Trendelenburg Sign: Difference between revisions
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There are two important elements that maintain the stability of the hip in the standing position. <br>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.<br>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. <br>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. <br>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.<br>A positive test can indicate an unstable hip on the unsupported side or a weak gluteus medius muscle of the standing leg . <br>People who have a positive trentelenburg test mostly walks with 'dipping gate' | There are two important elements that maintain the stability of the hip in the standing position. <br>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.<br>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. <br>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. <br>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.<br>A positive test can indicate an unstable hip on the unsupported side or a weak gluteus medius muscle of the standing leg . <br>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.<br><ref>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&amp;amp;amp;nbsp;By Richard Jasper Day, John Fox, Graeme Paul-Taylor p137.</ref><br> | Another function of the trendelenburg test is to test the function of the lesser saphenous vain and perforating vains.<br><ref>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&amp;amp;amp;amp;nbsp;By Richard Jasper Day, John Fox, Graeme Paul-Taylor p137.</ref><br> | ||
http://www.prohealthsys.com/anatomy/grays/arthrology/hipjoint.php<br>=> picture of the hipjoint | http://www.prohealthsys.com/anatomy/grays/arthrology/hipjoint.php<br>=> picture of the hipjoint | ||
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<br>hip abductors : m. gluteus medius = stabilize the pelvis dynamically<br> m. Tensor facia latae<br> m. gluteus maximus<br> m. gluteus minimus<br> m. piriformis<br> m. obturatorus internus<br> ==> keeps the hip from dropping down or backwards<br>femoral neck<br>femoral head<br>hip joint<br>pelvis | <br>hip abductors : m. gluteus medius = stabilize the pelvis dynamically<br> m. Tensor facia latae<br> m. gluteus maximus<br> m. gluteus minimus<br> m. piriformis<br> m. obturatorus internus<br> ==> keeps the hip from dropping down or backwards<br>femoral neck<br>femoral head<br>hip joint<br>pelvis | ||
<ref>1. Clinical anatomy: applied anatomy for students and junior doctors&amp;amp;amp;nbsp;By Harold Ellis p228</ref><br><br> | <ref>1. Clinical anatomy: applied anatomy for students and junior doctors&amp;amp;amp;amp;nbsp;By Harold Ellis p228</ref><br><br> | ||
== Purpose<br> == | == Purpose<br> == | ||
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The purpose of the Trendelenburg Test is to identify weakness of the [http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-medius gluteus medius] muscle. | The purpose of the Trendelenburg Test is to identify weakness of the [http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/gluteus-medius 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 <ref>Rang M. Anthology of orthopaedics. Edinburgh. E&amp;amp;amp;amp;S Livingstone, 1966; 139-43.</ref> | 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 <ref>Rang M. Anthology of orthopaedics. Edinburgh. E&amp;amp;amp;amp;amp;S Livingstone, 1966; 139-43.</ref> | ||
== Technique<br> == | == Technique<br> == | ||
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<br> | <br> | ||
== Several dysfunctions can produce a positive Trendelenburg Test == | |||
Revision as of 17:13, 8 January 2011
Original Editor - Tyler Shultz, Lesley Dumitresco
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Search Strategy[edit | edit source]
web: keywords: trendelenburg test
definition trendenlenburg test
purpose trendelenburg test
book: keywords: clinically relavant anatomy for trendelenburg test
purpose trendelenburg test
pubmed: research AND trendelenburg test
physiotherapy AND trendelenburg test
Definition/Description[edit | edit source]
2.1 Definition:
definition for the musculoskeletal system:
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]
2.2 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://www.prohealthsys.com/anatomy/grays/arthrology/hipjoint.php
=> picture of the hipjoint
http://stemcelldoc.wordpress.com/2009/03/10/trendelenburg-test/
=>Patient with a dropping down hip
a) picture
http://orthoteers.blogspot.com/2007/10/standard-trendelenburg-test.html
b) video
Video: http://www.youtube.com/watch?v=4wxNFMxIgCE
Clinically Relevant Anatomy[edit | edit source]
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
Purpose
[edit | edit source]
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
[edit | edit source]
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].
Several dysfunctions can produce a positive Trendelenburg Test, including[6]:
- Superior Gluteal Nerve Palsy
- Lumbar disk herniation
- Weakness of gluteus medius
- Advanced degeneration of the hip
Several dysfunctions can produce a positive Trendelenburg Test[edit | edit source]
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1Zorz_P_0HTHaoqdwjqsB3Y1Bc-1-fMCJY_vc5rB0Ldqaszkq|charset=UTF-8|short|max=10: Error parsing XML for RSS
- 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. [email protected] - 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.
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ http://www.medilexicon.com/medicaldictionary.php
- ↑ 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&amp;amp;amp;nbsp;By Richard Jasper Day, John Fox, Graeme Paul-Taylor p137.
- ↑ 1. Clinical anatomy: applied anatomy for students and junior doctors&amp;amp;amp;nbsp;By Harold Ellis p228
- ↑ Rang M. Anthology of orthopaedics. Edinburgh. E&amp;amp;amp;amp;S Livingstone, 1966; 139-43.
- ↑ Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.
- ↑ Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.
