March in Trendelenburg

Specialty: Musculoskeletal.

• hip swing gait
• gluteus medius incompetence
• unilateral duck march

Why it occurs

• Weakness or paralysis of the ipsilateral gluteus medius and minimus muscle
• Injury of the superior gluteal nerve (post-surgical iatrogenesis in lateral hip approaches or due to compression)
• Untreated congenital hip subluxation or dislocation
• Severe osteoarthritis of the hip with shortening of the femoral neck and mechanical dysfunction of the abductors
• Severe L5 compressive radiculopathy with motor denervation
• Girdle myopathies with bilateral proximal muscle involvement (bilateral Trendelenburg gait or duck gait)

Initial workup

Physical examination (Positive Trendelenburg sign when asking the patient to stand on one foot and observing that the pelvis on the contralateral side descends) | MRI of the affected hip (assesses the gluteus medius tendon and bursa) | Electromyography of the lower limbs (assesses the superior gluteal nerve and the L5 root).

Standard management

• There are no curative drugs for this biomechanical dysfunction — treatment is mainly physical therapy to strengthen the gluteus medius); in case of pain due to associated gluteal bursitis: Naproxen (500 mg every 12 hours orally
• Ultrasound-guided corticosteroid infiltration into the tendon and insertion of the gluteus medius.