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Chapter 16 *Lecture Outline Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. *See separate FlexArt PowerPoint.

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Presentation on theme: "Chapter 16 *Lecture Outline Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. *See separate FlexArt PowerPoint."— Presentation transcript:

1 Chapter 16 *Lecture Outline Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. *See separate FlexArt PowerPoint slides for all figures and tables pre-inserted into PowerPoint without notes.

2 Chapter 16 Outline Gross Anatomy of the Spinal Cord Spinal Cord Meninges Sectional Anatomy of the Spinal Cord Spinal Nerves Reflexes Development of the Spinal Cord

3 Spinal Cord—Introduction The spinal cord provides a vital link between the brain and the rest of the body. The spinal cord and its attached spinal nerves serve two important functions: 1. a pathway for sensory and motor impulses 2. responsible for reflexes, which are the quickest reactions to a stimulus

4 Gross Anatomy of the Spinal Cord Length: 42–45 cm, 16–18 inches Roughly cylindrical, slightly flattened posteriorly and anteriorly Two longitudinal depressions on external surface: –Posterior median sulcus on posterior surface –Anterior median fissure on anterior surface

5 Gross Anatomy of the Spinal Cord Parts of the spinal cord: 1. Cervical 2. Thoracic 3. Lumbar 4. Sacral 5. Coccygeal

6 Gross Anatomy of the Spinal Cord Figure 16.1

7 Gross Anatomy of the Spinal Cord

8 The diameter of the spinal cord changes along its length because the amount of gray matter and white matter and the function of the cord vary in different regions. The cervical enlargement is located in the inferior cervical part of the spinal cord and innervates the upper limbs. The lumbosacral enlargement extends through the lumbar and sacral parts of the spinal cord and innervates the lower limbs.

9 Gross Anatomy of the Spinal Cord The spinal cord is shorter than the vertebral canal that houses it. The tapering inferior end of the spinal cord is called the conus medullaris and is the official “end” of the spinal cord proper (usually at the level of the first lumbar vertebra).

10 Gross Anatomy of the Spinal Cord Inferior to the conus medullaris, groups of axons called the cauda equina project from the spinal cord. Within the cauda equina is the filum terminale, which is a thin strand of pia mater that helps anchor the conus medullaris to the coccyx.

11 Gross Anatomy of the Spinal Cord The spinal cord is associated with 31 pairs of spinal nerves that connect the CNS to muscles, receptors and glands. Each side contains: 8 cervical nerves (C1–C8). 12 thoracic nerves (T1–T12). 5 lumbar nerves (L1–L5). 5 sacral nerves (S1–S5) 1 coccygeal nerve (Co1)

12 Spinal Cord Meninges The spinal cord is protected and encapsulated by spinal cord meninges, which are continuous with the cranial meninges. Some of the spaces between some of the meninges have clinical significance.

13 Spinal Meninges and Structure of the Spinal Cord Figure 16.2

14 Spinal Cord Meninges Epidural space: lies between the dura mater and periosteum covering the inner walls of the vertebra houses areolar connective tissue, blood vessels, and adipose connective tissue Dura mater: most external of the meninges fuses with the connective layers that surround the spinal nerves

15 Spinal Cord Meninges Narrow subdural space separates dura mater from arachnoid; a potential space Arachnoid mater is deep to the dura mater and the subdural space Subarachnoid space is a real space filled with cerebral spinal fluid

16 Spinal Cord Meninges Pia mater: innermost meningeal layer that adheres directly to the spinal cord delicate layer composed of elastic and collagen fibers and supports some of the blood vessels supplying the spinal cord has paired, lateral triangular extensions called denticulate ligaments, which suspend and anchor the spinal cord laterally to the dura mater

17 Sectional Anatomy of the Spinal Cord The spinal cord is partitioned into an inner gray matter region and an outer white matter region: Gray matter—dendrites and cell bodies of neurons, unmyelinated axons, and glial cells White matter—myelinated axons

18 Gray and White Components of Spinal Cord Figure 16.3

19 Gray and White Components of Spinal Cord Figure 16.3

20 Location and Distribution of Gray Matter Gray Matter: Centrally located in spinal cord Sectioned shape resembles butterfly Subdivided into: Anterior Horns Lateral Horns Posterior Horns Gray Commissure

21 Location and Distribution of Gray Matter Anterior horns house the cell bodies of somatic motor neurons, which innervate skeletal muscle Lateral horns: –found in the T1–L2 parts of the spinal cord only –contain cell bodies of autonomic motor neurons, which innervate cardiac muscle, smooth muscle, and glands

22 Location and Distribution of Gray Matter The posterior horns contain axons of sensory neurons and cell bodies of interneurons. The gray commissure contains unmyelinated axons and serves as a communication route between the right and left side. The gray commissure houses a narrow central canal.

