The Trendelenburg gait pattern (or gluteus medius lurch) is an abnormal gait (as with walking) caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus. People with a lesion of superior gluteal nerve have weakness of abducting the thigh at the hip.
What is a positive Trendelenburg gait?
Trendelenburg Gait. A positive Trendelenburg gait (gluteus medius gait/lurching gait ) is generally indicative of hip abductor weakness.
What causes Trendelenburg gait in hip abductors?
Trendelenburg gait occurs when a patient has paralysis/paresis of the hip abductors. Hip abductor weakness may be caused due to neuronal injury to the superior gluteal nerve either due to nerve entrapment or by iatrogenic factors.
What happens if you don’t get treatment for Trendelenburg gait?
Muscular dystrophy, a condition that causes muscles and bones to become weak over time. While many people who get Trendelenburg gait recover quickly, there are some individuals with moderate-to-severe symptoms that experience serious complications. This is usually when they don’t receive treatment for the condition.
What are the causes of Trendelenburg gait?
The trendelenburg gait is caused by a unilateral weakness of the hip abductors, mostly the gluteal musculature. This weakness could be due to superior gluteal nerve damage or in 5th lumbar spine lesion. This condition makes it difficult to support the body's weight on the affected side.
What does Trendelenburg sign indicate?
Trendelenburg sign is a physical examination finding seen when assessing for any dysfunction of the hip. A positive Trendelenburg sign usually indicates weakness in the hip abductor muscles consisting of the gluteus medius and gluteus minimus.
How do you fix a Trendelenburg gait?
There are several ways to treat Trendelenburg gait:Physical therapy. Physical therapy can reduce the effects of the weakened hip muscles and help improve your gait.Medication. Anti-inflammatories, such as acetaminophen and ibuprofen, can be used to help ease discomfort caused by this gait. ... Surgery.
Is waddling gait and Trendelenburg gait the same?
The answer is no. Furthermore, a Trendelenburg gait is often mista- kenly called a waddling gait. But, as argued above, these two terms are not synonymous. Trendelenburg gait is not a true waddling gait.
Which side is weak with Trendelenburg gait?
A trendelenburg gait is an abnormal gait resulting from a defective hip abductor mechanism. The primary musculature involved is the gluteal musculature, including the gluteus medius and gluteus minimus muscles. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking.
What muscle keeps the pelvis level during walking?
hip abductor musclesFundamentals of Human Gait Activation of the stance leg's hip abductor muscles normally holds the pelvis level, allowing the swing leg to advance toward the next step.
Why are my hip muscles weak?
Lack of exercise Not partaking in regular physical activity can lead to weak hip flexors. Underuse of the hip muscles can cause the muscle to degenerate and become weak, which is known as muscle atrophy.
How can I stop my hips from dropping?
Four Simple Exercises to Correct Your Hip Drop Hip Hitches – 3 sets of 15 each side. Isometric Glute Med Hold – 3 sets of 30 second holds each side. Resistance Band Crab Walk – 3 sets of 30 seconds each direction. Glute Med & Psoas Drill – 3 sets of 10 each side.
Why does my hip drop when I walk?
Hip drop occurs when there is a weakness in our hip abductor muscles, most commonly the gluteus medius.
How do you know if you have a weak hip abductor?
When a client is walking on their right leg in the stance phase of the gait cycle and their left hip drops down, this indicates a weakness in the right hip abductors. If hip abductors are weak on both sides, it results in a waddling gait, which is reminiscent of the strut of a Vegas showgirl.
Which nerve can be tested using the Trendelenburg test?
Purpose: To detect gluteus medius tendon tears or weakness in the hip abductors. Test Position: Standing. Performing the Test: Patient stands on one leg.
What is Parkinson's gait?
In contrast to normal adult gait, Parkinsonian Gait – also called Parkinson's Walk – is characterized by very short, shuffling steps, in which the feet do not lift far from the floor.
What does Trendelenburg test show?
Trendelenburg test investigates stability of the hip and particularly the ability of the hip abductors (gluteus medius and gluteus minimus) to stabilize the pelvis on the femur. Fundamental causes for a positive Trendelenburg test include: 1. Paralysis of the abductor muscles, which can occur with poliomyelitis.
