Trendelenburg Test

Def. The Trendelenburg test is a quick physical examination that can assist the therapist to assess for any hip dysfunction.

 

A positive Trendelenburg test usually indicates weakness in the hip abductor muscles: gluteus medius and gluteus minimus. These findings can be associated with various hip abnormalities such as congenital hip dislocation, rheumatic arthritis, osteoarthritis.

A positive test is one in which the pelvis drops on the contralateral side during a single leg stand on the affected side. This can also be identified during gait: compensation occurs by side flexing the trunk towards the involved side during the stance phase on the affected extremity.

 

Clinically relevant anatomy

Gluteus medius (중둔근) and minimus (소둔근) are the primary abductors of the hip. When fully weight-bearing they act to abduct the femur away from the mid-line of the body and provide stability of the hip and pelvis.

Purpose

The purpose of the Trendelenburg Test is to identify the weakness of the hip abductors.

Besides the identification of weakness in the hip abductors of the standing leg, the Trendelenburg test can be used to assess other mechanical, neurological, or spinal disorders, such as the Congenital dislocation of the hip or hip subluxation.

 

Technique 

The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can hold onto something if balance is an issue.  The therapist observes the patient see if the pelvis stays level during the single-leg stance.  A positive Trendelenburg Test is indicated if during unilateral weight-bearing the pelvis drops toward the unsupported side

www.youtube.com/watch?time_continue=15&v=mA3enWJ53Kc&feature=emb_logo

 

Modified Trendelenburg Test - Pelvic Dysfunction & Lumbar Instability 

Examiner stands behind the patient and asks to flex the hip/ knee to 90 degrees. 

(+) Test = hip descends on flexed side. 

www.youtube.com/watch?v=8MR35VoTQDw&list=PL005A7AAC229BFF9C&index=22%EF%BB%BF

Clinical relevance

Several dysfunctions can produce a positive Trendelenburg Test:

• The weakness of gluteus medius
• Hip instability and subluxation
• Hip osteoarthritis 
• Initially post Total Hip Replacement
• Superior Gluteal Nerve Palsy
• Lower back pain
• Legg-Calvé-Perthes Disease
• Congenital hip dislocation

A Trendelenburg gait can also be observed caused by abductor insufficiency and is characterized by:

• Pelvic drop-in swing phase
• Trunk side flexion towards the stance limb
• Hip adduction during the stance phase.

Clinical bottom line

The Trendelenburg test alone cannot diagnose hip conditions such as osteoarthritis or hip instability. It has been shown to be more effective when part of a battery of tests such as hand dynamometry and observation to help assess hip abductor strength. It is a quick, easy test that can help identify functional weakness in a standing position.

 

 

중둔근 약화를 검사하기 위해 자주 사용되는 검사법. 

원래대로라면 버티고 서있는 쪽의 중둔근이 긴장하면서 그쪽 골반이 내려가고 다리를 들고 서 있는 쪽의 골반이 올라가는 것이 정상. 

하지만 장골에서 대퇴골까지 이어지는 중둔근이 긴장해있어야할 상황에서, 중둔근이 약화되어 길이가 길어져버리는 상황. 

그러므로 정상적인 상황과는 반대로, 버티고 서있는 쪽의 골반이 올라가고 다리를 들고 서있는 쪽의 골반이 내려가버리는 것.

 좌측 이미지가 정상적인 상태에서 왼쪽다리르 들고 서 있을 때 모습. 우측 이미지는 중둔근이 약화되어 있는 상태에서 왼쪽 다리를 들고 서 있을 때 모습. 

사진의 경우 좌측 다리를 들고 서 있으며, 

우측 다리는 버티고 서 있는 상태이다. 

우측 중둔근이 정상적이라면, 좌측 골바는 올라가고 우측 골반은 내려가야 한다. 그런데 환자분은 그 반대의 상황. 

다리를 들고 서 있는 좌측 골반이 내려가고, 

버티고 서 있는 우측 골반은 올라가 있는 상황. 

이것이 트렌델렌버그 테스트 양성. 

환자의 우측 중둔근이 약화되어 있다는 것을 알 수 있다.

 

 

 

 

중둔근 약화된 상황이면 뒤뚱뒤뚱 보행의 모습을 보이게 된다. Trendelenburg Gait.