The role of the Trendelenburg Test in the examination of gait

Abstract

Background: The Trendelenburg Test was developed by Friedrich Trendelenburg, an orthopaedic surgeon, in 1895. Contemporary evidence shows the Trendelenburg Test is now being used internationally by a wide variety of practitioners. Method: This review describes the evolution of the Trendelenburg Test and its role within the examination of gait and examines the evidence relating clinical assessment using the Trendelenburg Test to the mechanics of walking. Literature was reviewed from electronic databases CINAHL, Medline, ScienceDirect, Ovid. Papers written in English were reviewed. Results: The possible outcomes of the Trendelenburg Test and its interpretation are defined. The outcomes and interpretation for the future use of the Trendelenburg Test are discussed. Conclusion: Further research is required into the biomechanics of the Trendelenburg Test and its relationship to functional anatomy and to investigate its reliability and validity within specific populations.

Trendelenburg Test: pass or fail? Invited Commentary on: 'The role of the Trendelenburg Test in the examination of gait', Baileyet al.

“…The validity of the Trendelenburg Test needs further research as mentioned by Bailey et al 1 A measure lacking reliability cannot be depended upon to measure what it is intended to measure. 5 In order to establish whether the Trendelenburg Test is actually measuring hip abductor weakness, then its results should agree with the results of a gold standard or criterion test.…”

A biomechanical investigation of selected lumbo-pelvic hip tests: implications for the examination of walking

“…Clinicians commonly use tests including the Trendelenburg, 1 Single Leg Squat 2 and Corkscrew Tests during the examination of the Lumbo-Pelvic and Hip complex. These tests are used to examine the movements of the Lumbar, Pelvic and Hip regions in a weight bearing position.…”

“…These tests are used to examine the movements of the Lumbar, Pelvic and Hip regions in a weight bearing position. 1,2,3,4 They may be used in isolation, 5,6 or to compliment the examination of functional tasks including walking. 3,7 The clinical assumption is that the Lumbar, Pelvic and Hip movements generated during these tests are similar to those of walking.…”

Friedrich Trendelenburg: Historical background and significant medical contributions

“…When the results are positive, inability to support the pelvis against gravity is most often attributed to anatomical changes that occur with hip dislocation, as the hip abductors are unable to support the pelvis. Moreover, as described by Bailey et al (), “the gluteus medius is reduced to approximately a third of its normal size, with the direction of its fibers altered in such a manner that the muscle can no longer act as an abductor.” The gluteus minimus becomes dysfunctional, incapacitating the entire muscular apparatus responsible for abduction of the hip (Bailey et al, ).…”

“…The Trendelenburg sign has been used to assess different conditions, but interpretation of the results remains controversial as no clear standard has been established for a positive test. According to Bailey et al (), only two authors have objectively defined the point at which pelvic drop can be considered a positive Trendelenburg test result: Asayama et al () established a positive Trendelenburg test result as a pelvic tilt angle of >2°, while Westhoff et al (2005) considered “positive” to be a pelvic drop in the non‐stance limb during the single‐stance phase of >4° and/or a maximum pelvic drop in the stance phase of >8° (Bailey et al, ).…”