[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) › Trendelenburg sign and gait [Clinical exam](https://durgical.com/en/clinical-exam/) · [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) # 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](https://durgical.com/en/anatomy/gluteus-medius-muscle/) · [Gluteus minimus](https://durgical.com/en/anatomy/gluteus-minimus-muscle/) · [Gluteus medius tendon](https://durgical.com/en/anatomy/tendon-of-gluteus-medius/) · [Hip bone](https://durgical.com/en/anatomy/hip-bone/) · [Femur](https://durgical.com/en/anatomy/femur/) ## Key points - Positive: when standing on one leg, the pelvis drops on the side of the lifted leg; the weak muscle belongs to the standing leg. - Muscles: gluteus medius and gluteus minimus, supplied by the superior gluteal nerve (L4 to S1). - Compensated gait: the trunk leans over the affected leg at each step to unload the abductors. - Bilateral: waddling gait (myopathies such as Duchenne dystrophy, bilateral hip dislocation). - Causes: hip osteoarthritis, dysplasia, Perthes, slipped epiphysis, superior gluteal nerve injury, gluteal tendon tear and L5 radiculopathy. ## 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. ## Memory aid In Trendelenburg the hip that sags is the sound one: blame the leg you stand on. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/trendelenburg-sign-and-gait/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Gluteus medius](https://durgical.com/en/anatomy/gluteus-medius-muscle/) - [Gluteus minimus](https://durgical.com/en/anatomy/gluteus-minimus-muscle/) - [Gluteus medius tendon](https://durgical.com/en/anatomy/tendon-of-gluteus-medius/) - [Hip bone](https://durgical.com/en/anatomy/hip-bone/) - [Femur](https://durgical.com/en/anatomy/femur/) ## Related - [Inspection of gait and posture (orthopedic)](https://durgical.com/en/clinical-exam/inspection-of-gait-and-posture/) - [Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling](https://durgical.com/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/) - [FABER (Patrick) and FADIR tests](https://durgical.com/en/clinical-exam/faber-and-fadir-tests/) - [Ortolani and Barlow maneuvers](https://durgical.com/en/clinical-exam/ortolani-and-barlow-maneuvers/) - [Motor examination: bulk, tone and strength grading](https://durgical.com/en/clinical-exam/motor-examination-bulk-tone-and-strength-grading/) ## Related conditions - [Hip Osteoarthritis](https://durgical.com/en/conditions/hip-osteoarthritis/) - [Developmental dysplasia of the hip](https://durgical.com/en/conditions/developmental-dysplasia-of-the-hip/) - [Legg-Calvé-Perthes disease](https://durgical.com/en/conditions/legg-calve-perthes-disease/) - [Slipped capital femoral epiphysis](https://durgical.com/en/conditions/slipped-capital-femoral-epiphysis/) - [Duchenne muscular dystrophy](https://durgical.com/en/conditions/duchenne-muscular-dystrophy/) [← All of the clinical exam](https://durgical.com/en/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](https://aafp.org/pubs/afp/issues/2014/0101/p34a.html) (American Family Physician (American Academy of Family Physicians), 2014). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/trendelenburg-sign-and-gait/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/trendelenburg-sign-and-gait/