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Anatomy

Lower Limb

Question 22 of 180

A 32 year old builder is brought to the ED after falling through a glass sky light onto the floor below. A primary survey has been performed and the patient is stable enough to undergo imaging. Imaging shows multiple injuries including a transection of the nerve supplying the adductor longus and brevis muscles. Which nerve has been injured:

Answer:

The adductor muscles are innervated by the obturator nerve, except for the hamstrings portion of the adductor magnus innervated by the sciatic nerve (tibial division).

Medial Thigh Muscles

There are five muscles in the medial compartment of the thigh (adductor longus, adductor brevis, adductor magnus, obturator externus, gracilis), which collectively adduct the thigh at the hip joint.

Table: Function and Innervation of the Medial Thigh Muscles

Muscle Function Innervation
Adductor longus Adduction and medial rotation at hip Obturator nerve
Adductor brevis Adduction at hip Obturator nerve
Adductor magnus Adduction and medial rotation at hip Adductor part: Obturator nerve

Hamstring part: Sciatic nerve (tibial division)

Obturator externus Lateral rotation at hip Obturator nerve
Gracilis Adduction at hip and flexion at knee Obturator nerve

Innervation

These muscles are all innervated by the obturator nerve (except for the hamstrings portion of the adductor magnus, innervated by the tibial division of the sciatic nerve).

Function

The adductor longus, brevis, and magnus are the prime adductors of the thigh at the hip joint and also assist in medial rotation.

The obturator externus muscle acts to laterally rotate the thigh at the hip joint.

The gracilis adducts the thigh at the hip joint and flexes the leg at the knee joint.

Testing of the medial thigh muscles can be performed with the patient lying supine and the knee straight. The patient is asked to adduct the thigh against resistance and the strength assessed (if the adductors are normal the proximal ends of the gracilis and adductor longus can easily be palpated).

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Medial Thigh Muscles: Obturator Externus (yellow), Adductor Longus (red), Adductor Brevis (green), Adductor Magnus (blue). (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Gracilis Muscle. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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