Trendelenburg Test – Examination of the Hip

The Trendelenburg Test is one of the most fundamental clinical assessments for evaluating hip abductor function. A positive finding indicates weakness or inhibition of the gluteus medius and minimus — muscles critical for single-leg stability and normal gait mechanics. The test is relevant across a wide range of patients, from post-surgical hip cases to athletes presenting with lateral hip pain, and understanding both the static sign and the dynamic gait pattern is essential for complete hip assessment.

Involved Structures

The primary structures assessed by the Trendelenburg Test are:

• Gluteus medius — the primary hip abductor and the main target of this test
• Gluteus minimus — secondary hip abductor, works in conjunction with gluteus medius
• Superior gluteal nerve (L4–L5–S1) — neurological compromise here produces classic Trendelenburg findings
• Tensor fascia latae — secondary stabilizer

The gluteus medius is the critical pelvic stabilizer during single-leg stance. During normal gait, it contracts eccentrically to prevent the contralateral pelvis from dropping during the stance phase. Weakness, pain inhibition, or neurological compromise of the superior gluteal nerve can all produce a positive Trendelenburg sign.

How to Perform the Trendelenburg Test

Starting position: Patient stands with weight evenly distributed, facing away from the examiner. Expose the iliac crests and posterior superior iliac spine (PSIS) for clear observation.

Test procedure:

1. Ask the patient to stand on the affected leg and lift the opposite foot 2–3 inches off the floor.
2. Maintain the hold for at least 30 seconds — shorter holds reduce sensitivity in borderline cases.
3. Observe the pelvis from behind: note whether the non-stance side drops, remains level, or rises.
4. Test bilaterally and compare.

Common errors to avoid:

• Allowing the patient to laterally shift their trunk — this is a compensatory strategy that masks a true positive
• Testing for fewer than 10 seconds — gluteus medius fatigue takes time to become apparent
• Failing to document bilateral findings for comparison

Positive Test

The test is positive when the pelvis drops on the non-stance side (contralateral pelvic drop) during single-leg stance on the affected limb. This indicates the ipsilateral hip abductors cannot maintain pelvic level against body weight.

Important distinction: Some patients compensate by leaning their trunk toward the stance side — this shifts the center of mass over the hip, reducing the mechanical demand on the abductors. This is called a compensatory Trendelenburg or abductor lurch. It is not the same as a true positive Trendelenburg sign, but it is equally significant clinically and should be documented separately.

Trendelenburg Sign vs. Trendelenburg Gait

These terms are related but describe different findings:

Trendelenburg sign is a static finding observed during the single-leg stance test. It is positive when the contralateral pelvis drops.

Trendelenburg gait is a dynamic finding observed during walking. The patient lurches laterally toward the affected stance limb with each step — compensating for inadequate hip abductor strength. This is also called an abductor lurch gait or compensated Trendelenburg.

A patient can display a Trendelenburg gait pattern without a positive static Trendelenburg sign, particularly if the compensatory strategy is well-established. Both findings should be assessed and documented independently.

Common Causes of a Positive Test

• Gluteus medius weakness (most common)
• Superior gluteal nerve palsy (L4–L5–S1)
• Pain inhibition from hip OA, greater trochanteric bursitis, or gluteal tendinopathy
• Post-surgical hip (total hip replacement, hip arthroscopy)
• Developmental dysplasia of the hip (DDH)
• Femoral neck fracture or avascular necrosis
• Neurological conditions including cerebral palsy and stroke

Accuracy of Test

The Trendelenburg Test has moderate diagnostic accuracy for hip abductor dysfunction.

Hardcastle and Nade (1985) evaluated the test in patients with hip pathology and reported sensitivity of approximately 55% and specificity of approximately 70%. More recent studies examining the test specifically for gluteus medius weakness report sensitivity ranging from 55–73% and specificity of 70–77%, depending on patient population and the threshold used to define a positive result.

Practical implications:

• The test is best used as a screening tool and as part of a clinical cluster — a negative result does not rule out hip abductor weakness
• Prolonged holds (30 seconds) improve sensitivity compared to brief tests
• Manual muscle testing for hip abductors should accompany the Trendelenburg Test for a complete picture

Video Demonstration

Related Hip Tests

• Ober’s Test: assesses IT band and TFL mobility alongside hip abductor strength findings
• Fingertip-to-Floor Test: screens lumbar mobility when hip and spine pathology overlap

See all common hip orthopedic tests.

Frequently Asked Questions

What does a positive Trendelenburg test indicate? A positive test indicates that the hip abductors on the stance side — primarily the gluteus medius — are weak, inhibited by pain, or neurologically compromised. It does not identify the cause; further assessment is needed to determine whether weakness is structural, pain-related, or neurological.

Can a patient have a Trendelenburg gait without a positive Trendelenburg test? Yes. The Trendelenburg gait (lateral trunk lurch toward the stance limb) is a compensatory strategy that reduces demand on the hip abductors. A patient with moderate weakness may walk with this pattern but still pass the static test by compensating effectively.

How long should the single-leg stance be held? At least 30 seconds. Shorter holds reduce sensitivity, particularly in patients with borderline weakness who only fatigue under sustained effort.

Is the Trendelenburg test accurate enough to use alone? No. With sensitivity of 55–73% and specificity of 70–77%, it is a useful screening tool but should not be used in isolation. Combine it with manual muscle testing, symptom history, and other hip assessment findings.

What is the difference between a Trendelenburg sign and a Trendelenburg lurch? The Trendelenburg sign is a contralateral pelvic drop during the test. A Trendelenburg lurch is an ipsilateral trunk lean toward the stance limb — a compensation to reduce the abductor load. Both are clinically meaningful but represent different findings.

>> Return to the list of Common Tests in Orthopaedic Examination of the Hip

Here are some other articles you may be interested in:

• Introduction to Osteoarthritis of the Knee
• Lachman Test for ACL Integrity
• Basic Anatomy of the Hip