What is the difference between Trendelenburg sign and gait?
Causes of a positive Trendelenburg's sign include skeletal and neuromuscular abnormalities affecting the hip and hip abductors respectively. Trendelenburg's gait should be differentiated from antalgic gait (due to pain) and short-leg gait (due to differences in leg length).
What causes right hip drop?
Hip drop occurs when there is a weakness in our hip abductor muscles, most commonly the gluteus medius. When this muscle is strong, it keeps the pelvis level when standing on one leg. It also helps prevent the knee from caving in towards the midline of the body.
How do you test for hip abductor weakness?
0:241:08Trendelenburg Test | Hip Abductor Weakness - YouTubeYouTubeStart of suggested clipEnd of suggested clipPatients. What you ask a patient to do is to stand on one leg. And the sign that you're looking forMorePatients. What you ask a patient to do is to stand on one leg. And the sign that you're looking for is a dropping of the hip because of the weakness of his a lead actor muscles which is usually the
What Is Trendelenburg Gait?
Trendelenburg gait occurs when your hip abductor muscles are very weak. This muscle group includes the gluteus medius and gluteus minimus muscles, located in the area of your butt. When these muscles are not strong enough, your pelvis will droop on the opposite side of the body from the affected muscles.
How Is Trendelenburg Gait Diagnosed?
A physical examination and overview of your medical history are necessary to accurately diagnose Trendelenburg gait and rule out other gait disorders caused by weak hip muscles. Those might include:
What Are the Long-Term Effects of Untreated Trendelenburg Gait?
Chronic untreated Trendelenburg gait can lead to long-term complications in your knees and ankles. It also speeds up the effects of degenerative arthritis. The “wear and tear” appears at the hip joint in areas that aren't usually affected by a normal gait.
What is Trendelenburg gait?
Trendelenburg gait is an abnormal gait caused by weakness of the hip abductors. Therefore, the main purpose of physical therapy with regards to this impairment is to strengthen the abductors of the hip.
Why does trendelenburg gait occur after hip replacement?
In patients with hip replacement, trendelenburg gait ensues due to the surgical dissecction of the gluteus medius muscle during surgery to expose the hip joint; thus the dysfunction in the abductor muscles.
How does EMG help with gait?
EMG device provides warning tones, giving feedback of improper gait through sensing the level of gluteus medius activity.
What is trendelenburg biofeedback?
Patients with trendelenburg suffer from abnormal range of motion in hip and trunk; so, a wall mirror biofeedback could also be used. This treatment is used to increase the hip and trunk range of motion. The patient get visual feedback about how he/she walks. The therapists watches and gives advise/correction to posture, so as to facilitate proper gait re-education.
Why does my hip have a tendencyelenburg gait?
The trendelenburg gait is caused by a unilateral weakness of the hip abductors, mostly the gluteal musculature. This weakness could be due to superior gluteal nerve damage or in 5th lumbar spine lesion. This condition makes it difficult to support the body’s weight on the affected side.
What is the purpose of observing gait from the side?
Observation of the patient’s gait from the side enables the examiner to detect stride and step length deficiencies as well as motion of the trunk and lower extremity in the sagittal plane , including the extensor or gluteus maximus lurch in which the patient thrusts the trunk posteriorly to compensate for weak hip extensors (gluteus maximus muscle).
How to diagnose hip pain?
When pain in the hip is diagnosed, the surgeon will base the diagnose on data obtained from clinical and X-ray assessments. These two data sources will provide an answer to: 1 The level of the proximal osteotomy 2 The amount of valgus, extension and derotation at the proximal osteotomy 3 The level of the distal osteotomy 4 The amount of varus and lengthening at the distal osteotomy. Level of evidence: B
Why does the pelvis drop in swing phase?
Where the pelvis of the lower limb in swing phase drops because the recruitment of hip abductor muscles in the the stance limb isn’t sufficient to maintain a level pelvis.
Can a trendelenburg test be performed with a x-ray?
X-rays can be used to confirm diagnosis, when the Trendelenburg test is performed under X-ray and subsequently hip and pelvis angles are measured. When pain in the hip area accompanies a Trendelenburg gait, again an X- ray, or other investigations can be useful to help detect the cause of the pain and potential reasons for the presence ...
