Summer 2002 Course

Case # 5 - Difficulty Walking

(click here for a printable version of this case study)

Presentation: A middle-aged man is referred to you for examination. He states he became ill while traveling in an under-developed country. He went to see his physician upon his return and received an intragluteal injection of a very strong antibiotic. The day after the injection, the man noticed he was having difficulty walking. He again visited his physician, who was unable to diagnose the problem. The physician then referred the man to you. The patient states the injection was given in his left gluteal region. You observe his gait and note that his difficulty involves his right lower limb. You proceed to examine the joints of each limb to try and determine the source of the problem. The left limb appears to be functioning well. The right foot, ankle and knee are fine, but the patient does have problems with his hip. You carry out the following tests:

Activities:

I. Discuss the movements of the following joints:

1. tarsal
2. ankle
3. knee
4. hip

II. Provide the following for each of the above joints:

1. the movements that take place at each joint
2. the prime movers for each movement
3. the nerve supply to each prime mover

III. Demonstrate on one of your tablemates how you would test to see if the prime mover(s) of each joint are functioning properly.

IV. Discuss the anatomical basis for each of the following:

1. Foot Drop
2. Hopping Test
3. Waddling Gait
4. Trendelenburg Test

V. Prepare a diagram that demonstrates the quadrants of the gluteal region. Indicate the location of the main neurovascular bundles associated with each quadrant.

1. If the patient did not pass the Trendelenburg Test, where would you expect he received the injection?
2. Why did the injection result in a motor deficit but no sensory deficit?
3. Explain the anatomical basis of Trendelenburg gait.