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1. Trendelenburg Sign and Gait
- Definition: A clinical test and walking pattern associated with weakness or paralysis of the hip abductors (gluteus medius and minimus).
- Causes:
- Superior gluteal nerve injury
- Hip joint pathology (e.g., osteoarthritis, hip dislocation)
- Muscle wasting from prolonged immobilization
- Testing: Observe pelvic drop on the unsupported side when the patient stands on one leg.
2. Anatomy of the Hip Joint
- Structure: Ball-and-socket joint formed by the acetabulum (pelvis) and femoral head.
- Movements: Includes flexion, extension, abduction, adduction, rotation, and circumduction.
- Stabilizers:
- Ligaments (e.g., iliofemoral, ischiofemoral, pubofemoral)
- Muscles, especially the abductors and rotators.
3. Superior Gluteal Nerve
- Course and Distribution:
- Exits the pelvis via the greater sciatic foramen above the piriformis.
- Supplies gluteus medius, gluteus minimus, and tensor fasciae latae.
- Injury Causes:
- Direct trauma (e.g., stab wound to the buttock)
- Iatrogenic during surgeries like hip replacements.
- Clinical Features: Trendelenburg sign, weakness in abduction, and muscle atrophy.
4. Biomechanics of Gait
- Phases of Gait Cycle: Stance phase and swing phase.
- Role of Hip Abductors: Prevent pelvic drop during the stance phase, allowing smooth forward motion.
- Abnormal Gait Patterns: Waddling gait (bilateral abductor weakness) and Trendelenburg gait.
5. Rehabilitation for Hip Abductor Weakness
- Exercises:
- Side-lying leg lifts
- Clamshells
- Resistance band exercises for glute strengthening
- Functional Training: Gait retraining, balance exercises, and pelvic stabilization.
6. Conditions Affecting Hip Abduction
- Superior Gluteal Nerve Palsy
- Polio or muscular dystrophy
- Femoral neck fractures or hip dislocations
- Trochanteric bursitis: Pain over the greater trochanter may limit abduction.
