Trendelenburg test+gait+normal range of movement

Trendelenburg test:

Tell patient to stand up, and then alternatively stand on one leg and then the other. In normal cases the non weight bearing hip rises up due to normal abductor muscle strength (gluteus medius, gluteus minimus primarily, also tensor fascia lata), but if the abductors are weak the non weight bearing hip sags – trendelenburg positive test, inhibition from hip pain (such as osteoarthritis) or structural deformity of the hip joint (e.g coxa vara) also causes a positive result.

Types of gait:

Antalgic gait – is one which is altered to reduce pain. Painful conditions are aggrevated by weight bearing so the patient minimises time spend in the stance phase, on the injured/affected limb, resulting in a “dot-dash” mode of walking.

Trendelenburg gait – marked by the dropping of the pelvis on the unaffected limb at the moment of the heel strike on the affected limb. The pelvic drop during the walking cycle lasts until heel-strike on the unaffected limb, and has with it sideways movement of the entire trunk, and the affected limb. Common causes: hip abductor weakness, structural hip joint problems, painful hip joint problems (osteoarthritis).

Normal range of movement of the lower limb (according to study guide):

Medial & lateral rotation – 45 degrees

Abduction – 50 degrees

Adduction – 45 degrees

Flexion – 90-120 degrees

Extension – 30 degrees

Jane’s case: abduction on the R limb reduced (less compared to L (normal) limb) can be due to muscle weakness (the gluts), nerve damage, pain restrictions (osteoarthritis).

Rotations were painful and restricted on the R limb can be due to problems in the hip joint (arthritis), nerve damage/injury, muscle injury/damage/weakness of respective rotational movements, fracture.

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~ by pcl4 on September 11, 2008.

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