Superior gluteal nerve
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Through Nerve
Structure
Origin
The superior gluteal nerve originates in the sacral plexus. It arises from the posterior divisions of L4, L5 and S1.
Course
It exits the pelvis through the greater sciatic foramen superior to the piriformis muscle. It is accompanied by the superior gluteal artery and the superior gluteal vein.
It passes lateral-ward in between the gluteus medius muscle and the gluteus minimus muscle, accompanied by the deep branch of the superior gluteal artery. It divides into a superior branch and an inferior branch.
The inferior branch continues to pass between the two muscles to end in the tensor fasciae latae muscle.
Distribution
Motor
- tensor fasciae latae muscle
- gluteus medius muscle (superior branch and inferior branch)
- gluteus minimus muscle (inferior branch, sometimes superior branch as well)
- piriformis muscle
Sensory
The superior gluteal nerve also has a cutaneous branch.
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Clinical significance
Gait
In normal gait, the small gluteal muscles on the stance side can stabilize the pelvis in the coronal plane. Weakness or paralysis of these muscles caused by a damaged superior gluteal nerve can result in a weak abduction in the affected hip joint. This gait disturbance is known as Trendelenburg gait. In a positive Trendelenburg's sign the pelvis sags toward the normal unsupported side (the swing leg). The opposite, when the pelvis is elevated on the swing side, is known as Duchenne limp. Bilateral loss of the small gluteal muscles results in a waddling gait.
Iatrogenic damage
The superior gluteal nerve may be damaged by intramuscular injections and nephrectomy.