Can you see Trendelenburg gait from the side?
Trendelenburg gait is best visualized from a front or back view, however gait observation from the side can enable detection of any ankle dorsiflexion weakness (potential foot drop), which can lead to an inability of the foot to clear the ground during swing phase.
What is Trendelenburg gait?
Trendelenburg gait is an abnormal gait resulting from a defective hip abductor mechanism. The primary musculature involved is the gluteal musculature, including the gluteus medius and gluteus minimus muscles. The weakness of these muscles causes drooping of the pelvis to the contralateral side while ….
Which muscle is involved in drooping pelvis?
The primary musculature involved is the gluteal musculature, including the gluteus medius and gluteus minimus muscles. The weakness of these muscles causes drooping of the pelvis to the contralateral side while walking.
What are the causes, risk factors, and complications of Trendelenburg gait?
Some people may be familiar with Trendelenburg gait due to straining their hip abductor muscles during physical activities. Any exercise that strengthens the glutes, which are a group of three muscles making up the buttocks, can lead to this gait problem. The good news is that the Trendelenburg gait usually disappears as muscle inflammation decreases. Trendelenburg gait causes have also been linked to surgery. For instance, it is possible to get this gait after a total hip replacement operation. This is due to the fact that a surgeon has to make incisions in the gluteus medius muscle, which has been known to weaken it.
What is Trendelenburg gait?
When someone experiences weakness in the hip abductor muscles and walks with a noticeable side-to-side motion, it might be Trendelenburg gait.
How to tell if you have Trendelenburg gate?
When we walk, our gait is made up of two elements – the swing and the stance. When one leg moves forward or swings, the other leg stays still to keep us balanced, which is called a stance. When one leg swings forward and the hip drops down and moves forward, this is a symptom of Trendelenburg gait. If you have Trendelenburg gate, you may lean back or slightly to the side in order to try to maintain your balance. You may also lift your foot higher off the ground than you normally would to avoid losing your balance, as your pelvis shifts in an uneven fashion.
What is a trochanteric osteotomy?
Trochanteric osteotomy is a type of hip replacement procedure that can also be done, but it is usually carried out under very specific circumstances. Physical therapy is used for some people who are suffering from the effects of Trendelenburg gait. It should only be used as a treatment when recommended by a doctor.
Does Trendelenburg gait disappear?
The good news is that the Trendelenburg gait usually disappears as muscle inflammation decreases. Trendelenburg gait causes have also been linked to surgery. For instance, it is possible to get this gait after a total hip replacement operation.
Is Trendelenburg gait a serious problem?
Having Trendelenburg gait is not considered a serious health problem. Many people with this condition don’t even have pain or other noticeable symptoms ...
Can a leg be pulled up to show Trendelenburg gait?
If the hip from the leg is pulled up and will become lower than the other one, this could be a positive sign for Trendelenburg gait. If a gait issue is suspected, a doctor will likely want to see the person walk. The doctor usually stands in front of the patient or behind to make their assessment.
What is Trendelenburg's gait?
Trendelenburg’s gait involves excessive up-down motion of the pelvis whilst walking.
When would you perform Trendelenburg’s test?
When a patient complains of a limp, or hip pain or as part of a normal physical examination assessing gait.
Why don't we fall when standing on one leg?
We don’t fall because the hip abductors pull the pelvis towards the femur of the weight-bearing leg.
Why do you feel your arms pressing down?
If the patient is using your arms for support, you will feel them pressing down on one of your arms if their hip abductors are unable to support their weight.
What is the gait cycle?
The gait cycle is the sequence of events between the time one foot touches the ground and the time the same foot returns to the same position. Events of the gait cycle include heel strike; foot flat; push off (heel off + toe-off) and the stance and swing phases. 1. During the foot flat phase of the gait cycle, the contralateral leg is lifted ...
What is single leg stance?
Single-leg stance. Ask the patient to lift each foot in turn off the ground. When the patient lifts their right foot, the left hip abductors are being tested. When the patient lifts their left foot, the right hip abductors are being tested.
When standing on one leg, what happens to the centre of gravity?
When standing on one leg, the centre of gravity, much like the chair, shifts to the unsupported leg.
What is Trendelenburg gait?
