechanical disorder, a neurological disorder or a spinal disorder in some situations, like for example the Congenital dislocation of the hip or the Subluxating hips [4]

Technique

The patient is asked to stand on one leg for 30 seconds without leaning to one side.  The therapist obsereves the patient to see if the pelvis stays level during the one-leg stance.  A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side[5].

http://orthoteers.blogspot.com/2007/10/standard-trendelenburg-test.html



Several dysfunctions can produce a positive Trendelenburg Test, including [6]

The Trendelenburg gait in LCP is caused by abductor insufficiency and is characterized by:

  • a pelvic drop of the swinging limb,
  • a trunk lean in relation to the pelvis towards the stance limb and
  • hip adduction during stance phase.


Resources

  • Anesthesiology. 2010 Jan;112(1):57-65.

Effects of prone and reverse trendelenburg positioning on ocular parameters.
Grant GP, Szirth BC, Bennett HL, Huang SS, Thaker RS, Heary RF, Turbin RE.
Department of Anesthesiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA. grantgp@umdnj.edu

  • Clin Nurse Spec. 2007 Jul-Aug;21(4):181-7.

Trendelenburg positioning to treat acute hypotension: helpful or harmful?
Shammas A, Clark AP.
University of Texas at Austin School of Nursing, Red River, Austin, TX 78701, USA.

Clinical Bottom Line

To perform the test properly does take time, and its accurate assessment demands the full understanding and co-operation of the patient.

See Also

www.physio-pedia.com/Trendelenburg_Gait

 Search Strategy

Search in Pubmed, PEDroArchives of Physical Medicine and Rehabilitation,

Keywords: Trendelenburg test or Trendelenburg sign

Recent Related Research (from Pubmed)

References


  1. http://www.medilexicon.com/medicaldictionary.php
  2. Inman VI. Functional aspects of the abductor muscles of the hip. J Bone Joint Surg~BrJ 1947;29:607-19. fckLRfckLRMitchell GP. The delayed Trendelenburg hip test. I nt Con gr Ser 1973; 291:1113. fckLRfckLRSpecial tests for orthopedic examinationBy Jeff G. Konin, Holly Brader p175fckLRfckLRNeuromusculoskeletal Clinical Tests: A Clinician's Guide By Richard Jasper Day, John Fox, Graeme Paul-Taylor p137.
  3. 1. Clinical anatomy: applied anatomy for students and junior doctors By Harold Ellis p228
  4. Rang M. Anthology of orthopaedics. Edinburgh. E&S Livingstone, 1966; 139-43.
  5. Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.
  6. Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.



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