1336 - Compensatory Use of Hamstrings for Hip Extension in Traumatic Transfemoral Amputation Complicated by Loss of Gluteal Activation Due to Lumbosacral Plexopathy: Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CT

Claire v. Turgeon, MD

Resident Physician
Northwestern University / Shirley Ryan Ability Lab
Chicago, Illinois, United States

Co-Author(s)

MH

Mark E. Huang, MD

Professor, Dept of PM& R
Shirley Ryan Abilitylab
Chicago, Illinois, United States

Submitter(s)

CT

Claire v. Turgeon, MD

Northwestern University / Shirley Ryan Ability Lab
Chicago, Illinois, United States

Case Diagnosis: Patient is a 19-year-old female who presented to outpatient amputee clinic after traumatic left transfemoral amputation from crush injury complicated by lumbosacral plexopathy.

Case Description: During inpatient rehab, she underwent electromyography and nerve conduction study (EMG & NCV) of the LLE after physical exam revealed 1/5 strength left hip extension and decreased sensation to left posterior thigh and gluteal region. EMG & NCV demonstrated severe but incomplete denervation changes in gluteus medius, gluteus maximus, and adductor longus. Magnetic resonance neurography findings were consistent with L4 nerve root avulsion plus lumbosacral plexopathy. Per Complex Nerve Injury team and Neurosurgery evaluations, she was not a candidate for nerve reconstruction.

During her outpatient course, she underwent outpatient physical therapy and utilized compensatory strategies to extend her prosthesis at the hip. After five months, functional hip extension strength improved from 1/5 to 4/5. Other improvements included ambulation speed and distance, stair negotiation, floor recovery, and functional independence. She was successfully fitted for a transfemoral prosthesis with an advanced microprocessor knee.

Discussions: This case demonstrates the possibility for patients to utilize hamstring muscles to substitute for loss of primary hip extensors in patients with lower limb amputation and concomitant lumbar plexopathy. She also may have had some partial recovery of the gluteal muscles of her lumbosacral plexus injury. Her functional hip extension improved her ability to functionally use a prosthesis.

Conclusions: Compensatory muscle group activation may be able to substitute for loss of primary muscle function in patients with amputation and peripheral nerve injury to still allow for successful prosthetic fitting.