Trendelenburg gait

The Trendelenburg gait, named after Friedrich Trendelenburg, is an abnormal gait (as with walking) caused by weakness or ineffective action of the abductor muscles of the lower limb, gluteus medius and gluteus minimus.

Trendelenburg gait
Other namesGluteus medius lurch
SpecialtyNeurology

Gandbhir and Rayi point out[1] 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.

Causes
  • Damage to the motor nerve supply of the lateral glutei (Gluteus medius and Minimus)
    • Poliomyelitis involving L5 or L5 radiculopathy (foot drop may also be seen because L5 innervates the Tibialis anterior).
    • 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 (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.

Description of Gait

During the stance phase, or when standing on one leg, the weakened abductor muscles allow the pelvis 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.

Thus, 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.[2]

Treatment

Treatment is directed at the underlying cause. In addition, Biofeedback and physical therapy are used to strengthen the muscles.[3]

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See also

References
  1. Viraj N. Gandbhir; Appaji Rayi. Trendelenburg gait. https://www.ncbi.nlm.nih.gov/books/NBK541094/ Accessed June 4 2020.
  2. "Gait Analysis". Retrieved 6 May 2012.
  3. Petrofsky JS (September 2001). "The use of electromyogram biofeedback to reduce Trendelenburg gait". Eur. J. Appl. Physiol. 85 (5): 491–5. doi:10.1007/s004210100466. PMID 11606020. Archived from the original on 2013-02-12.
  • Wheeless' textbook of orthopaedics
  • Ropper and Brown, Adams and Victor's Principles of Neurology, 8th edition (2005), p. 105
Classification
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