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Anatomy

Lower Limb

Question 77 of 180

A 43 year old window cleaner is brought to the ED after falling from a 5 metre platform. Imaging has shown multiple vertebral fractures and you are concerned about possible neurological injuries including the obturator nerve. Which of the following muscles is NOT innervated by the obturator nerve:

Answer:

The obturator nerve innervates all of the muscles in the medial compartment of the thigh, except for the hamstrings portion of the adductor magnus muscle. The obturator internus muscle is a deep gluteal muscle innervated by the nerve to the obturator internus.

The obturator nerve arises from the lumbar plexus, formed from the anterior rami of L2 - L4.

Table: Anatomical Overview of the Obturator Nerve

Nerve Obturator
Nerve roots L2 – L4
Motor supply Medial thigh muscles (adductor longus, brevis and magnus, gracilis, obturator externus)
Sensory supply Upper medial thigh
Injury Motor Loss: Loss of hip adduction and difficulty walking with lateral swinging of limb (due to unopposed abduction)

Sensory Loss: Loss of sensation over upper medial thigh

Anatomical Course

The obturator nerve descends along the posterior abdominal wall, passes through the pelvic cavity and enters the medial thigh by passing through the obturator canal.

Function

The obturator nerve innervates all of the muscles of the medial compartment of the thigh (except for the hamstring part of the adductor magnus innervated by the tibial portion of the sciatic nerve).

It also gives off a cutaneous branch that supplies skin on the medial side of the upper thigh.

Table: Motor Supply of the Obturator Nerve

Muscle Function
Adductor longus Adduction and medial rotation at hip
Adductor brevis Adduction at hip
Adductor magnus Adduction and medial rotation at hip
Obturator externus Lateral rotation at hip
Gracilis Adduction at hip and flexion at knee

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

Cutaneous Innervation of Lower Limb. (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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