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Trendelenburg Position

What Is It, Uses, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Emily Miao, PharmD

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is the Trendelenburg position?

The Trendelenburg position is a surgical position where the individual lies supine, or flat on their back, with their feet raised higher than their head. It was named after the German surgeon Friedrich Trendelenburg (1844-1924) who originally used this position to improve surgical access to the abdominal and pelvic organs by taking advantage of gravity. For many years, the Trendelenburg position was used in the treatment of hypovolemic shock to increase cardiac output and circulation to the heart as well as to improve blood flow to the vital organs. Due to its adverse effects, however, it is no longer recommended for this purpose in individuals with pre-existing cardiopulmonary disorders. 

What is the Trendelenburg position used for?

Currently, the Trendelenburg position is often used in lower abdominal surgeries, including colorectal, gynecological, and genitourinary procedures. In this position, gravity pulls the intra-abdominal organs away from the pelvis, allowing for better surgical access to the pelvic organs. In critical care settings, the Trendelenburg position is also used for the placement of a central venous catheter in the internal jugular or subclavian vein. Gravity causes blood to pool in the upper body, increasing the filling and distension of the upper central veins and making them easier to puncture. 

The Trendelenburg position can also increase intraocular and intracranial pressure. Therefore, it should be avoided in individuals with head injuries or known intracranial hypertension. In addition, prolonged Trendelenburg positioning may result in significant facial and upper airway edema, which may lead to airway compromise after extubation. Pulmonary function may also be affected as the movement of the abdominal organs towards the diaphragm can decrease lung expansion and lung volumes. Finally, the shoulder braces used to keep individuals from sliding off the operating table can lead to brachial plexus injuries, thereby causing damage to the nerves supplying the upper limbs. Nowadays, other products such as non-slip foam pads and safety belts may be used to keep individuals in the Trendelenburg position without shoulder support. 

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What is the modified Trendelenburg position?

The modified Trendelenburg position is when the individual laying flat on their back with their head level to their body and their legs are passively raised. This position is often used to help venous return to the heart and restore adequate brain perfusion in individuals with hypotension

On the other hand, in the reverse Trendelenburg position, the individual lies supine with their head raised higher than their feet. This position is used for laparoscopic surgeries including gallbladder, biliary tract, and stomach procedures as well as head and neck surgeries. 

What does a positive Trendelenburg sign mean?

Although they share the same name, the Trendelenburg sign has nothing to do with the Trendelenburg position

The Trendelenburg sign is a physical exam finding seen when assessing for any dysfunction of the hip. To test for this sign, the individual is asked to stand on one leg for 30 seconds without leaning to either side. A positive Trendelenburg’s sign is when the pelvis drops to the unsupported side instead of staying level or rising slightly. A positive Trendelenburg’s sign usually indicates weakness of the hip abductor muscles (e.g., gluteus medius and minimus) of the standing leg, but it can also be associated with various conditions affecting the hip (e.g., dislocation of the hip, Legg-Calve-Perthes disease, osteoarthritis of the hip). It may also occur with nervous lesions affecting the muscles of the hip, such as a superior gluteal nerve injury or iatrogenic injury to the upper medial gluteal region during an intramuscular injection. 

What are the most important facts to know about the Trendelenburg position?

The Trendelenburg position is a surgical position most often used during lower abdominal surgeries and central venous catheter placement. In Trendelenburg position, the individual lies supine, or flat on their back, on the operating table with their feet raised higher than their head

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Related links

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Resources for research and reference

Bridges, N., & Jarquin-Valdivia, A. A. (2005). Use of the Trendelenburg position as the resuscitation position: To T or not to T? American Journal of Critical Care, 14(5): 364–368. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16120887/

Duke, J. (2011). Patient Positioning. In Duke, J. (Ed.), Anesthesia Secrets (4th ed.). Elsevier. DOI: 10.1016/C2009-0-54968-9

Geerts, B. F., van den Bergh, L., Stijnen, T., Aarts, L. P., & Jansen, J. R. (2012). Comprehensive review: Is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia? Journal of Clinical Anesthesia, 24(8): 668–674. DOI: 10.1016/j.jclinane.2012.06.003

Gogu, S., & Gandbhir, V.N. (2020). Trendelenburg Sign. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK555987/

Halm, M. A. (2012). Trendelenburg Position: “Put to Bed” or Angled Toward Use in Your Unit? American Journal of Critical Care, 21(6): 449–452. DOI:10.4037/ajcc2012657 

Welch, M. B. (2021). Patient positioning for surgery and anesthesia in adults. In UpToDate. Retrieved January 12, 2022, from https://www.uptodate.com/contents/patient-positioning-for-surgery-and-anesthesia-in-adults