Anatomy
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Lower Limb
A 21 year old male presents to ED having sustained a stab wound to his left buttock. You note that he walks with a waddling gait, with the pelvis falling towards the right side with each step. Which of the following nerves was most likely injured:
Answer:
This describes Trendelenburg gait, which is caused by weakness of the gluteus medius and gluteus minimus muscles, innervated by the superior gluteal nerve. These gluteal muscles normally function to abduct the thigh and stabilise the pelvis when the opposite foot is off the ground. In damage to the superior gluteal nerve, the weakened muscles allow the pelvis to tilt down on the opposite side.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 |
