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The Trendelenburg test can actually refer to two different medical examinations: one is given to determine any incompetency of valves in varicose veins, while the other is given to patients to evaluate the performance of hip joints. In this way, the test has different purposes for the musculoskeletal and the circulatory systems. In either cases, the Trendelenburg test can be done independently or with other medical tests to assess the wellness of a patient or the advancement of a present illness. The name of the test was in honor of Friedrick Trendelenburg, an accomplished German surgeon in the 19th century who introduced many surgical techniques and mentored several surgeons as well.
For varicose veins, the first step in the Trendelenburg test involves having the patient lie down on his back and instructing him to lift up the leg where the varicose veins are located. This is to empty the veins of the blood flowing into it. The physician or examiner will then put a tourniquet, a tool that helps stop blood flow, around the upper thigh. Once the tourniquet is in place, the patient is requested to stand up, and the physician will then observe the refilling of blood in the veins.
Under normal conditions, the emptied veins will be filled with blood from the bottom up in around 30 seconds, as the tourniquet only slows down the filling and doesn't block it. If the veins have not been filled before or after 30 seconds, or if the veins are filled from above, some vein openings or valves may be incompetent. A rapid and sudden blood flow into the veins after the tourniquet is removed may also be diagnosed as valve incompetence. The Trendelenburg test may be repeated in different areas until the blocked or twisted vein is determined.
If the Trendelenburg test is meant to examine the hips, the first step for the patient is to stand or balance himself on one leg without any assistance, while the examiner places his fingers on the anterior superior iliac spine located just above the buttocks. In some cases, the examiner only observes from behind and does not touch the patient. To lift one leg, the patient should flex his knee, so that the weight is fully supported by the hips and not by the upper thigh. The patient can be asked to hold the position for 30 seconds, or lift one leg in different angles.
A patient may have some hip problems if he is leaning too much towards the leg he is standing on, or if the hip in which the lifted leg is connected drops lower than the other side. Similar diagnosis may also be established if the patient cannot hold the position for 30 seconds. Diagnosis can range from skeletal misalignment, muscle weakness on the hip area, or even a type of neurological disorder that prohibits a person from balancing himself.