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Anatomy

Lower Limb

Question 127 of 180

A 28 year old man is brought into ED following a motorcycle accident where his left lower limb was caught beneath the bike, and stabilised in the department. Later he is examined, and is noted to demonstrate a waddling gait. When asked to stand with his weight supported by just his left lower limb, the right side of his pelvis sags. Which of the following nerves has most likely been damaged:

Answer:

The patient demonstrates Trendelenburg's sign which is seen in patients with weakened or paralysed abductor muscles - primarily the gluteus medius and gluteus minimus, which are innervated by the superior gluteal nerve.

Superior Gluteal Nerve Injury

Anatomy / Lower Limb / Hip Joint and Gluteal Region

Last Updated: 20th February 2019

Damage to the superior gluteal nerve may occur in association with pelvic fractures, with space-occupying lesions within the pelvis extending into the greater sciatic foramen, and following hip surgery.

Trendelenburg's sign is seen in people with weak/paralysed abductor muscles of the hip, namely the gluteus medius and gluteus minimus muscles innervated by the superior gluteal nerve.

The Trendelenburg sign is said to be positive if, when standing on one leg (the 'stance leg'), the pelvis drops on the side opposite to the stance leg. The muscle weakness is present on the side of the stance leg. Typically the patient may also demonstrate a Trendelenburg gait.

Positive Trendelenburg’s Sign. (Image by Foto H.-P.Haack [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], 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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