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The Trendelenburg symptom (named after the German surgeon Friedrich Trendelenburg) consists of a pelvic drop when standing on one leg or walking. The Trendelenburg symptom indicates failure of the thigh abduction muscles, i.e. the pelvic or gluteal muscles. Typically, the cause of the Trendelenburg symptom is hip dysplasia or some type of gluteal muscle failure.
How is Trendelenburg symptom diagnosed?
The Trendelenburg symptom is quite easily recognizable and can be observed in some patients by looking at the way they move. If a Trendelenburg symptom is suspected, a simple one-leg stand test, also known as the Trendelenburg test, is used.. The purpose of this test is to assess the performance of the thigh abduction muscles and confirm the suspicion of a dysfunction. The thigh abduction muscles include the gluteus muscles, i.e. the middle and small gluteus muscles. If they do not function properly, the patient has problems maintaining correct posture and walking properly.
Trendelenburg test is carried out as follows. The patient is asked to stand on one leg, bend the other leg at the hip joint and lift it up. If the patient is young, he is to stand on one leg in the stork position. The patient is then asked to stand in the same position on the other leg. If the pelvis descends on the side of the raised leg, it is a sign of impaired functioning of the gluteal muscles, i.e. the thigh abductors muscles. This is the so-called Trendelenburg symptom. If the Trendelenburg symptom is positive unilaterally, the patient usually has a limp on one leg (the side on which the Trendelenburg symptom occurs). If the Trendelenburg symptom is bilateral, a so-called duck gait is observed – the patient sways to both sides as he walks.
The Trendelenburg symptom is often accompanied Duchenne symptom. It consists in the fact that the lowering of the pelvis on the healthy side of the body causes the center of gravity of the body to shift. The patient tilts the upper torso to the side of the leg supported on the ground so as not to fall over, which leads to the fixation of the defective posture. In this way, the lateral curvature of the spine develops and strengthens, which leads to further ailments, including pain.
Causes of the Trendelenburg symptom
The cause of the Trendelenburg symptom may be weakness or paralysis of the pelvic muscles (thigh abductors). Failure of this group of muscles can be caused by paralysis of the superior gluteal nerve, for example as a result of an injury or pressure. In children, the Trendelenburg symptom is observed in patients with hip dysplasia and hip dislocation (which occurs as a result of dysplasia). Children with this condition have a specific limp or move with a “duck’s gait”.
Other causes responsible for the Trendelenburg symptom include:
- muscular dystrophies,
- complications after hip surgery,
- hip joint injuries,
- pseudo-joints (for example, after hip fractures),
- varus hip,
- Perthes’ disease (aseptic necrosis of the femoral head), which most commonly affects boys between the ages of 3 and 14.
The Trendelenburg symptom is often a consequence of congenital dislocation of the hip joint, it may also be the result of inflammation of the hip joint, coxarthrosis, and flaccid or spastic paralysis of the medium and small gluteal muscles. The Trendelenburg symptom often accompanies degenerative states of the hip joint. Then it is joined by soreness when walking and standing on one leg.
Treatment in the event of a Trendelenburg symptom
The Trendelenburg symptom, or rather its cause, is treated with physical therapy and rehabilitation, i.e. muscle strengthening exercises – primarily the group of thigh abduction muscles, i.e. gluteal muscles. A positive result of the Trendelenburg test (Trendelenburg symptom) indicates paralysis or failure of the gluteal muscles, so in order to eliminate or alleviate this symptom, this group of muscles should be strengthened. Massages are used to eliminate possible contractures and physiotherapeutic treatments that maintain the mobility of the hip joint and prevent muscle atrophy. In the event of a Trendelenburg symptom, therapy is recommended by an orthopedic surgeon in consultation with a rehabilitator and a physiotherapist.
In some cases, it is necessary to undergo surgery. This is important because permanent Trendelenburg symptom may lead to curvature of the spine and further serious health problems such as contractures and muscle atrophy. The main issue in the case of Trendelenburg symptom is to establish its immediate cause and initiate appropriate treatment.