Trendelenburg Sign: Difference between revisions
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The Trendelenburg test is a quick physical examination that can assist the therapist to assess for any hip dysfunction.<ref name=":0">Hardcastle PH, Nade SY. [https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.67B5.4055873 The significance of the Trendelenburg test.] The Journal of bone and joint surgery. British volume. 1985 Nov;67(5):741-6.</ref> | The Trendelenburg test is a quick physical examination that can assist the therapist to assess for any hip dysfunction.<ref name=":0">Hardcastle PH, Nade SY. [https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.67B5.4055873 The significance of the Trendelenburg test.] The Journal of bone and joint surgery. British volume. 1985 Nov;67(5):741-6.</ref> | ||
A positive Trendelenburg test usually | A positive Trendelenburg test usually indicates weakness in the hip abductor muscles: [[Gluteus Medius|gluteus medius]] and [[Gluteus Minimus|gluteus minimus]].<ref name=":0" /> These findings can be associated with various hip abnormalities such as congenital hip dislocation, rheumatic arthritis, [[Hip Disability and Osteoarthritis Outcome Score|osteoarthritis]].<ref name=":0" /><ref name=":2" /> | ||
A positive test is one in which the pelvis | A positive test is one in which the pelvis drops on the contralateral side during a single leg stand on the affected side. This can also be identified during [[Gait Cycle|gait]]: compensation occurs by side flexing the trunk towards the involved side during stance phase on the affected extremity.<ref>[[Trendelenburg Gait]]</ref> | ||
== Clinically relevant anatomy == | == Clinically relevant anatomy == | ||
Gluteus medius and minimus are the primary abductors of the hip. When fully weight baring they act to abduct the femur away from the | [[Gluteus Medius|Gluteus medius]] and [[Gluteus Minimus|minimus]] are the primary abductors of the hip. When fully weight baring they act to abduct the femur away from the mid-line of the body and provide stability of the hip and pelvis.<ref>Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.</ref> | ||
== Purpose<br> == | == Purpose<br> == | ||
The purpose of the Trendelenburg Test is to identify weakness of the hip abductors. | The purpose of the Trendelenburg Test is to identify weakness of the hip abductors.<ref name=":0" /> | ||
Beside the identification of | Beside the identification of weakness in the hip abductors of the standing leg, the Trendelenburg test can be used to assess other mechanical, neurological or spinal disorders, such as the Congenital dislocation of the hip or hip subluxation.<ref name=":0" /><ref name=":2" /><ref>Rang M. Anthology of orthopaedics. Edinburgh. E&S Livingstone, 1966; 139-43.</ref><ref name=":3">Windhager RE, Pongracz NI, Schonecker WO, Kotz RA. [https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.73B6.1955430 Chiari osteotomy for congenital dislocation and subluxation of the hip. Results after 20 to 34 years follow-up]. The Journal of bone and joint surgery. British volume. 1991 Nov;73(6):890-5.</ref> | ||
== Technique<br> == | == Technique<br> == | ||
{{#ev:youtube|0rcczDEWDqU}}<ref>Physiotutors Trendelenburg sign|hip abductors. Available from https://www.youtube.com/watch?v=0rcczDEWDqU [last accessed 07/11/2015]</ref> | {{#ev:youtube|0rcczDEWDqU}}<ref>Physiotutors Trendelenburg sign|hip abductors. Available from https://www.youtube.com/watch?v=0rcczDEWDqU [last accessed 07/11/2015]</ref> | ||
The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue. The therapist observes the patient to see if the pelvis stays level during the single-leg stance. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side<ref>Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.</ref><ref name=":0" />. | The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue. The therapist observes the patient to see if the pelvis stays level during the single-leg stance. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side<ref name=":4">Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.</ref><ref name=":0" />. | ||
<br> | <br> | ||
== Clinical relevance == | == Clinical relevance == | ||
Several dysfunctions can produce a positive Trendelenburg Test: <ref | Several dysfunctions can produce a positive Trendelenburg Test:<ref name=":4" /> | ||
*Weakness of gluteus medius<ref name=":0" /> | *Weakness of gluteus medius<ref name=":0" /> | ||
*Hip instability | *Hip instability and subluxation<ref name=":3" /> | ||
*Hip osteoarthritis <ref name=":1">Youdas JW, Madson TJ, Hollman JH. [https://www.tandfonline.com/doi/abs/10.3109/09593980902750857?src=recsys&journalCode=iptp20 Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis]. Physiotherapy theory and practice. 2010 Jan 1;26(3):184-94.</ref> | *Hip osteoarthritis <ref name=":1">Youdas JW, Madson TJ, Hollman JH. [https://www.tandfonline.com/doi/abs/10.3109/09593980902750857?src=recsys&journalCode=iptp20 Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis]. Physiotherapy theory and practice. 2010 Jan 1;26(3):184-94.</ref> | ||
*Initially post [[Total Hip Replacement]]<ref>Odak S, Ivory J. [https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620x.95b3.31098 Management of abductor mechanism deficiency following total hip replacement]. The bone & joint journal. 2013 Mar;95(3):343-7.</ref> | *Initially post [[Total Hip Replacement]]<ref>Odak S, Ivory J. [https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620x.95b3.31098 Management of abductor mechanism deficiency following total hip replacement]. The bone & joint journal. 2013 Mar;95(3):343-7.</ref> | ||
