Nervous system
Chapter 18 peripheral nerveous system
•
spinal nerve
overview
•
cervical plexus
•
brachial plexus
•
anterior branches of thoracic nerve
•
lumbar plexus
•
sacral plexus
•
the correlate anatomical basement of the spinal nerve
injury’s location
•
the innervation of main joints all over the body
cranial nerve
visceral nervous system
-1-
overview
cranial nerve
peripheral nerve
spinal nerve
visceral nerve
visceral nerve（automatic nervous system)
sympathetic nerve
parasympathetic nerve
-2-
ganglia
cranial ganglia
spinal ganglia（dorsal root ganglion）
visceral motor ganglion
nerve
In peripheral nervous system, the fibers
assemble as nerve.
endoneural membrane
Endoneurium
lamellar sheath
epineurium
medullary sheath：is composed of
Sch’s processes by convoluted neurons
of layers.
-3-
the regeneration of peripheral nerve
the degeneration of nerve fiber
anterograde degeneration
retrogression degeneration
nerve growth factor
nerve growth factor (NGF)
brain-derived neurotrophic factor (BDNF)
ciliary neurotrophic factor (CNTF)
fibroblast growth factor (FGF)
-4-
Spinal cord
overview
(一)the construction, subdivision and fiber
ingredients
anterior root—motor
posterior root—nerve spinal ganglia
31对
C8
T 12
L5
S5
Co 1
-5-
Fiber ingredients
somatic sensory fiber
visceral sensory fiber
somatic motor fiber
visceral motor fiber
-6-
the typical branches of spinal nerve
1.Meningeal branch
2. communicating branch white communicating
branch, gray communicating branch
3. posterior branch medial branch, lateral branch,
muscular branch , cutaneous branches
4. anterior branches cervical plexus ,brachial plexus,
lumbar plexus ,sacral plexus
cervical plexus
the composition and position of cervical plexus
anterior branches of C1-4
branches of cervical plexus
superficial cutaneous branches
—the middle point of
sternomastoid’s posterior border
1. lesser occipital nerve(C2)
2. great auricular nerve(C2－C3)
3. transverse nerve of neck(C2－C3)
（superficial cervical nerve）
4. supraclavicular nerves(C3－C4)
-7-
muscular branch
dominate the muscle of deep layer, levator scapulae and infrahyoid muscles
group
5. diaphragmatic nerve(C3－C5)
ansa cervicalis(loop of hypoglossal nerve)
-8-
brachial plexus
the construction and position of
brachial plexus
C5-8, anterior branches of T1
scalene fissure
the branches of brachial
plexus
1. long thoracic nerve(C5－C7)
serratus anterior
2. thoracodorsal nerve(C6－C8)
latissimus dorsi muscle
3. axillary nerve(C5－C6)
4. musculocutaneous nerve(C5－C7)
-9-
5. median nerve(C6－T1)
6. ulnar nerve(C8,T１)
7. radial nerve(C5－T１)
-10-
the innervation of skin of hand
M median
nerve
U ulnar nerve
R radial nerve
-11-
dorsal nerve of scapula(C4-C5)
suprascapular nerve(C5-C6)
subscapular nerve(C5-C7)
medial pectoral nerve(C8,T1)
lateral pectoral nerve(C5-C7)
medial brachial cutaneous nerve(C8,T１)
medial antebrachial cutaneous nerve(C8,T１)
-12-
the anterior branch of thoracic nerve
12 pairs
the 1st to 11th intercostal nerve
the 12th subcostal nerve
cutaneous branches
lateral cutaneous branch
anterior cutaneous branch
T2 sternal angle
T4 mammary papilla
T6 xiphoid process
T8 costal arch
T10 umbilicus
T12 the middle point of the line of umbilicus and pubic symphysis
-13-
The segmental distribution of anterior branch of thoracic nerve
T2 areal is at the level of sternal angle
T4 areal is at the level of mammary
papilla
T6 areal is at the level of xiphisternal
synchondrosis
T8 areal is at the level of costal arch
（between umbilicus and
xiphoid process）
T10 areal is at the level of umbilicus
T12 areal is at the level of middle point
of line of umbilicus
and pubic symphysis
-14-
lumbar plexus
the constitution and position of lumbar plexus
T12 L1-3.4
the branches of lumbar plexus
1. iliohypogastric nerve(T12,L1)
2. ilioinguinal nerve(L1)
3. lateral femoral cutaneous nerve(L２-３)
4. femoral nerve(L２-L4)
5. obturator nerve(L２-L4)
6. genitofemoral nerve(L1,L２)
-15-
sacral plexus
the constitution and position of sacral plexus
L4.5 S1-5 Co1
the branches of sacral plexus
1. superior gluteal nerve(L4,L5,S1）
2. inferior gluteal nerve(L5,S1,S2)
3. posterior femoral cutaneous nerve(S1-S3)
4. pudendal nerve(S2-S4)
inferior gluteal nerve
pudendal nerve
posterior femoral cutaneous nerve
-16-
superior gluteal
nerve
5. sciatic nerve(L4 L5 S1-S3)
(1) tibial nerve(L4,L5,S1-S3)
medial plantar nerve
lateral plantar nerve
lateral plantar nerve
medial plantar nerve
-17-
(2) common peroneal nerve(L4, L5, S1, S2)
superficial peroneal nerve
deep peroneal nerve
deep peroneal
nerve
superficial peroneal nerve
-18-
the related anatomical basement of the
injury location of spinal cord
the segmental regularity
of the distribution of
spinal cord
-19-
the muscles detected for clinical affection and its innervation
the motor related muscles for level diagnosis of upper limb nerve
and its innervation
motor
the name of muscles
nerve
abduction of shoulder
deltoid
bending of
elbow
biceps brachii
extending wrist of
radialis
extensor carpi radialis muscle
axillary
nerve
musculocutaneous
nerve
radial nerve
extending wrist of
radialis
extending elbow
flexion of finger
abduction of thumb
triceps brachii
flexor pollicis longus，flexor
digitorum profundus
abductor pollicis brevis
first dorsal interossei
radial nerve
median nerve
median nerve
ulnar nerve
-20-
nerve
segment
C5
C5,C6
C6
C7
C8
T1
C8,T1
The related muscles detected for level diagnosis
of lower limb nerve and its innervation
motor
flexion of
hip bone
adduction of
hip bone
extention of
knee
dorsiflexion
of ankle
cross-foot
strephexopodia
genuflex
plantar flexion
of ankle
-21-
name of muscle
nerve
nerve segment
iliopsoas muscle
femoral nerve
L1,L2
ator of thigh
obturator nerve
L2,L3
quadriceps femoris
anterior tibial deep
muscle
tibialis posterior
peroneus longus
peroneus brevis
biceps femoris
triceps surae
femoral nerve
L 3,L 4
peroneal
L4
nerve
tibial nerve
L4,L 5
superficial
peroneal nerve L5,S1
sciatic nerve
S1
tibial nerve
S1,S 2