peripheral nerves- the mystery of the braids neuroanatomy: a clinician’s review: chrmc...
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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.
Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.
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.
Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.
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
Fundamentals of Anatomy & Physiology, 7eby Frederic H. Martini, Ph.D.
Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.
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
Fundamentals of Anatomy & Physiology, 7eby Frederic H. Martini, Ph.D.
Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.
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.
Common Dermatomal LevelsCommon Dermatomal Levels
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
Common Dermatomal LevelsCommon Dermatomal Levels
Nipples- T4Nipples- T4
Umbilicus- T10Umbilicus- T10
Common Dermatomal LevelsCommon Dermatomal Levels
L4- Anteromedial ShinL4- Anteromedial Shin
L5- Anterolateral Shin, dorsum of foot to big L5- Anterolateral Shin, dorsum of foot to big toetoe
Common Dermatomal LevelsCommon Dermatomal Levels
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
ASIA, 2006
Common Dermatomal LevelsCommon Dermatomal Levels
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
Blumenfeld, 2002
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.