trendelenburg

Trendelenburg test

·      aimed to determine functional integrity of hip abductor mechanism

Background

·      Friedrich Trendelenburg 1844-1924

·      German surgeon

·      described in 1897

·      specifically for congenital dislocation of hip

·      described prior to clinical use of x-ray

·      confusion on method, meaning and value of test

Technique

·      look from behind

·      ask patient to lift bad leg by bending hip and knee

·      pelvis rises

·      ask patient to lift good leg

·      sag of pelvis on sound side

results
False positives

·      pain

·      poor balance

·      lack of co-ordination or understanding

·      costo-pelvic impingement

False negatives

·      use of suprapelvic muscles

·      shift of trunk over affected hip

·      reduces amount of abductor activity needed

Modified techniques
Apley’s modification

Rationale

·      provides alternative method of attaining true positive result

·      supporting hand obviates need for hip sag (hip adduction)

Method

·      identify and expose ASISs

·      underwear as marker

·      stand in front of patient

·      place one hand on shoulder of test side

·      use other hand to support hand of opposite side

·      ask patient to stand on test side and lift opposite leg

·      positive test if opposite hip sags

·      sound side sags

Interpretation

·      positive test with

·      dislocation or subluxation of hip

·      weakness of abductors

·      shortening of femoral neck

·      painful disorder of hip

Hardcastle & Nade’s modification

Method

·      stand behind patient

·      observe tilt of pelvis

·      ask patient to lift opposite leg with

·      knee flexed for foot to clear ground

·      hip flexed 0-30o

·      ask patient to lift affected pelvis as high as possible

·      support patient’s arm on affected side

·      if patient leans to affected side, correct using shoulders

·      observe tilt of pelvis

·      wait 30 sec and note time of sag

Interpretation

·      normal

·      pelvis elevated on affected side

·      as high as hip abduction allows

·      with trunk (vertebra prominens) centred over hip and foot

·      maintained for 30 sec

·      abnormal

·      unable to raise pelvis at all

·      unable to raise pelvis maximally

·      unable to maintain position for 30 sec

Invalid

·      false positives as above