Examination of Hip : Trendelenburg test or sign

Normal: When the body weight is supported on one limb, the abductors (gluteus medius and minimus) of the supported side contract and raise the opposite unsupported side of the pelvis.

Abnormal: If the abductor mechanism is defective, the unsupported side of pelvis drops and this is known as positive trendelenburg’s test.

Use: To assess the integrity of abductor mechanism of hip

Causes of positive trendelenburg sign or test:

This test is positive in conditions in which any of the three – fulcrum (femoral head), lever arm (femoral neck length) or power (muscles/nerves) are affected.

Note: The primary abductors of hip are gluteus medius and minimus while tensor fascia lata and sartorius are accessory abductors of hip.

Trendelenburg sign test

1. Power paralysis of abductor muscles:

  • Superior gluteal nerve palsy
  • Polio
  • Iliotibial tract palsy

2. Decreased lever arm:

  • Fracture neck of femur

3. Absence of stable fulcrum:

  • Dislocation of hip
  • Destruction of femoral head: Perthe’s disease, Avascular necrosis of head of femur, Late stages of TB hip, Septic arthritis

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