| Trendelenburg's sign | |
|---|---|
 | |
| Positive Trendelenburg's sign (on right) | |
| Differential diagnosis | paralyzed abductor muscles |
Trendelenburg's sign is found in people with weak or paralyzed abductor muscles of the hip, namely gluteus medius and gluteus minimus. [1] It is named after the German surgeon Friedrich Trendelenburg. It is often incorrectly referenced as the Trendelenburg test which is a test for vascular insufficiency in the lower extremities.
The Trendelenburg sign is said to be positive if, when standing on one leg (the 'stance leg'), the pelvis severely drops on the side opposite to the stance leg (the 'swing limb'). The muscle weakness is present on the side of the stance leg. If the patient compensates for this weakness by tilting their trunk/thorax to the affected side, then the pelvis will be raised, rather than dropped, on the side opposite to the stance leg. Ergo, in the same situation, the patient's hip may be dropped or raised, dependent upon whether the patient is actively compensating or not. Compensation shifts the center of gravity to the affected side, and also decreases the angle between the hip adductor muscles and femur, both of which decrease the forces needing to be applied by the hip adductor muscles to maintain relevant posture.[ citation needed ]
The gluteus medius is very important during the stance phase of the gait cycle to maintain both hips at the same level. Moreover, one leg stance accounts for about 60% of the gait cycle. Furthermore, during the stance phase of the gait cycle, there is approximately three times the body weight transmitted to the hip joint. [ citation needed ] The hip abductors' action accounts for two thirds of that body weight. A Trendelenburg sign can occur when there is presence of a muscular dysfunction (weakness of the gluteus medius or minimus) or when someone is experiencing pain.
A positive Trendelenburg's sign is caused by weakness or ineffective action of the abductor muscles of the lower limb, the gluteus medius muscle and the gluteus minimus muscle. [2]
The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula.
The gluteus maximus is the main extensor muscle of the hip in humans. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human body. Its thick fleshy mass, in a quadrilateral shape, forms the prominence of the buttocks. The other gluteal muscles are the medius and minimus, and sometimes informally these are collectively referred to as the glutes.
The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis.
The gluteus minimus, or glutæus minimus, the smallest of the three gluteal muscles, is situated immediately beneath the gluteus medius.
The piriformis muscle is a flat, pyramidally-shaped muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group.
Friedrich Trendelenburg was a German surgeon. He was son of the philosopher Friedrich Adolf Trendelenburg, father of the pharmacologist Paul Trendelenburg and grandfather of the pharmacologist Ullrich Georg Trendelenburg.
In vertebrate anatomy, the hip, or coxa in medical terminology, refers to either an anatomical region or a joint on the outer (lateral) side of the pelvis.
The gluteal sulcus is an area of the body of humans and anthropoid apes, described by a horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh. The gluteal sulcus is formed by the posterior horizontal skin crease of the hip joint and overlying fat and is not formed by the lower border of the gluteus maximus muscle, which crosses the fold obliquely. It is one of the major defining features of the buttocks. Children with developmental dysplasia of the hips are born with uneven gluteal folds and can be diagnosed with a physical examination and sonogram.
The biceps femoris is a muscle of the thigh located to the posterior, or back. As its name implies, it consists of two heads; the long head is considered part of the hamstring muscle group, while the short head is sometimes excluded from this characterization, as it only causes knee flexion and is activated by a separate nerve.
The quadratus lumborum muscle, informally called the QL, is a paired muscle of the left and right posterior abdominal wall. It is the deepest abdominal muscle, and commonly referred to as a back muscle. Each is irregular and quadrilateral in shape.
The external obturator muscle or obturator externus muscle is a flat, triangular muscle, which covers the outer surface of the anterior wall of the pelvis.
The adductor magnus is a large triangular muscle, situated on the medial side of the thigh.
The tensor fasciae latae is a muscle of the thigh. Together with the gluteus maximus, it acts on and is continuous with the iliotibial band, which attaches to the tibia. The muscle assists in keeping the balance of the pelvis while standing, walking, or running.
The gluteal muscles, often called glutes, are a group of three muscles which make up the gluteal region commonly known as the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and sacrum and insert on the femur. The functions of the muscles include extension, abduction, external rotation, and internal rotation of the hip joint.
Trendelenburg gait, named after Friedrich Trendelenburg, is an abnormal human gait. It is caused by weakness or ineffective action of the gluteus medius muscle and the gluteus minimus muscle.
In human anatomy, the muscles of the hip joint are those muscles that cause movement in the hip. Most modern anatomists define 17 of these muscles, although some additional muscles may sometimes be considered. These are often divided into four groups according to their orientation around the hip joint: the gluteal group; the lateral rotator group; the adductor group; and the iliopsoas group.
The inferior gluteal nerve is the main motor neuron that innervates the gluteus maximus muscle. It is responsible for the movement of the gluteus maximus in activities requiring the hip to extend the thigh, such as climbing stairs. Injury to this nerve is rare but often occurs as a complication of posterior approach to the hip during hip replacement. When damaged, one would develop gluteus maximus lurch, which is a gait abnormality which causes the individual to 'lurch' backwards to compensate lack in hip extension.
The superior gluteal nerve is a mixed nerve of the sacral plexus that originates in the pelvis. It provides motor innervation to the gluteus medius, gluteus minimus, tensor fasciae latae, and piriformis muscles; it also has a cutaneous branch.
The superior gluteal artery is the terminal branch of the posterior division of the internal iliac artery. It exits the pelvis through the greater sciatic foramen before splitting into a superficial branch and a deep branch.
Gluteal gait is an abnormal gait caused by neurological problems. If the superior gluteal nerve or obturator nerves are injured, they fail to control the gluteus minimus and medius muscles properly, thus producing an inability to tilt the pelvis upward while swinging the leg forward to walk. To compensate for this loss, the leg swings out laterally so that the foot can move forward, producing a shuffling or waddling gait.
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