23 Location and Distribution of Gray Matter Within the gray matter are functional groups of neuron cell bodies called nuclei: –Sensory nuclei in the posterior horns contain interneuron cell bodies of: –somatic sensory nuclei –visceral sensory nuclei –Motor nuclei in the anterior horns contain somatic motor nuclei –Autonomic motor nuclei are in the lateral horns

24 Neuron Pathways and Nuclei Locations Figure 16.4

25 Location and Distribution of White Matter The white matter of the spinal cord is external to the gray matter and is partitioned into three regions, each called a funiculus: posterior funiculus lateral funiculus anterior funiculus –interconnected by the white commissure The axons within each funiculus are organized into tracts.

26 Spinal Nerves 31 pairs Made up of motor and sensory axons Contain connective tissue wrappings called endoneurium, perineurium, and epineurium

27 Spinal Nerves Multiple anterior rootlets arise from the spinal cord and merge to form a single anterior root. Anterior roots contain motor axons only. The cell bodies of the motor axons arise from cell bodies in the anterior and lateral horns of the spinal cord.

28 Spinal Nerves Multiple posterior rootlets are derived from a single posterior root. Posterior roots contain sensory axons only. The cell bodies of the sensory axons arise from cell bodies in the posterior root ganglion, which is attached to the posterior root.

29 Spinal Nerves Each anterior root and its corresponding posterior root unite within the intervertebral foramen to become a spinal nerve. A spinal nerve contains both motor and sensory axons.

30 Spinal Nerves Spinal nerves are numbered according to the location of the intervertebral canal. In the cervical region the first seven pairs of spinal nerves (C1–C7) exit the intervertebral foramen above the vertebra of the same number. The eighth pair of cervical spinal nerves (C8) exit above the first thoracic vertebra. The remaining pairs of spinal nerves exit below the vertebra of the same number.

31 Spinal Nerves Because the spinal cord is shorter than the vertebral canal, the roots of the lumbar and sacral spinal nerves travel inferiorly to reach their respective intervertebral foramen.

32 Spinal Nerve Distribution After leaving the intervertebral foramen, a typical spinal nerve splits into branches termed rami. The posterior ramus is the smaller of the two main branches and innervates the deep muscles of the back and the skin of the back. The anterior ramus is the larger of the two main branches and innervates the anterior and lateral portions of the trunk and the upper and lower limbs.

33 Spinal Nerve Distribution The anterior ramus splits into multiple other branches. Many of the anterior rami go on to form nerve plexuses. Additional rami, the rami communicantes, extend between the spinal nerve and the sympathetic trunk ganglion.

34 Spinal Nerve Branches Figure 16.5

35 Dermatomes A dermatome is a specific segment of skin supplied by a single spinal nerve. All spinal nerves except C1 innervate a segment of skin. The dermatome map follows a segmental pattern along the body.

36 Dermatome Maps Figure 16.6

37 Dermatomes The dermatome map can be important because anesthesia (numbness) in one or more of the segments could indicate potential spinal nerve damage. Dermatomes are also involved in referred visceral pain, where a pain in a dermatome may arise from an organ nowhere near the dermatome.

38 Nerve Plexuses A nerve plexus is a network of interweaving anterior rami of spinal nerves. The anterior rami of most spinal nerves form nerve plexuses on both sides of the body. The plexuses split into multiple named nerves that innervate body structures. The principle plexuses are the: cervical plexuses, brachial plexuses, lumbar plexuses, and sacral plexuses.

39 Intercostal Nerves The anterior rami of spinal nerves T1–T11 are called intercostal nerves because they travel in the intercostal spaces between adjacent ribs. Spinal nerve T12 is called a subcostal nerve, because it arises below the ribs. With the exception of spinal nerve T1, the intercostal nerves do not form plexuses.

40 Intercostal Nerves T1 forms part of the brachial plexus. T2 innervates the intercostal muscles of the second intercostal space and is sensory for the axilla and medial surface of the arm. T3–T6 innervate the intercostal muscles and are sensory for the anterior chest wall. T7–T12 innervate the intercostal muscles, the abdominal muscles, and the overlying skin.

