Name of test



Trendelenburg’s sign

What it tests



Strength of the abductor mechanism of the hip

How to do it



Prequisites of testing

  • Patient able to stand on affected side for more than 30 seconds
  • Patient able to understand commands
  • Intact coordination (usually patients > 4 years old)
  • Free abduction movement possible; no fixed adduction deformity

Standing test

  • Patient stands on affected leg (single leg stance)
  • Positive Trendelenburg’s sign: pelvis droops on the unaffected side

Gait test

  • The patient is asked to walk a short distance.
  • In a normal gait, the body shifts the weight to the stance leg,allowing the shift of the center of gravity, which stabilizes or balances the body.
  • When a patient with abductor weakness lifts the unaffected leg, the shift does not occur and he/she cannot maintain balance, leading to instability.

The normal response


  • The pelvis does not droop during the standing test.
  • The patient does not sway, or the sway is less then 5 degree to vertical, during the gait test

What it means if not normal



Deficiency in the abductor mechanism of the hip (either the abductor musculature or the femoral neck of the the hip joint)

Occurs as a result of

  • Fracture of the femoral neck
  • Posterior dislocation of the hip
  • Abductor muscle paralysis (ie, polio myelitis)
  • Developmental dysplasia of the hip
  • Painful hip disorder such as rheumatic arthritis or osteoarthritis

Comments



False positives can occur with:

  • Obesity
  • Fixed adduction deformity (if not checked before the test)
  • Medialization of lower limb axis, such as coxa vara, genu varum, and malunited supracondylar femur with varus deformity
  • Affected state of quadratus lumborium (pulls the pelvis on the unaffected side up; if it is not intact, then also false positive)

Citations





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Figures



Attachments:


trendelenburg.jpg (image/jpeg)