Trendelenburg gait, named after

Friedrich Trendelenburg Friedrich Trendelenburg (; 24 May 184415 December 1924) was a German surgeon. He was son of the philosophy, philosopher Friedrich Adolf Trendelenburg, father of the pharmacology, pharmacologist Paul Trendelenburg and grandfather of the pharmaco ...

, is an abnormal

gait Gait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency. Di ...

. It is caused by weakness or ineffective action of the

gluteus medius muscle The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeuros ...

and the

gluteus minimus muscle The gluteus minimus, or glutæus minimus, the smallest of the three gluteal muscles, is situated immediately beneath the gluteus medius. Structure It is fan-shaped, arising from the outer surface of the ilium, between the anterior and infe ...

. 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 The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed lateral and medially and slightly posterior. In the adult it is about 2–4 cm lower than the femoral head.Stan ...

of the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...

, 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 allow the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle. When the hip abductor muscles (gluteus medius and minimus) are weak or ineffective, the stabilizing effect of these muscles during gait is lost. When standing on the right leg, if the left hip drops, it is a positive ''right'' Trendelenburg sign (the opposite side drops because the hip abductors on the right side do not stabilize the pelvis to prevent the droop). 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 Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

of the

lower limb The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb ext ...

, the

and the

. * Damage to the motor nerve supply of the lateral gluteal muscles (gluteus medius muscle and gluteus minimus muscle) **

Polio Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe s ...

involving L5 (foot drop may also be seen because L5 innervates the

tibialis anterior muscle The tibialis anterior muscle is a muscle in humans that originates along the upper two-thirds of the lateral (outside) surface of the tibia and inserts into the medial cuneiform and first metatarsal bones of the foot. It acts to dorsiflex and inve ...

). ** Damage to the superior gluteal nerve. * Temporary or permanent weakness of the lateral glutei ** Tendinitis. ** Penetrating injury. ** Infection, abscess – blood borne, post-traumatic or post-surgical. * Ineffective action (insufficient leverage) of the lateral glutei ** Greater trochanteric avulsion. ** Fracture, (or non-union) of the femoral neck. **

Coxa Vara Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It may be congenital and is commonly cau ...

(the angle between the femoral neck head and shaft is less than 120 degrees). * Damage to the hip joint (fulcrum) - Chronic or Developmental Hip Dislocation/Dysplasia ** Osteonecrosis. ** Legg-Calve-Perthes disease. ** developmental dysplasia. ** chronic infection. ** uncorrected traumatic dislocation.

Treatment

Treatment is directed at the underlying cause. In addition,

biofeedback Biofeedback is the process of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate t ...

and

physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

are used to strengthen the muscles.

History

Trendelenburg gait was first described by

in 1895.

References

* Wheeless' textbook of orthopaedic

* Ropper and Brown, ''Adams and Victor's Principles of Neurology'', 8th edition (2005), p. 105

External links