41 Intercostal Nerves Figure 16.7

42 Cervical Plexus Formed by anterior rami of spinal nerves C1–C4 Branches of the cervical plexus innervate anterior neck muscles and the skin of the neck and head and shoulders. The phrenic nerve originated primarily from C4 and some contributing axons of C3 and C5. –travels through the thoracic cavity to innervate the diaphragm

43 Cervical Plexus Figure 16.8

44 Cervical Plexus

45 Brachial Plexus The left and right brachial plexuses are networks of nerves that supply the upper limbs. Each plexus is formed by the anterior rami of spinal nerves C5–T1. Each brachial plexus innervates the pectoral girdle and the entire upper limb of one side.

46 Brachial Plexus The anterior rami of C5–T1 form the roots of the brachial plexus The roots unite to form the: –superior trunk—nerves C5 and C6 –middle trunk—nerve C7 –inferior trunk—nerves C8 and T1

47 Brachial Plexus Portions of each trunk divide into an anterior division and a posterior division The anterior and posterior divisions converge to form three cords: –posterior cord –medial cord –lateral cord

48 Brachial Plexus Five major terminal branches emerge from the three cords: 1. axillary nerve 2. median nerve 3. musculocutaneous nerve 4. radial nerve 5. ulnar nerve

49 Brachial Plexus Figure 16.9

50 Brachial Plexus Figure 16.9

51 Brachial Plexus Figure 16.9

52 Brachial Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Superolateral arm Cutaneous Innervation Motor Innervation Anterior Rami Terminal Branch Branches of the Brachial Plexus Table 16.3 Axillary Nerve Formed from posterior cord, posterior division of the brachial plexus C5, C6Deltoid (arm abductor) Teres minor (lateral rotator of arm) Posterior cord Teres minor Axillary nerve Deltoid

53 Brachial Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Median Nerve Formed from medial and lateral cords, anterior division of the brachial plexus Lateral cord Medial cord Posterior cord Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Flexor digitorum profundus (lateral half) Flexor pollicis longus Lateral two lumbricals Most anterior forearm muscles (pronators, flexors of wrist, digits) Palmar aspects and dorsal tips of lateral 3-1/2 digits (thumb, index finger, middle finger, and 1/2 of ring finger) Lateral two lumbricals (flex MP joints and extend PIP and DIP joints) Flexor pollicis brevis Abductor pollicis brevis Opponens pollicis Thenar (thumb) muscles (move thumb) Flexor carpi radialis Flexor digitorum superficialis Pronator teres Pronator quadratus Lateral 1/2 of flexor digitorum profundus Flexor pollicis longus C5–T1 Pronator quadratus Thenar muscles Median nerve

54 Brachial Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Musculocutaneous Nerve Terminal Branch Branches of the Brachial Plexus (continued) Table 16.3 Cutaneous InnervationMotor InnervationAnterior Rami Formed from the lateral cord, anterior division of the brachial plexus C5–C7 Anterior arm muscles (flex humerus, flex elbow joint, supinate forearm) Lateral region of forearm Coracobrachialis Biceps brachii Brachialis Biceps brachii Lateral cord Coracobrachialis Musculocutaneous nerve Brachialis

55 Brachial Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Extensor indicis Extensor pollicis longus and brevis Extensor digitorum Extensor digiti minimi Extensorcarpiulnaris Supinator Anconeus Medial head of triceps brachii Long head of triceps brachii Medial cord Posterior cord Lateral cord Radial Nerve Formed from the posterior cord, posterior division of the brachial plexus C5–T1 Radial nerve Lateral head of triceps brachii Brachioradialis Extensor carpi radialis Abductor pollicis longus Posterior arm muscles (extend forearm) Triceps brachii Anconeus Posterior forearm muscles (supinate forearm, extend wrist, digits, one muscle that abducts thumb) Supinator Extensor carpi radialis muscles Extensor digitorum Extensor carpi ulnaris Extensor pollicis longus Extensor pollicis brevis Abductor pollicis brevis Extensor digiti minimi Extensor indicis Brachioradialis (flexes forearm) Posterior region of arm Posterior region of forearm Dorsal aspect of lateral three digits (except their distal tips)

