The Hip
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
While in this position, it is convenient to perform Trendelenburg’s test for postural stability when the patient stands on one leg. Normally, in one-legged stance, the person’s body moves over the standing leg and the pelvis is hitched upwards on the unsupported side. However, if the weightbearing hip is unstable, the pelvis will drop on the unsupported side, showing a positive Trendelenburg sign. If the difference between the two hips is marked, you can detect this abnormality by simply looking at the patient’s stance. However, small differences are not so obvious. In the classical Trendelenburg test the examiner stands behind the patient, who is asked to stand first on one leg and then on the other: see if the buttock-line drops on the side opposite to the weightbearing hip — which would denote a positive Trendelenburg sign on the weightbearing side.
Hip and knee
Ian Mann, Alastair Noyce in 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.
SBA Answers and Explanations
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury in SBAs for the MRCS Part A, 2018
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.
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