Re: Trendelenburg gait

[Guest guest]

Hi,

(at the bottom of this posting, is a bit about treatment of this problem)

I had never heard about this before, so because I

was curious, I did a web search on google.com and

got 17,700 hits... I found several pages which I

pasted parts of below. The first is a page with

the below text, and when I scrolled up and down I

found a lot more info on hip stuff... Including

figures that explains this problem and the

cause. So have a look if you are interested. It

is part of an exam in clinical examination of the

hip. If you look at the bottom of the page, you

will also find links to different parts of the

exam. The page has questions and answers about

different hip problems:

http://www.echo.uqam.ca/mednet/anglais/hermes_a/hip/part_2.html#Answer_09_01

What is a Trendelenburg gait

(also called a gluteus medius lurch or an abductor lurch)?

A Trendelenburg gait is seen in patients with

poorly functioning hip abductors. The causes of

this have already been discussed under

" Trendelenburg test " .

Because of inadequate pelvic abductor function,

the patient with a Trendelenburg gait tends to

fall to the opposite side when in the stance

phase on the affected side (the opposite hip sags

down). To prevent himself from falling the

patient shifts his center of gravity towards the

affected side by throwing his trunk and head in

that direction. The result is a gait with a

lateral lurch towards the affected side, the

lurch occurring when in the stance phase on the

affected side (fig. 143).

If the patient has bilateral abductor

dysfunction, as may occur with bilateral

congenital hip dislocation or in muscular

dystrophy, the lateral lurching will be

bilateral. This is often referred to as a " waddle

gait " (as in waddling ducks).

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From another page http://www.whonamedit.com:

Trendelenburg's symptom

Also known as:

Duchenne-Trendelenburg phenomenon

Trendelenburg's test

Associated persons:

Guillaume Amand Duchenne de Boulogne

Friedrich Trendelenburg

Description:

Sign of congenital dislocation of the hip joint.

Clinical sign in static insufficiency of the

gluteal muscles, for instance as a result of

luxation of the hip joint.

If the child stands on the leg on the affected

side, pelvis is tilted down towards the sound

side and the buttock sags down. Normally the

pelvis tilts upwards and the buttock therefore

rises. The body will attempt to restore

equilibrium and gait in shifting the upper part

of the body to the loaded side. In double-sided

luxation of the hip joint the upper part of the

body is therefore swaying from side to side.

This sign is also seen in late Perthes disease

(osteochondropathia deformans coxae juvenilis),

infantile paralysis of the gluteal muscles, old

fractures in the neck of the femur and advanced

osteo-arthritis.

Bibliography:

* F. Trendelenburg:

Über den Gang bei angeborener Hüftgelenksluxation.

Deutsche medicinische Wochenschrift, Berlin, 1895, 21: 21-24.

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In a medical encyclopedia online, I found this (veeery helpful, he-he)

Trendelenburg gait,

(Friedrich Trendelenburg, 1844-1924, German surgeon), see limp

HC

The Encyclopaedia of Medical Imaging Volume VII

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This was probably the most useful of the first hits I got:

from http://www.gpnotebook.co.uk/

Trendelenburg test

The Trendelenburg test is used to assess hip stability.

The patient is asked to stand unassisted on each

leg in turn, whilst the examiner's fingers are

placed on the anterior superior iliac spines. The

foot on the contralateral side is elevated from

the floor by bending at the knee. An alternative

approach is to have the patient undertake this

manoeuvre facing the examiner and supported only

by the index fingers of the outstretched hands;

this accentuates any instability of balance shown

during a positive test.

In normal function, the hip is held stable by

gluteus medius acting as an abductor in the

supporting leg. If the pelvis drops on the

unsupported side - positive Trendelenburg sign -

the hip on which the patient is standing is

painful or has a weak or

mechanically-disadvantaged gluteus medius.

A positive Trendelenburg test is found in:

* any condition that brings the origin and

insertion of gluteus medius together:

* subluxation or dislocation of the hip

* coxa vara

* greater trochanter fractures

* slipped upper femoral epiphysis

* abductor paralysis or weakness e.g.:

* polio

* root lesion

* post-operative nerve damage

* muscle-wasting disease

* any painful hip disorder which results in gluteal inhibition

Caution must be exercised as false positives have been noted in 10% of cases.

It has a link to more information, followed it

and found amongst others this (go there and

follow all links for more extensive information):

congenital dislocation of the hip

Congenital dislocation of the hip is an important

condition in both paediatrics and orthopaedics,

affecting about 5 in 1000 babies at birth and 1

in 1000 babies at 3 weeks.

Untreated it can lead to appreciable

malformation, whereas treatment can have

excellent results.

This condition has recently been renamed

developmental dysplasia of the hip or DDH, as

some feel that this may more accurately describe

the condition.

* predisposition

* pathology

* clinical features

* screening

* imaging

* treatment

* complications

* prognosis

I followed the link about " treatment " above and

found this about treatment for persons over the

age of 6 years:

(Treatment)more than 6 years old

If CDH is unilateral, then operative reduction is

preferred. If the head is reduced but there is

poor coverage, then a bony roof should be

constructed. This is achieved by repositioning

the acetabulum and entire innominate bone - a

Salter or innominate osteotomy - or constructing

a shelf in the acetabulum.

If there has been marked anteversion of the

femoral head, then this may be corrected with a

de-rotational osteotomy of the femur.

In a bilateral dislocation, operative reduction

is only undertaken if the deformity is severe.

After the age of 11, operations are generally

only carried out if pain exists: possibilities

include total hip replacement and arthrodesis

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I won't paste more here, but if you want to look

for some more, do the search at

http://www.google.com I am sure that many of

the sites have the exact same info, but...

Take care!

Aase Marit