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Anatomy

Lower Limb

Question 166 of 180

A 21 year old man received a stab wound to the posterior part of his gluteal region. Following resuscitation, he is found to have great difficulty rising to a standing position from the seated position. Which of the following muscles was most likely affected by this injury:

Answer:

The gluteus maximus is responsible for extension and lateral rotation at the hip and is the prime muscle that extends the flexed hip, and is used to rise from a seated position. It is innervated by the inferior gluteal nerve which may have been injured in this case.

Table: Function and Innervation of the Gluteal Muscles

Muscle Function Innervation
Gluteus maximus Extension, lateral rotation and abduction at hip Inferior gluteal nerve
Gluteus medius Abduction and medial rotation at hip Superior gluteal nerve
Gluteus minimus Abduction and medial rotation at hip Superior gluteal nerve
Piriformis Lateral rotation and abduction at hip Branches from S1 and S2

Gluteus Maximus

The gluteus maximus is the main extensor of the thigh at the hip joint and also acts to laterally rotate and abduct the thigh. Through its insertion into the iliotibial tract, it also stabilises the knee and hip joints. The gluteus maximus is innervated by the inferior gluteal nerve.

Gluteus Medius and Gluteus Minimus

The gluteus medius and gluteus minimus act to abduct and medially rotate the thigh at the hip joint, and also act to secure the pelvis, reducing pelvic drop on the opposite swing side during walking. They are both innervated by the superior gluteal nerve.

Piriformis

The piriformis acts to abduct and laterally rotate the thigh at the hip joint. It is innervated by the nerve to the piriformis, originating from the sacral plexus (S1, S2).

The obturator internus, gemelli and quadratus femoris muscles act as synergistic femoral lateral rotators and hip stabilisers.

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

Gluteal Muscles: Gluteus Maximus (red), Gluteus Medius (green), Gluteus Minimus (blue), Piriformis (yellow). (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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