peripheral nerves- the mystery of the braids neuroanatomy: a clinician’s review: chrmc...

Peripheral Nerves- The Mystery of Peripheral Nerves- The Mystery of the Braidsthe Braids

Neuroanatomy: A Clinician’s Review: CHRMC Neuroanatomy: A Clinician’s Review: CHRMC Spring 2007Spring 2007

Bernadette Gillick, MS, PT Bernadette Gillick, MS, PT

Fundamentals of Anatomy & Physiology , 7eby Frederic H. Martini, Ph.D.

Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.

Figure 13 -10: The Cervical Plexus

Cranial nerves

Transverse cervical nerve

Great auricular nerve

Accessory nerve (XI)

Hypoglossal nerve (XII)

Lesser occipital nerve

Supraclavicular nerves

Clavicle

Sternothyroid muscle

Sternohyoid muscle

Phrenic nerve

Omohyoid muscle

Ansa cervicalisC1

C2

C3

C4

C5

Thyrohyoid muscle

Geniohyoid muscle

Nerve roots of cervical plexus

Brachial Plexus “Simplified”Brachial Plexus “Simplified”Dorsal Scapular NerveDorsal Scapular NerveSuprascapular NerveSuprascapular NerveNerve to SubclaviusNerve to SubclaviusLateral Pectoral NerveLateral Pectoral NerveAxillary NerveAxillary NerveRadial NerveRadial NerveThoracodorsal NerveThoracodorsal NerveSubscapular NerveSubscapular NerveMedial Pectoral NerveMedial Pectoral NerveMedial Cutaneous Nerve- Arm and ForearmMedial Cutaneous Nerve- Arm and ForearmMusculocutaneous NerveMusculocutaneous NerveMedian NerveMedian NerveUlnar NerveUlnar Nerve

Fundamentals of Anatomy & Physiology, 7eby Frederic H. Martini, Ph.D.


Figure 13 -11a: The Brachial Plexus

.

(a)

Musculocutaneousnerve

Lateral antebrachialcutaneous nerve

Superficial branchof radial nerve

Anteriorinterosseous

nerve

Palmar digital nerves

Median nerve

Ulnar nerve

Deep branch of ulnar nerveSuperficial branch of ulnar nerve

Ulnar nerve

Median nerve

Radial nerve

Deep radial nerve

Superior trunk

Suprascapular nerveDorsal scapular nerve

Middle trunkBRACHIAL

PLEXUSInferior trunk

T 1

C8

C7

C6

C5

C4

Anterior view

Nerves acting on the ThumbNerves acting on the Thumb

Radial- Abductor Pollicis LongusRadial- Abductor Pollicis Longus

Ulnar- Adductor PollicisUlnar- Adductor Pollicis

Median- Flexor Pollicis Longus and Median- Flexor Pollicis Longus and Brevis (sup head)Brevis (sup head)

Lumbar Plexus “Simplified”Lumbar Plexus “Simplified”Iliohypogastric NerveIliohypogastric NerveIlioinguinal NerveIlioinguinal NerveGenitofemoral NerveGenitofemoral NerveLateral Femoral Cutaneous NerveLateral Femoral Cutaneous NerveFemoral NerveFemoral NerveObturator NerveObturator NerveSaphenous NerveSaphenous NerveSuperior Gluteal NerveSuperior Gluteal NerveInferior Gluteal NerveInferior Gluteal NerveSciatic NerveSciatic NerveCommon Peroneal NerveCommon Peroneal NerveSuperficial Peroneal NerveSuperficial Peroneal NerveDeep Peroneal NerveDeep Peroneal NerveTibial NerveTibial NerveSural NerveSural NervePosterior Femoral CutaneousPosterior Femoral CutaneousPudendal NervePudendal Nerve

Fundamentals of Anatomy & Physiology , 7eby Frederic H. Martini, Ph.D.


Figure 13 -12a,b: The Lumbar and Sacral Plexuses

(b)(a)

Intercostal nerve

Iliohypogastricnerve

Ilioinguinal nerve

Genitofemoralnerve

Lateral femoralcutaneous nerve

Femoral nerveObturator nerve Lumbosacral

trunk

LUMBAR PLEXUS

T 12

L1

L2

L3

L4

L 5

The lumbar plexus, anterior view

Lumbosacraltrunk

Inferior glutealnerve

Superior glutealnerve

Sciatic nerve

Pudendal nerve

SACRAL PLEXUS

L 5

S1

S 2

S3

S4

S5

Co1

L 4

The sacral plexus, anterior view

Posterior femoralcutaneous nerve



Figure 13 -12c: The Lumbar and Sacral Plexuses

Common fibular nerve

Ilioinguinal nerve

Lateral femoralcutaneous nerve

Femoral nerveSuperior gluteal nerve

Pudendal nerveSciatic nerve

Posterior femoralcutaneous nerve (cut)

(c)

