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pain in right hip on trendelenberg test

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Right hip pain associated with a positive Trendelenburg test usually points to hip abductor dysfunction on the stance side (the side you stand on during the test), most often:
  1. Gluteus medius/minimus tendinopathy or tear (very common)
  2. Superior gluteal nerve weakness/injury
  3. Hip joint pathology causing pain-inhibited abductor weakness (OA, inflammation)
  4. Less commonly: structural causes (coxa vara, post-THA abductor insufficiency)

How to interpret your finding

  • In Trendelenburg, if standing on the right leg causes the pelvis to drop on the left, that is a positive right Trendelenburg and suggests right abductor insufficiency.
  • If your main symptom is lateral hip pain, think greater trochanteric pain syndrome (often gluteal tendinopathy ± trochanteric bursitis).

Helpful next exam steps

  • Palpation over greater trochanter
  • Single-leg stance pain reproduction
  • Resisted hip abduction strength test
  • Check gait for Trendelenburg lurch

When to get imaging

  • Persistent pain >6 to 12 weeks, marked weakness, or failed conservative treatment:
    • X-ray first (OA, bony causes)
    • Ultrasound or MRI for gluteal tendon tear/tendinopathy

Initial management (typical)

  • Activity modification (avoid prolonged single-leg loading, side-lying on painful side)
  • Hip abductor strengthening, pelvic stability PT
  • NSAIDs/topical NSAIDs if appropriate
  • Consider guided injection in selected cases
  • Tendon tears with significant weakness may need orthopedic referral
If you want, I can help you narrow this to the most likely cause based on where exactly the pain is (groin vs lateral vs buttock), age, gait pattern, and any trauma history.
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