Rotation is tested in both extension and 90 degrees of flexion. Flexion, extension, abduction, and adduction, as well as internal and external rotation, are noted. The examination continues with the patient supine with both hips examined for symmetry of motion. Tenderness over the greater trochanter and abductor tendon will be present with trochanteric bursitis and partial tears of the gluteus medius or minimus. The muscular origins of the rectus femoris and adductor longus can be tender with strains or avulsion injuries. Tenderness along the inguinal canal may represent a classic inguinal hernia or deficiency of the abdominal wall known as a sports hernia. Palpation of the pelvis may identify tenderness at the pubic symphysis typical of osteitis pubis. Many patients with a snapping iliotibial band, also known as an external snapping hip, can reproduce the snapping by bearing weight on the leg while flexing and extending the hip. A snapping iliotibial band frequently can be palpated or visualized as it catches while sliding over the lateral border of the greater trochanter during gait. The examiner may have the patient reproduce the snapping while palpating the lateral side of the hip. Some patients experience a snapping sensation during gait or with specific standing maneuvers.
This asymmetric external rotation of the pelvis during extension of a hip with a flexion contracture is known as a pelvic wink. With a flexion contracture the pelvis also may rotate toward the affected side during extension of the hip because of the inability of the patient to extend the hip adequately.
During gait, extension of the hip is accomplished by further extension of the lumbar spine. With a fixed or painful hip flexion contracture, a patient will stand with compensatory hyperextension of the lumbar spine. The Trendelenburg test is positive for hip abductor weakness when the pelvis sags more than 2 cm during single-leg stance on the limb tested ( Fig. 6.3). Weakness of the hip abductor is tested with the Trendelenburg test. This same type of gait is seen with weakness of the hip abductor. A painful hip, however, often causes the patient to walk with an abductor lurch, in which he or she lurches toward the affected side during the stance phase of gait in an effort to reduce the joint reactive forces on the hip. An antalgic gait is described as having a decreased stance phase on the affected limb. Physical examination of the hip begins with observation of the patient’s gait. Azar MD, in Campbell's Operative Orthopaedics, 2021 Physical Examination The result is that the pelvis tilts downward instead of rising on the side of the lifted leg.įor instance, upward dislocation of the hip is associated with an unstable fulcrum and approximation of the origin of the abductor muscles to their insertion.įrederick M. If the abductors are inefficient, they are unable to sustain the pelvis against the body weight. This automatic mechanism allows the lifted leg to clear the ground while walking. Normally, when one leg is raised from the ground, the pelvis tilts upward on that side because of the action of the hip abductors of the supporting limb. Sometimes, a combination of two of the aforementioned factors Marked approximation of the insertion of the muscles to their origin by upward displacement of the greater trochanter causing the muscles to be slack (This slackening may occur in severe coxa vara or congenital dislocation of the hip.) 3.Ībsence of a stable fulcrum causes a positive test (This result occurs in the ununited fracture of the femoral neck.) 4. Paralysis of the abductor muscles, which can occur with poliomyelitis 2. 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.įundamental causes for a positive Trendelenburg test include: 1. In addition, after performing the test, the patient was asked to score the perceived effort to perform the test ( Roussel et al, 2007). If the patient was not able to hold the test position, or if the pelvis of the nonstance side could not be elevated above the transiliac line, then the test was scored positive by the examiner. The patient was allowed to touch the table with one finger to correct for potential balance problems. The pelvis should not tilt or rotate as the weight is shifted to the supporting leg. This position was maintained for 30 seconds.
The patient was asked to flex one hip to 30 degrees and to lift the pelvis of the nonstance side above the transiliac line. The test was performed in the standing position, based on the description provided by Hardcastle and Nade. The Trendelenburg test was developed to assess the function of the hip joint.
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