Trendelenburg sign and gait !

Sign

When a person stands on one leg and the hip on the other side drops, the gluteus medius of the standing leg is weak.

Updated 2026-11-01

See it in 3D: Gluteus medius · Gluteus minimus · Gluteus medius tendon · Hip bone · Femur

What it is

The Trendelenburg sign tests the hip abductors, mainly the gluteus medius. When standing on one leg, these muscles keep the pelvis level; if they fail, the pelvis drops toward the side of the lifted leg. In walking it causes a typical limp, seen in hip osteoarthritis, dysplasia, Perthes disease, superior gluteal nerve injury and myopathies.

The anatomy it tests

Gluteus medius and minimus run from the outer surface of the ilium to the greater trochanter of the femur and are the main hip abductors.
When standing on one leg, they contract to hold up the opposite, unsupported side of the pelvis.
They are supplied by the superior gluteal nerve, with fibres from the L4, L5 and S1 roots.
If the lever arm is short (dislocated hip, short femoral neck) the abductors work at a disadvantage even when healthy.

How to elicit it

Patient standing barefoot with the pelvis exposed; the examiner stands behind with hands or eyes on the iliac crests.
Ask the patient to lift one foot off the floor by bending the knee, without leaning; a fingertip on the wall for balance is allowed.
Hold single-leg stance for about 30 seconds and watch the height of both iliac crests.
Normal: the pelvis on the side of the lifted leg stays level or rises slightly.
Positive: the pelvis drops on the side of the lifted leg, or the patient leans the trunk over the standing leg to stay up.
Repeat standing on the other leg and compare both sides.
Watch the gait: the pelvis dropping on the swing side or the trunk leaning over the standing leg at each step.

What a positive result means

Positive standing on the right leg (left pelvis drops): weak or inhibited right hip abductors.
Joint causes: hip osteoarthritis, developmental dysplasia, Perthes disease and slipped capital femoral epiphysis in children and teenagers.
Nerve causes: superior gluteal nerve injury (hip surgery, misplaced gluteal injections), L5 radiculopathy, poliomyelitis.
Muscle causes: tear or tendinopathy of gluteus medius and minimus, muscular dystrophies.
A negative sign does not rule out mild weakness: trunk compensation can hide it.

Usefulness and limits

Mild weakness or poor balance can give false positives; the sign is read with abduction strength and gait.
The sign points the way but is not a diagnosis: the cause is found with the hip exam, the neurological exam and imaging.

Test yourself

Think of the answer, then tap the question to see it.

If the right side of the pelvis drops while standing on the left leg, which muscle is weak?

The left gluteus medius (and minimus), on the standing leg.

Which nerve supplies the gluteus medius?

The superior gluteal nerve, with fibres from the L4, L5 and S1 roots.

What is a compensated Trendelenburg gait?

Leaning the trunk over the affected leg at each step, which brings the centre of gravity over the hip and unloads the weak abductors.

What does a bilateral Trendelenburg gait suggest in a child?

A waddling gait, as in muscular dystrophies (for example Duchenne) or bilateral hip dislocation.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: eTable A. Differential Diagnosis of Hip Pain (American Family Physician (American Academy of Family Physicians), 2014).

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Representative model, for educational purposes only.