Guest guest Posted April 27, 2004 Report Share Posted April 27, 2004 Hi Alan I just came back from 2 weeks physiotherapy (3 hours a day, 6 days a week). At the start I got examined by a physiotherapy doctor (a doctor who having completed 6 years medical studies then specialised for 2 years in medical physiotherapy; in the clinic where she practices she has a number of degree-holding physiotherapists who are not physicians/doctors but have graduated after a 4-year study at the Faculty of Physiotherapy) who wrote her finds and diagnosis where she mentions among other things the following (this is my translation into English): “When standing on his left leg pos. (presumably abbreviation for ‘position’) Trendelnburg’s sign (presumably meaning ‘observed Trendelnburg’s sign or as you refer to it as gait).†When I had to leave that place I was examined again by the same specialist who wrote another report detailing progress made during the 2 weeks of physiotherapy. There was again a comment which I translated as: “When standing on left leg still pos. Trendelenburg’s sign.†Indicating no change/improvement in that aspect. In the initial report she also mentioned the following: “During today’s examination walk with a slight left leg limp (that’s my operated leg)and a pronounced Duchenn’s sign (maybe I should translate this as gait).†The final report has the following observation: “At today’s examination left leg limp has been reduced, with a less observable Duchenn’s sign/gait.†I don’t know what Trendelenburg and Duchenn sign/gait/syndrome are but intend to find out and will post when I do. I did become aware, now that I have nearly completely lost the limp despite my left leg being 8mm shorter, that I cannot convince myself to stand upright resting on my left leg while my right leg is loosely stretched out. I always rest with my right leg straight and upright. I would have thought that the opposite should be my body’s natural preference given that the left leg is 8mm shorter (1/3 of an inch) thus making it more natural for the longer right leg to be slightly forward. But, I guess it has a lot to do with muscles and tendons strength and flexibility as well as their ‘memory’ as I must have been using my ‘good’ leg as a support ‘pole’ when standing upright for a number of years without thinking about it or being aware of that fact. Regards Dan * +44 (0)7974 981-407 * +44 (0)20 8501-2573 @ dan.milosevic@... _____ From: Alan Ray Sent: 28 April 2004 01:47 To: surfacehippy Subject: Trendelenberg Yo, Hippies... Has any among you gone into resurf with a condition called Trendelenberg gait? Does resurf help or matter in eliminating it? Thanks... Alan _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 27, 2004 Report Share Posted April 27, 2004 > Yo, Hippies... > > Has any among you gone into resurf with a condition called > Trendelenberg gait? Does resurf help or matter in eliminating it? If my understanding of what the " sign of Trendelenberg " is is correct ( " adductor lurch " , a sort of waddling gait often found in folks with hip arthritis), then I'd bet that nearly all of us did. I'm only a week out, but most people seem to return to normal gait post resurf (although many of us seem to need some retraining to break the habit). Since I'm not a doc, I may be way off-base on this of course. Steve (bilateral C+, 4/20/04, Amstutz) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 Hi Alan I spoke today with my OS and he demonstrated to me the Trendelenburg position and explained the mechanics of it. I then checked it up – see below the most succinct and simple explanation: Trendelenburg's symptom Also known as: Duchenne-Trendelenburg phenomenon Trendelenburg’s test Associated persons: Guillaume http://www.whonamedit.com/doctor.cfm/950.html> Amand Duchenne de Boulogne Friedrich Trendelenburg http://www.whonamedit.com/doctor.cfm/976.html> 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. * +44 (0)7974 981-407 * +44 (0)20 8501-2573 @ dan.milosevic@... _____ From: Alan Ray Sent: 28 April 2004 01:47 To: surfacehippy Subject: Trendelenberg Yo, Hippies... Has any among you gone into resurf with a condition called Trendelenberg gait? Does resurf help or matter in eliminating it? Thanks... Alan _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 Hi Alan See the following explanation for the Trendelenburg Gait (if you surf the net make sure you spell it with “u†as “burg†not “bergâ€): TRENDELENBURG GAIT * 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 centre 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. http://www.echo.uqam.ca/mednet/anglais/hermes_a/hip/part_2.html#Fig143#Fig143> 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). By the way check this link as it has very simple and self-explanatory drawings of the body positions in various gaits (these appear further down after the Trendelenburg Test explanation: http://www.echo.uqam.ca/mednet/anglais/hermes_a/hip/part_2.html#Answer_06_01 Hope this is of use to you. Regards Dan * +44 (0)7974 981-407 * +44 (0)20 8501-2573 @ dan.milosevic@... _____ From: Alan Ray Sent: 28 April 2004 01:47 To: surfacehippy Subject: Trendelenberg Yo, Hippies... Has any among you gone into resurf with a