Adductor magnus: A post‐operative illustration of its dual nerve supply

Barrett, Tristan; Arthurs, Owen J.

doi:10.1002/ca.20886

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…These cases are not surprising, but nicely complement our clinical example of partial adductor magnus denervation following sciatic nerve pathology, demonstrating its dual innervation (Barrett and Arthurs, 2010). In our index case, the patient underwent surgical resection of the sciatic nerve, and subsequently presented with a clear corresponding weakness and sensory loss.…”

supporting

confidence: 68%

Dual innervation of adductor magnus

Barrett¹,

Arthurs²

2011

Clinical Anatomy

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We read with interest the cases presented by Mylne et al. (2011) regarding segmental adductor magnus denervation following obturator nerve pathology. These cases are not surprising, but nicely complement our clinical example of partial adductor magnus denervation following sciatic nerve pathology, demonstrating its dual innervation (Barrett and Arthurs, 2010). In our index case, the patient underwent surgical resection of the sciatic nerve, and subsequently presented with a clear corresponding weakness and sensory loss. Our patient underwent follow-up MRI to investigate possible tumour recurrence along the path of the sciatic nerve.Both cases reported in this letter are of malignant infiltration or compression of the obturator nerve in the pelvis, but the clinical indication for an MRI of the thigh is unclear. In itself, loss of isolated leg adduction might not necessitate MRI at our institution, so it would be interesting to know how these two patients presented clinically. Was there a corresponding cutaneous sensory loss in these patients? This would be unusual, as the medial thigh skin over the adductors is jointly supplied by distal branches of the obturator nerve (L2-4) joining the saphenous nerve and medial femoral cutaneous nerve (both femoral nerve origin; also L2-4) to form the subsartorial plexus, and thus should remain intact.Taken together, these cases highlight the clinical consequences of an interesting idiosyncrasy of anatomical evolution. Equally, therefore, one would expect that there may be individuals in whom the adductor magnus muscle is supplied by either the sciatic or the obturator nerve in its entirety, by natural anatomical variation. However, we suspect the chances of such an individual also suffering from these relatively uncommon clinical conditions would be remote. How would these individuals present? The distinctive ''signature'' of the adductor magnus is the loss of one, but not both, functions of the muscle secondary to its dual innervation, but an individual in whom the entire muscle has a single nerve supply would simply lose both functions. Are there cases in the literature or in our every day practice of an isolated sciatic or obturator palsy giving rise to a larger functional deficit than expected? REFERENCES Barrett T, Arthurs OJ. 2010. Adductor magnus: A post-operative illustration of its dual nerve supply.

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confidence: 68%

Dual innervation of adductor magnus

Barrett¹,

Arthurs²

2011

Clinical Anatomy

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“…The adductor magnus has traditionally been regarded as a muscle with double innervation (Moore and Dalley, ; Standring, ), its adductor part (AM1–AM3 in the present study) and hamstrings part (AM4 in the present study) supplied by the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve (Agur and Lee, ; Moore and Dalley, ; Barrett and Arthurs, ). Our results thus indicate that the tibial nerve innervates a larger area of the adductor magnus than has previously been thought.…”

Section: Discussionmentioning

confidence: 67%

“…Double innervation of the adductor magnus is also well known, an “adductor” part arising from the pubic arch and a “hamstrings” part from the ischial tuberosity (Agur and Lee, ; Moore and Dalley, ; Askling et al, ; Barrett and Arthurs, ). In this scheme, the adductor part and the hamstrings part are innervated by the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve, respectively (Moore and Dalley, ; Standring, ).…”

Section: Introductionmentioning

confidence: 99%

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves

et al. 2013

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The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty-one lower limbs were examined from 21 formalin-fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1-AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1-AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability.

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“…The rarely injured ischial tendon of adductor magnus arises from the medial aspect of the ischial tuberosity and rapidly fuses with the muscular origin of adductor magnus from the posterolateral aspect of the inferior pubic ramus (Fig. 1c), with both heads receiving a separate nerve supply (sciatic and obturator nerves, respectively) [4].…”

Section: Mri Of Proximal Hamstring Injuriesmentioning

confidence: 99%

Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation

Askling

Koulouris

Saartok

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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The aim of this article is to provide a state-of-the-art review for treatment of acute, total proximal hamstring tendon ruptures. For total proximal hamstring tendon ruptures, early (<2-3 w) surgical refixation minimizes muscle atrophy and facilitates a somewhat predictable time course for healing and rehabilitation. A postoperative rehabilitation program is detailed that has been used by one physical therapist for the past 7 years on over 200 patients with surgical repair for total proximal hamstring tendon rupture. One re-rupture has occurred, 7 months after surgery, following the rehabilitation program described herein. The rehabilitation program, including avoidance of postoperative bracing, appears effective for total proximal hamstring ruptures. Early surgery together with a specific rehabilitation program appears to be the treatment of choice for timely and safe return to sport and an active lifestyle. Level of evidence V.

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Adductor magnus: A post‐operative illustration of its dual nerve supply

Cited by 7 publications

References 14 publications

Dual innervation of adductor magnus

Dual innervation of adductor magnus

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves

Total proximal hamstring ruptures: clinical and MRI aspects including guidelines for postoperative rehabilitation

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