A positive Trendelenburg gait (gluteus medius gait/lurching gait ) is generally indicative of hip abductor weakness. The classic Trendelenburg's gait pattern is seen when the stance phase hip abductors cannot resist the pull of gravity on the unsupported swing phase lower extremity. The therapist will observe the swing phase pelvis dip below level. A compensated Trendelenburg's pattern is observed when the client deviates the body in the frontal plane toward the stance leg to decrease the moment arm of gravitational forces pulling on the swing side, decreasing load on the stance side abductors. Although Dimattia et al. found that alone, the Trendelenburg's position was a poor predictor of hip abduction strength, it remains a useful observational tool to clue the therapist to core impairments affecting gait.
What does a positive Trendelenburg sign mean?
A positive Trendelenburg sign is defined as either a compensatory tilt of the torso (vide supra) or a drop of the contralateral iliac crest (See Fig above), indicating that the ipsilateral hip abductors are unable to contract with adequate force to maintain a level pelvis.
What is Trendelenburg gait?
Specialty. Neurology. Trendelenburg gait, named after Friedrich Trendelenburg, is an abnormal gait. It is caused by weakness or ineffective action of the gluteus medius muscle and the gluteus minimus muscle .
When was the Trendelenburg gait first described?
Trendelenburg gait was first described by Friedrich Trendelenburg in 1895.
What does it mean when your hip drops on the right side?
When standing on the right leg, if the left hip drops, it is a positive right Trendelenburg sign (the opposite side drops because the hip abductors on the right side do not stabilize the pelvis to prevent the droop).
Why does the trunk lurch to the weakened side?
To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle. When the hip abductor muscles (gluteus medius and minimus) are weak or ineffective, the stabilizing effect of these muscles during gait is lost.
Mechanism
Function
- The hip joint is composed of the acetabulum and the femoral head. These structures are surrounded by soft tissues and twenty-two muscles. These muscles provide the stability and the force required for movement of the femur during activity. [6][7] The gluteus medius and gluteus minimus are the two main hip abductors,support the opposition of the pelvis and prevents the p…
Clinical significance
- Trendelenburg gait occurs when a patient has paralysis/paresis of the hip abductors. [6][12] Hip abductor weakness may be caused due to neuronal injury to the superior gluteal nerve either due to nerve entrapment or by iatrogenic factors.[13][14][15] Trendelenburg gait is also observed in patients with developmental dysplasia of the hip, congenital dislocation of the hip (CDH), conge…
Characteristics
- A trendelenburg gait is characterized by trunk shift over the affected hip during stance and away during the swing phase of gait and it is best visualized from behind or in front of the patient. During gait, the pelvis tilts downwards instead of upwards on the non-weight bearing extremity. In an attempt to lessen this effect, the person compensates by lateral tilt of the trunk away from th…
Diagnosis
- The Trendelenburg test determines the integrity of hip abductor muscle function. The therapist can use this test when there is no X-ray taken but there are signs of Trendelenburg. The person has to stand on one leg. The test is negative when the hip of the leg that is lifted, will also go up i.e, hiking of hip or the pelvis tilts upwards. The test is positive, when there is a drop of the hip or …
Assessment
- The modified McKay criteria is useful to assess if a patient has Trendelenburg gait. These criteria measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement.
Management
- For patients with compensated Trendelenburg gait, medical management can attempt to deal with the causes underlying a Trendelenburg gait. Open reduction and Salter innominate osteotomy (SIO) without preoperative traction is effective in the management of developmental dysplasia of the hip in children younger than 6 years. [26]
Results
- Pelvic support osteotomies cause a significant improvement in outcomes relating to posture, gait and walking tolerance in patients who had untreated congenital dislocations.[27] [28] Level of evidence: B
Treatment
- Other exercises in the treatment of Trendelenburg gait include functional closed-chain exercises, lateral step-ups and functional balance exercises. It is also important to strengthen the rest of the hip muscles on the affected side.
Research
- A research investigated the usefulness of a two-channel EMG biofeedback training device that patients could wear at home. The conclusion of this study was that the group that used the home training device, showed almost normal gait after two months. This goal is only achievable when patients are doing exercises which strengthen the hip abductors in combination with the two-ch…