condition called Trendelenberg gait? Does resurf help or matter in eliminating it? Thanks... Alan _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 Hi Alan One more reference about Trendelenburg Gait: Abductor lurch or Trendelenburg gait is observed with hip disease. The trunk swings over the affected leg on the ground (stance phase). If the condition is bilateral, the trunk swings from side to side. The cause is weakness of the hip abductors (eg, gluteus medius) responsible for keeping the pelvis level during the swing phase. It may become weak if the hip is chronically affected. A child with Legg-Calve-Perthes disease or a slipped capital femoral epiphysis may present with this type gait, particularly if the condition has been chronic. Regards Dan * +44 (0)7974 981-407 * +44 (0)20 8501-2573 @ dan.milosevic@... _____ From: Alan Ray Sent: 28 April 2004 01:47 To: surfacehippy Subject: Trendelenberg Yo, Hippies... Has any among you gone into resurf with a condition called Trendelenberg gait? Does resurf help or matter in eliminating it? Thanks... Alan _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 > Hi Alan > > One more reference about Trendelenburg Gait: > > Abductor lurch or Trendelenburg gait is observed with hip disease. The trunk swings over the affected leg on the ground (stance phase). If the condition is bilateral, the trunk swings from side to side. The cause is weakness of the hip abductors (eg, gluteus medius) responsible for keeping the pelvis level during the swing phase. ***Dan... Thanks... There truly are times when the obvious takes a bit longer to figure out. My sports med doc misspelled Trendelburg on the diagnostic notes he gave me. The descriptions you found for mechanics and cause give me even a bit more encouragement. My hip problem (until about a month ago) had always been in flexors and glutes. I never had pain in the joint itself, always in the glutes and outer quad along the IT band. It happened when I started to swing at a handball shot with the left hand, planted the left foot, swung through to send the ball to the right front corner...and the left footed locked in some water on the wood court floor. My whole body...except for the left foot torqued with considerable force about 110 to the right. The flexors snapped. I've been left with chronic weakness and swelling in the flexors and the abductor. A second " read " of my x-rays by a physical therapist and sports trainer suggest some OA, and some accretion of bone mass in the areas where flexors attach to the acetabulum and trochanter. But they he didn't see " end-stage " OA. I'm in for a consultation with Dr. Amstutz in LA on Monday. I'm going to hold hope that, as much as he knows about hips, he may be a less severe solution for mine than resurfacing or THR. Thanks for your research...and for recognizing the obvious when I didn't All the best.. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 > Hi Alan > > One more reference about Trendelenburg Gait: > > Abductor lurch or Trendelenburg gait is observed with hip disease. The trunk swings over the affected leg on the ground (stance phase). If the condition is bilateral, the trunk swings from side to side. The cause is weakness of the hip abductors (eg, gluteus medius) responsible for keeping the pelvis level during the swing phase. ***Dan... Thanks... There truly are times when the obvious takes a bit longer to figure out. My sports med doc misspelled Trendelburg on the diagnostic notes he gave me. The descriptions you found for mechanics and cause give me even a bit more encouragement. My hip problem (until about a month ago) had always been in flexors and glutes. I never had pain in the joint itself, always in the glutes and outer quad along the IT band. It happened when I started to swing at a handball shot with the left hand, planted the left foot, swung through to send the ball to the right front corner...and the left footed locked in some water on the wood court floor. My whole body...except for the left foot torqued with considerable force about 110 to the right. The flexors snapped. I've been left with chronic weakness and swelling in the flexors and the abductor. A second " read " of my x-rays by a physical therapist and sports trainer suggest some OA, and some accretion of bone mass in the areas where flexors attach to the acetabulum and trochanter. But they he didn't see " end-stage " OA. I'm in for a consultation with Dr. Amstutz in LA on Monday. I'm going to hold hope that, as much as he knows about hips, he may be a less severe solution for mine than resurfacing or THR. Thanks for your research...and for recognizing the obvious when I didn't All the best.. