Trendelenburg test

The Trendelenburg test is used to assess hip abductor strength, specifically gluteus medius and gluteus minimus function.A positive Trendelenburg sign may indicate hip dysfunction such as:

• Weakness of gluteus medius/minimus

• Hip subluxation or instability

• Hip osteoarthritis (OA)

• Postoperative weakness after total hip arthroplasty (THA)

• Superior gluteal nerve palsy

• Legg-Calvé-Perthes disease

• Congenital hip dysplasia [1][2][5][8][9]

Clinical Anatomy

The gluteus medius and gluteus minimus are the primary hip abductors that:

• Stabilize the pelvis during single-leg stance.

• Prevent pelvic drop on the contralateral side during gait.

• Are innervated by the superior gluteal nerve (L4–S1).

Weakness of these muscles may result in:

• Trendelenburg gait → pelvic drop on the opposite side, hip adduction, and compensatory trunk lean toward the stance leg.

Test Procedure

Patient position

• Patient stands upright, may hold support for balance if needed.

Execution

1. Patient lifts one leg off the ground, balancing on the tested leg for 30 seconds.

2. Examiner observes pelvic alignment.

Interpretation

• Normal test: Pelvis remains level.

• Positive test: Pelvis drops on the non–weight-bearing side → hip abductor weakness on stance side.

Clinical Interpretation

• A positive Trendelenburg test indicates hip abductor weakness on the weight-bearing side.

• A negative test indicates sufficient hip abductor strength.

Trendelenburg gait (seen in severe cases):

• Pelvic drop on swing side.

• Compensatory trunk lean toward stance leg.

Differential Diagnosis

A positive Trendelenburg test can be due to:

• Gluteus medius/minimus weakness

• Hip osteoarthritis

• Superior gluteal nerve palsy

• Hip instability (post-THA, dysplasia)

• Neurological disorders affecting hip abduction [5][7][8][9]

Diagnostic Validity

Parameter	Sensitivity	Specificity
Hip OA	55%	70%
Hip instability	Moderate	Moderate
Inter-rater reliability	Good	Good

• Test alone is not diagnostic for specific hip pathology [8].

• Should be combined with other assessments (e.g., handheld dynamometry, gait analysis) [13].

Clinical Relevance

• Quick and simple screening test for hip abductor weakness.

• Commonly used post-THA to assess abductor integrity.

• Should not be used in isolation but can help guide further diagnostic imaging or functional testing.

Conclusion

The Trendelenburg test is a simple clinical tool for detecting hip abductor weakness. A positive test indicates gluteus medius/minimus dysfunction, but due to limited specificity, it should always be combined with other clinical tests and patient history.

Sources:

1. Hardcastle PH, Nade SY. The significance of the Trendelenburg test. The Journal of bone and joint surgery. British volume. 1985 Nov;67(5):741-6.

2. Macnicol MF, Makris D. Distal transfer of the greater trochanter. The Journal of bone and joint surgery. British volume. 1991 Sep;73(5):838-41.

3. Krishnan S, Nicholls SC. Chronic venous insufficiency: clinical assessment and patient selection. InSeminars in Interventional Radiology 2005 Sep (Vol. 22, No. 03, pp. 169-177). Copyright© 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA..

4.  Rang M. Anthology of orthopaedics. Edinburgh. E&S Livingstone, 1966; 139-43. [1]

5. Windhager RE, Pongracz NI, Schonecker WO, Kotz RA. Chiari osteotomy for congenital dislocation and subluxation of the hip. Results after 20 to 34 years follow-up. The Journal of bone and joint surgery. British volume. 1991 Nov;73(6):890-5.

6. Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.

7. Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.

8.  Youdas JW, Madson TJ, Hollman JH. Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis. Physiotherapy theory and practice. 2010 Jan 1;26(3):184-94.

9.  Odak S, Ivory J. Management of abductor mechanism deficiency following total hip replacement. The bone & joint journal. 2013 Mar;95(3):343-7.

10. Roussel NA, Nijs J, Truijen S, Smeuninx L, Stassijns G. Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. Journal of manipulative and physiological therapeutics. 2007 May 1;30(4):270-8.

11.  Kline PW, Christiansen CL, Judd DL, Mañago MM. Clinical utility of the Trendelenburg Test in people with multiple sclerosis. Physiotherapy theory and practice. 2023 May 4;39(5):1016-23.

12. McCarney L, Andrews A, Henry P, Fazalbhoy A, Selva Raj I, Lythgo N, Kendall JC. Determining Trendelenburg test validity and reliability using 3-dimensional motion analysis and muscle dynamometry. Chiropractic & Manual Therapies. 2020 Dec;28:1-0.

13.  Grimaldi A. Assessing lateral stability of the hip and pelvis. Manual therapy. 2011 Feb 1;16(1):26-32.