The Trendelenburg sign describes the degree of pelvic tilting when the patient is in a one-legged stance.
The nonsupporting leg should be extended at the hip to keep the psoas muscle from elevating the pelvis on that side. The foot is lifted with the thigh kept extended and the knee flexed.
A positive Trendelenburg sign occurs when the pelvis tilts toward the unsupported side.
Parameters:
(1) sagging or dropping of the hip in the one-legged stance
(2) instability of stance, unsteadiness
(3) limp
Sagging
Instability
Limp
Grade
none
none
none
0
none
mild
with prolonged walking
1
mild to moderate
moderate
present
2
severe
severe
present
3
unable to assume one legged stance
NA
present
3
A positive Trendelenburg sign may indicate:
(1) paralysis of the gluteus medius (hip abductor)
(2) operative injury to the gluteus medius
(3) laxity of the gluteus medius
(4) instability of a subluxating hip joint
A false negative Trendelenburg sign may occur if the nonsupporting leg is not kept extended (see above).
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