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2004 Report Share Posted April 29, 2004 Hi Alan, That sounds like a very nasty accident indeed......... Sadly once the support structure of the hip gets damaged/is lacking for any reason it seems that the result is friction between the bones and arthritis follows at some point............... Lets hope you are still back at the stage where something more can be done for the support muscles to take the pressure off the joint itself............and therefore the need for any form of prothesis............. I still have that gait after a resurface because I had no muscles left working after years of a fused hip........... so just the prothesis alone will not make the gait go away...........and will still leave potential hassles with the spine.......... which also takes great exception to being used this way........... Best of luck, Edith LBHR Dr. L Walter Syd Aust 8/02 > ***Dan... > Thanks... There truly are times when the obvious takes a bit longer > to figure out. My sports med doc misspelled Trendelburg on the > diagnostic notes he gave me. The descriptions you found for > mechanics and cause give me even a bit more encouragement. My hip > problem (until about a month ago) had always been in flexors and > glutes. I never had pain in the joint itself, always in the glutes > and outer quad along the IT band. It happened when I started to > swing at a handball shot with the left hand, planted the left foot, > swung through to send the ball to the right front corner...and the > left footed locked in some water on the wood court floor. My whole > body...except for the left foot torqued with considerable force about > 110 to the right. The flexors snapped. I've been left with chronic > weakness and swelling in the flexors and the abductor. > > A second " read " of my x-rays by a physical therapist and sports > trainer suggest some OA, and some accretion of bone mass in the areas > where flexors attach to the acetabulum and trochanter. But they he > didn't see " end-stage " OA. > > I'm in for a consultation with Dr. Amstutz in LA on Monday. I'm > going to hold hope that, as much as he knows about hips, he may be a > less severe solution for mine than resurfacing or THR. > > Thanks for your research...and for recognizing the obvious when I > didn't > > All the best.. > Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2004 Report Share Posted April 30, 2004 Edith... It was a pretty nasty turn. Actually the I-T band snapped over the trochanter and back into place. They told me at first that I'd never play handball again. Proved 'em wrong for almost 8 years. Now...I'd like to do it again. I have the advantage of being a gym-rat... Three days a week in the weightroom...three days of handball (up until about a month ago; now, on what would have been the handball days, I ride the Stairmaster for 20 to 30 minutes (though sometimes the pain makes me stop at ten minutes.) I'm hoping Dr. Amstutz would be willing to tell me that I don't need more than arthoscopy...if that's the case. I get concerned at times that surgeons get so wedded to their procedures that they can't admit when they're not needed. We shall see. Monday's the consultation day. I'll be in touch. Alan -- In surfacehippy , " ecrow " wrote: > Hi Alan, > > That sounds like a very nasty accident indeed......... Sadly once the > support structure of the hip gets damaged/is lacking for any reason it seems > that the result is friction between the bones and arthritis follows at some > point............... Lets hope you are still back at the stage where > something more can be done for the support muscles to take the pressure off > the joint itself............and therefore the need for any form of > prothesis............. > > I still have that gait after a resurface because I had no muscles left > working after years of a fused hip........... so just the prothesis alone > will not make the gait go away...........and will still leave potential > hassles with the spine.......... which also takes great exception to being > used this way........... > > Best of luck, > > Edith LBHR Dr. L Walter Syd Aust 8/02 > > > > ***Dan... > > Thanks... There truly are times when the obvious takes a bit longer > > to figure out. My sports med doc misspelled Trendelburg on the > > diagnostic notes he gave me. The descriptions you found for > > mechanics and cause give me even a bit more encouragement. My hip > > problem (until about a month ago) had always been in flexors and > > glutes. I never had pain in the joint itself, always in the glutes > > and outer quad along the IT band. It happened when I started to > > swing at a handball shot with the left hand, planted the left foot, > > swung through to send the ball to the right front corner...and the > > left footed locked in some water on the wood court floor. My whole > > body...except for the left foot torqued with considerable force about > > 110 to the right. The flexors snapped. I've been left with chronic > > weakness and swelling in the flexors and the abductor. > > > > A second " read " of my x-rays by a physical therapist and sports > > trainer suggest some OA, and some accretion of bone mass in the areas > > where flexors attach to the acetabulum and trochanter. But they he > > didn't see " end-stage " OA. > > > > I'm in for a consultation with Dr. Amstutz in LA on Monday. I'm > > going to hold hope that, as much as he knows about hips, he may be a > > less severe solution for mine than resurfacing or THR. > > > > Thanks for your research...and for recognizing the obvious when I > > didn't > > > > All the best.. > > Alan Quote Link to comment Share on other sites More sharing options...
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