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Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Superior gluteal nerve: Fall on the buttocks with entrapment of the nerve between the piriformis muscle and the major sciatic incisure.Intramuscular injection into the buttocks.Hip surgery via a posterior approach.
Practice Paper 10: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
The Trendelenburg gait is caused by unilateral weakness of the hipstabilizing lower limb abductor muscles (gluteus medius and minimus). The hip abductors prevent the pelvis from tilting down when the contralateral leg is lifted off the ground. If there is weakness of these stabilizing muscles, the pelvis sags when the opposite leg is lifted. To compensate, the trunk is swung to the other side (the side of the hip weakness) to maintain the pelvis level. Unilateral hip abductor weakness is primarily caused by damage to the superior gluteal nerve.
The Gluteal Region and Posterior Thigh
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
Reflect the gluteus medius anteriorly and inferiorly from its origin to see the deep branch of the superior gluteal artery and the superior gluteal nerve on the deep surface of the gluteus medius. The nerve and artery lie within the plane of cleavage between the gluteus medius and the gluteus minimus. Identify the gluteus minimus muscle. Reflect the gluteus medius and gluteus minimus to their insertions upon the greater trochanter. [NOTE: The gluteus medius, minimus and tensor fasciae latae muscle are all innervated by the superior gluteal nerve from L4, 5, S1 - especially L5]
Anatomical course of the lateral femoral cutaneous nerve with special reference to the direct anterior approach to total hip arthroplasty
Published in Modern Rheumatology, 2020
Masahiko Sugano, Junichi Nakamura, Shigeo Hagiwara, Takane Suzuki, Takayuki Nakajima, Sumihisa Orita, Tsutomu Akazawa, Yawara Eguchi, Yohei Kawasaki, Seiji Ohtori
Based on the anatomical features of the nerve, some preventive methods to avoid LFCN injury may be hypothesized. First, a skin incision in the midline of the TFL is recommended [1]. If the skin incision is positioned more laterally (posteriorly) and distally between the TFL and the gluteus medius muscle, chance of LFCN injury becomes lower [18]. However, such an anterolateral approach is likely to jeopardize the superior gluteal nerve and reduce visualization of the acetabulum because the TFL covers the anterior part of the hip joint. Second, subcutaneous fat tissue should be incised meticulously, because the nerve branches of the LFCN usually run within the deep layer and just above the fascia of the TFL. Excessive stretching of the skin and fat tissue should be avoided. Third, the fascia of TFL should be incised along the midline of the TFL as a skin incision. The anterior branch would be protected because it never crosses over the midline of the TFL posteriorly [10,12,19]. Fourth, at closure, the stitch of the anterior part of the fascia of the TFL should be sufficiently short enough so as not to involve the anterior branch of the LFCN.
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
The onset of the patient’s symptoms coincided with the recent D&C procedure, which was performed in the lithotomy position. Lithotomy positioning can result in stretch injuries to the femoral, lateral femoral cutaneous, obturator, sciatic, or common peroneal nerves (Barnett et al, 2007). It can also result in a lumbosacral plexus stretch injury, which is more consistent with the patient’s presentation (Flanagan, Webster, Brown, and Massey, 1985). Identifying the pattern of weakness and numbness clinically after a lumbosacral plexus injury may be difficult (Flanagan, Webster, Brown, and Massey, 1985; Preston and Shapiro, 2013). The patient exhibited hamstring weakness, which is innervated by the sciatic nerve, as well as weakness of the left ankle plantarflexors (i.e. gastrocnemius and soleus muscles), which are innervated by the tibial branch of the sciatic nerve (Kendall, McCreary, Provance, and Kendall, 1999). Yet, the patient also had left gluteus maximus and medius weakness, which are innervated by the inferior and superior gluteal nerve, respectively. The potential pattern in this case; each of these muscles is partially supplied by the S1 nerve root (Kendall, McCreary, Provance, and Kendall, 1999).
Great toe drop following knee ligament reconstruction: A case report
Published in Physiotherapy Theory and Practice, 2020
David A Boyce, Chantal Prewitt
Upon completion of the physical examination performed by the electromyographer, the provisional impression was to differentiate between a CFN injury and an L5 radiculopathy. The patient did not report any current or prior history of low back pain or radicular symptoms. Additionally, there was no mechanism of injury suggestive of spinal injury. Physical examination findings in a patient with an L5 lumbar radiculopathy could consist of weakness in multiple L5 muscles innervated by different peripheral nerves. For example, this patient had isolated weakness of the EHL and EDB, both innervated by the DFN. When screening for the presence of an L5 radiculopathy, the examiner should assess for weakness in other muscles such as the tensor fascia late (superior gluteal nerve), medial hamstrings (tibial nerve), and the tibialis posterior (tibial nerve), which share the same myotome level (L5) but do not share the same peripheral nerve innervation. In this case, there was no weakness in other L5 muscles supplied by nerves other than the CFN. Reduction or absence of a spinal reflex as compared to uninvolved side can also suggest involvement of spinal nerve root. The medial hamstrings reflex is often cited as the reflex of choice to evaluate the L5 nerve root (Magee, 2014). In this case, the patient had brisk and symmetrical knee jerk, ankle jerk, and the hamstring reflexes, suggesting no involvement of the L5 nerve root. An important anatomical distinction to note is that injury to the CFN at or about the knee would never impair the medial hamstring reflex due to the fact that it travels via the tibial nerve (Jenkins, 2008). Therefore, if it were to be impaired, it would only suggest L5 nerve root involvement.