Trendelenburg gait
Trendelenburg gait, first described by Friedrich Trendelenburg in 1895, is an abnormal human gait caused by an inability to maintain the pelvis level while standing on one leg. It is caused by weakness or ineffective action of the gluteus medius and gluteus minimus muscles.
Gandbhir and Rayi point out that the biomechanical action involved comprises a class 3 lever, where the lower limb's weight is the load, the hip joint is the fulcrum, and the lateral glutei, which attach to the antero-lateral surface of the greater trochanter of the femur, provide the effort. The causes can thus be categorized systematically as failures of this lever system at various points.
Signs and symptoms
During the stance phase, or when standing on one leg, the weakened abductor muscles on the side of the supporting leg allow the opposite hip to droop. To compensate, the trunk lurches to the weakened side to maintain the center of gravity over the supporting leg. This produces a characteristic "waddling" gait.Trendelenburg gait may be bilateral or unilateral. If, when standing on the right leg, the left hip drops, it is a positive right Trendelenburg sign. When the patient walks, if he swings his body to the right to compensate for left hip drop, he will present with a compensated Trendelenburg gait. The patient exhibits an excessive lean in which the upper body is thrust to the right to keep the center of gravity over the stance leg.
Causes
Trendelenburg gait is caused by weakness or ineffective action of the abductor muscles of the lower limb, the gluteus medius muscle and the gluteus minimus muscle.- Damage to the motor nerve supply of the lateral gluteal muscles
- * Polio involving Lumbar spinal [nerve 5|L5]
- * Damage to the superior gluteal nerve
- Temporary or permanent weakness of the lateral glutei
- * Tendinitis
- * Penetrating trauma
- * Infection, abscess - bloodborne, post-traumatic or post-surgical
- Ineffective action of the lateral glutei
- * Greater trochanteric avulsion injury
- * Fracture or non-union of the femoral neck
- * Coxa vara
- Damage to the hip joint ; chronic or developmental hip dislocation/dysplasia
- * Avascular necrosis
- * Legg–Calvé–Perthes disease
- * Developmental dysplasia
- * Chronic infection
- * Uncorrected traumatic dislocation