Fibular nerve

Suralnerve

Saphenous nerve

Iliohypogastric nerve

Intercostal nerve

Genitofemoral nerve

Inferior gluteal nerve

Obturator nerve

Suralnerve

Tibial nerve

Saphenous nerve

Saphenous nerve

Nerves of the lumbar and sacral plexus, anterior view



Figure 13 -12d: The Lumbar and Sacral Plexuses

(d)

Suralnerve

Tibial nerve

Tibial nerveSaphenousnerve

Superior gluteal nerve

Inferior gluteal nerve

Sciatic nerve

Posterior femoral cutaneous nerve

Common fibularnerve

Sural nerve

Pudendal nerve

Fibular nerve

Sural nerve

Tibialnerve

Saphenousnerve

Nerves of the sacral plexus, posterior view

Dermatomes and MyotomesDermatomes and Myotomes

Dermatome- sensory region of skin innervated Dermatome- sensory region of skin innervated by a nerve rootby a nerve rootMyotome- muscles innervated by a single Myotome- muscles innervated by a single nerve rootnerve root

28 Total Dermatomes28 Total DermatomesTwo aspects - absent, impaired, normalTwo aspects - absent, impaired, normal– Pin Prick (why?)Pin Prick (why?)– Light Touch (why?)Light Touch (why?)

Proprioception- absent, impaired, normalProprioception- absent, impaired, normal– Same one joint on each extremitySame one joint on each extremity– Index finger and Great ToeIndex finger and Great Toe

Common Dermatomal LevelsCommon Dermatomal Levels

Remember – Sensation on Chest and Back Remember – Sensation on Chest and Back skips from C4 to T2 as the upper extremities skips from C4 to T2 as the upper extremities are represented. C4 also dips low on the are represented. C4 also dips low on the anterior or ventral neck. anterior or ventral neck.


C5- ShoulderC5- Shoulder

C6- Lateral Arm and Digits 1&2C6- Lateral Arm and Digits 1&2

C7- Middle DigitC7- Middle Digit

C8- Digits 4 & 5C8- Digits 4 & 5


Nipples- T4Nipples- T4

Umbilicus- T10Umbilicus- T10


L4- Anteromedial ShinL4- Anteromedial Shin

L5- Anterolateral Shin, dorsum of foot to big L5- Anterolateral Shin, dorsum of foot to big toetoe


S1- 5S1- 5thth toe, lateral foot, sole and calf toe, lateral foot, sole and calf

S2, S3, S4 innervate the perineal area in a S2, S3, S4 innervate the perineal area in a “saddle-like” distribution“saddle-like” distribution

ASIA, 2006


Face- Trigeminal nerveFace- Trigeminal nerve

Head- C2 via the greater and lesser occipital Head- C2 via the greater and lesser occipital nervesnerves

Multiple Segments InnervatingMultiple Segments InnervatingBicepsBicepsECRLECRLTricepsTriceps

ASIA, 2006

MyotomesMyotomes

Helpful to have memorized at least one muscle Helpful to have memorized at least one muscle that gets major innervation from each nerve that gets major innervation from each nerve

rootroot

Neuro ExamNeuro Exam

Do you use components of these in Do you use components of these in your own exams?your own exams?

Blumenfeld, 2002

The beginning is the mostimportant part of the work.

- Plato

Thank you for working with me these past fourweeks!

- Bernadette Gillick

REFERENCES Behrman RE 1992. Nelson Textbook of Pediatrics. 14th Edition. WB Saunders Company, Philadelphia, PA. Blumenfeld, H. 2002. Neuroanatomy through Clinical Cases. Sinauer Associates, Inc. Sunderland, MA.

Gilbert SF, Tyler AL, Zackin EJ 2005. Bioethics and the New Embryology: Springboards for Debate. Sinaeur Associates, Sunderland, MA. Hansen JT, Koeppen BM 2004. Netter’s Atlas o f Neurophysiology and Neuroanatomy. Icon Custom Communications, Teterboro, NJ.

Human Anatomy and Physiology Society: HAPS Educator, Winter 2006. Kendall ER, Schwarts JH, Jessel TM 2000. Principles of Neural Science. 4th Edition. McGraw-Hill, New York, NY.

Martini, FH. 2006. Fundamentals of Anatomy and Physiology, 7th Edition. Pearson Education, Inc/Benjamin Cummings, San Francisco, CA.

Martini FH, Welch K. 2005. Anatomy and Physiology Applications Manual Pearson Education, Inc/Benjamin Cummings, San Francisco, CA. Menkes JH 1995. Textbook of Child Neurology. 5th Edition. Williams & Wilkins. Baltimore, MD. Netter FH1989. Atlas of Human Anatomy. CIBA-GIEGY Corporation, West Caldwell, NJ. Nolte, J 2002. The Human Brain- An Introduction to Its Functional Anatomy. 5th Edition. Mosby, Inc, St. Louis, MO. Purves D, Augustine GJ, Fitzpatrick D et al 2004. Neuroscience. 3rd Edition. Sinauer Associates, Sunderland, MA.

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