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== Clinical bottom line == | == Clinical bottom line == | ||
The Trendelenburg test alone cannot diagnose hip conditions such as osteoarthritis or hip instability<ref name=":1" />. It has been shown to be more effective when part of a battery of tests such as hand dynamometry and observation to help assess hip abductor strength<ref>Grimaldi A. [https://www.sciencedirect.com/science/article/pii/S1356689X10001499 Assessing lateral stability of the hip and pelvis]. Manual therapy. 2011 Feb 1;16(1):26-32.</ref>. | The Trendelenburg test alone cannot diagnose hip conditions such as osteoarthritis or hip instability<ref name=":1" />. It has been shown to be more effective when part of a battery of tests such as hand dynamometry and observation to help assess hip abductor strength<ref>Grimaldi A. [https://www.sciencedirect.com/science/article/pii/S1356689X10001499 Assessing lateral stability of the hip and pelvis]. Manual therapy. 2011 Feb 1;16(1):26-32.</ref>. It is a quick, easy test that can help identify functional weakness in standing position. | ||
== See Also == | == See Also == | ||
<div>[[Trendelenburg_Gait]]<br> | <div>[[Trendelenburg_Gait]]<br> | ||
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Definition/Description[edit | edit source]
The Trendelenburg test is a quick physical examination that can assist the therapist to assess for any hip dysfunction.[1]
A positive Trendelenburg test usually indicates weakness in the hip abductor muscles: gluteus medius and gluteus minimus.[1] These findings can be associated with various hip abnormalities such as congenital hip dislocation, rheumatic arthritis, osteoarthritis.[1][2]
A positive test is one in which the pelvis drops on the contralateral side during a single leg stand on the affected side. This can also be identified during gait: compensation occurs by side flexing the trunk towards the involved side during stance phase on the affected extremity.[3]
Clinically relevant anatomy[edit | edit source]
Gluteus medius and minimus are the primary abductors of the hip. When fully weight baring they act to abduct the femur away from the mid-line of the body and provide stability of the hip and pelvis.[4]
Purpose
[edit | edit source]
The purpose of the Trendelenburg Test is to identify weakness of the hip abductors.[1]
Beside the identification of weakness in the hip abductors of the standing leg, the Trendelenburg test can be used to assess other mechanical, neurological or spinal disorders, such as the Congenital dislocation of the hip or hip subluxation.[1][2][5][6]
Technique
[edit | edit source]
The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue. The therapist observes the patient to see if the pelvis stays level during the single-leg stance. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side[8][1].
Clinical relevance[edit | edit source]
Several dysfunctions can produce a positive Trendelenburg Test:[8]
- Weakness of gluteus medius[1]
- Hip instability and subluxation[6]
- Hip osteoarthritis [9]
- Initially post Total Hip Replacement[10]
- Superior Gluteal Nerve Palsy
- Lower back pain[11]
- Legg-Calvé-Perthes Disease[2]
- Congenital hip dislocation[2]
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.
Clinical bottom line[edit | edit source]
The Trendelenburg test alone cannot diagnose hip conditions such as osteoarthritis or hip instability[9]. It has been shown to be more effective when part of a battery of tests such as hand dynamometry and observation to help assess hip abductor strength[12]. It is a quick, easy test that can help identify functional weakness in standing position.
See Also[edit | edit source]
Trendelenburg_Gait
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Hardcastle PH, Nade SY. The significance of the Trendelenburg test. The Journal of bone and joint surgery. British volume. 1985 Nov;67(5):741-6.
- ↑ 2.0 2.1 2.2 2.3 Macnicol MF, Makris D. Distal transfer of the greater trochanter. The Journal of bone and joint surgery. British volume. 1991 Sep;73(5):838-41.
- ↑ Trendelenburg Gait
- ↑ Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.
- ↑ Rang M. Anthology of orthopaedics. Edinburgh. E&S Livingstone, 1966; 139-43.
- ↑ 6.0 6.1 Windhager RE, Pongracz NI, Schonecker WO, Kotz RA. Chiari osteotomy for congenital dislocation and subluxation of the hip. Results after 20 to 34 years follow-up. The Journal of bone and joint surgery. British volume. 1991 Nov;73(6):890-5.
- ↑ Physiotutors Trendelenburg sign|hip abductors. Available from https://www.youtube.com/watch?v=0rcczDEWDqU [last accessed 07/11/2015]
- ↑ 8.0 8.1 Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.
- ↑ 9.0 9.1 Youdas JW, Madson TJ, Hollman JH. Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis. Physiotherapy theory and practice. 2010 Jan 1;26(3):184-94.
- ↑ Odak S, Ivory J. Management of abductor mechanism deficiency following total hip replacement. The bone & joint journal. 2013 Mar;95(3):343-7.
- ↑ Roussel NA, Nijs J, Truijen S, Smeuninx L, Stassijns G. Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. Journal of manipulative and physiological therapeutics. 2007 May 1;30(4):270-8.
- ↑ Grimaldi A. Assessing lateral stability of the hip and pelvis. Manual therapy. 2011 Feb 1;16(1):26-32.
