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Hip and knee
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Two tests that you may wish to perform are: Trendelenburg test — With the patient standing, ask them to raise one leg for 30 seconds, so that the knee is level with the hip. Repeat on the other side. The test is positive if the iliac crest on the side of the raised leg drops below horizontal. For example, if the patient’s left leg was raised when the iliac crest on that side dropped, this would indicate weakness to the right hip abductors/gluteal weakness. It may also occur in osteoarthritis, due to pain.Thomas’ test — If the patient has a prosthetic hip, this test should not be performed for fear of dislocation. Thomas’ test measures fixed flexion deformities of the hip. Lay the patient on a hard surface. Place one hand, palm up, under the patient’s lumbar spine. Passively flex both of the patient’s knees and hips as far as possible. Maintaining the non-test hip fully flexed (indicated by the loss of the lumbar curvature), straighten the other leg (test hip). If there is incomplete extension, this indicates a fixed flexion deformity. Repeat for the other side.
Headache Disorders
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Utilize the Trendelenburg test to help with diagnosis. If a patient improves in head down tilt position, consider evaluation for a CSF leak, or if they rapidly worsen then consider utilizing a medication that lowers CSF pressure/volume.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
A Trendelenburg test can be positive for two main reasons: neurological or mechanical. Neurological causes can be due to generalized motor weakness as seen with myelomeningocele and spinal cord lesions, or more specific problems, such as superior gluteal nerve dysfunction/injury (e.g., following hip surgery). The mechanical causes include conditions that affect the abductor muscle lever arm, such as: Congenital dislocation of the hipCoxa varaFractures of the femoral neckDislocation or subluxation of the hip jointNeuromuscular diseases (e.g., poliomyelitis)Pain arising in the hip joint, inhibiting the gluteal muscles
Clinical utility of the Trendelenburg Test in people with multiple sclerosis
Published in Physiotherapy Theory and Practice, 2023
Paul W. Kline, Cory L. Christiansen, Dana L. Judd, Mark M Mañago
The Trendelenburg Test is a commonly used clinical assessment that has demonstrated good reliability in diagnosis of hip abductor muscle dysfunction in a variety of orthopedic conditions (Asayama, Naito, Fujisawa, and Kambe, 2002; Bailey, Selfe, and Richards, 2009; Roussel et al., 2007; Westhoff et al., 2006). To our knowledge, this is the first study to assess the reliability of the Trendelenburg Test in a population with a chronic neurological condition. By implementing the Trendelenburg Test based on previously validated methods emphasizing objective measurement of POF (Asayama, Naito, Fujisawa, and Kambe, 2002; Hardcastle and Nade, 1985; Westhoff et al., 2006), we demonstrated that the test had very strong intra-rater reliability when assessed using goniometry in people with MS. A prior study using goniometry reported an MDC of 4° for Trendelenburg POF in a sample of healthy adult men and women (Youdas et al., 2007). In the current study, we identified an MDC of 2.1° (range: 1.9–2.3°) (Table 2) in our sample of adults with MS. Given that the Trendelenburg POFs observed in our sample were between 2 and 15°, an MDC of 2.1° should have sufficient sensitivity to provide clinically useful data and capture change in frontal plane pelvic stability when longitudinally evaluating people with MS by a single rater. The smaller MDC observed in the current study in comparison to a population of healthy adult men and women illustrates the need to evaluate the psychometrics of tests and measures in specific patient populations as the results may be influenced by the unique characteristics of a condition or disease.