56 Brachial Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Table 16.3 Terminal BranchCutaneous InnervationMotor Innervation Anterior Rami Branches of the Brachial Plexus (continued) Ulnar Nerve Formed from the medial cord, anterior division of the brachial plexus Lateral cord Posterior cord Medial cord Ulnar nerve Flexor carpi ulnaris Flexor digitorum profundus (medial half) Adductor pollicis Dorsal and palmar interossei Hypothenar muscles Medial two lumbricals Anterior forearm muscles (flexors of wrist and digits) Medial half of flexor digitorum profundus Flexor carpi ulnaris Dorsal and palmar aspects of medial 1-1/2 digits (little finger, medial aspect of ring finger) Intrinsic hand muscles Hypothenar muscles Palmar interossei (adduct fingers) Dorsal interossei (abduct fingers) Medial two lumbricals (flex MP joints and extend PIP and DIP joints) C8–T1 Adductor pollicis (adducts thumb)

57 Brachial Plexus

58 Lumbar Plexus The left and right lumbar plexuses are formed from the anterior rami of spinal nerves L1–L4. The lumbar plexus is subdivided into an anterior division and a posterior division. The main nerve of the posterior division is the femoral nerve. The main nerve of the anterior division is the obturator nerve.

59 Lumbar Plexus Figure 16.10

60 Lumbar Plexus Figure 16.10

61 Lumbar Plexus Figure 16.10

62 Lumbar Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Femoral Nerve Table 16.4 Main BranchAnterior Rami Motor InnervationCutaneous Innervation Branches of the Lumbar Plexus L2 L3 L4 Iliacus Femoral nerve Sartorius Rectus femoris Vastus intermedius Vastus lateralis Sartorius Vastus medialis Pectineus Psoas major L2–L4Anterior thigh muscles Pectineus 1 Anterior thigh Inferomedial thigh Most medial aspect of foot Medial side of leg Quadriceps femoris (knee extensor) Iliopsoas (hip flexor) Sartorius (hip and knee flexor)

63 Lumbar Plexus L2–L4 L2 Obturator Nerve Obturator externus Adductor brevis Adductor longus Adductor magnus Gracilis Adductor longus Obturator nerve Obturator externus (lateral rotator of thigh) Superomedial thigh Medial thigh muscles (adductors of thigh) Pectineus 1 Gracilis Adductors L3 L4 1 Pectineus may be innervated by the femoral nerve, obturator nerve, or branches from both nerves Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

64 Lumbar Plexus

65 Sacral Plexus The left and right sacral plexuses are formed from the anterior rami of spinal nerves L4–S4. The lumbar and sacral plexuses are sometimes considered together as the lumbosacral plexus. The anterior rami are organized into an anterior division and a posterior division.

66 Sacral Plexus The sciatic nerve is the largest and longest nerve in the sacral plexus and in the body. The sciatic nerve is composed of two divisions wrapped in a common sheath: 1. the tibial division 2. the common fibular division.

67 Sacral Plexus The main branches of the sciatic nerve are the: tibial nerve common fibular nerve deep fibular nerve superficial fibular nerve

68 Sacral Plexus Figure 16.11

69 Sacral Plexus Figure 16.11

70 Sacral Plexus Figure Gluteus maximus (cut) Inferior gluteal nerve Sacrotuberous ligament Sciatic nerve Gluteus medius (cut) Gluteus minimus Superior gluteal nerve Posterior femoral cutaneous nerve Gluteus maximus (cut) Pudendal nerve (c) Right gluteal region Biceps femoris Gracilis Semimembranosus Tibial nerve Common fibular nerve Popliteal artery Medial sural cutaneous nerve Semitendinosus Plantaris Gastrocnemius, lateral head Lateral sural cutaneous nerve (d) Right popliteal region Gastrocnemius, medial head c,d: © The McGraw-Hill Companies, Inc./Photo and Dissection by Christine Eckel Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

71 Sacral Plexus Table 16.5 Sciatic Nerve Main Branch Branches of the Sacral Plexus Anterior RamiMotor InnervationCutaneous Innervation Tibial Nerve L4–S3 (Composed of tibial and common fibular divisions wrapped in a common sheath) (See tibial and common fibular nerves) (See tibial and common fibular nerves) L4 L5 S1 S2 S3 L4–S3 Posterior thigh muscles (extend thigh and flex leg) Branches to the heel, and via its medial and lateral plantar nerve branches (which supply the sole of the foot) Long head of biceps femoris Semimembranosus Semitendinosus Part of adductor magnus Posterior leg muscles (plantar flexors of foot, flexors of knee) Flexor digitorum longus Flexor hallucis longus Gastrocnemius Soleus Popliteus Plantar foot muscles (via medial and lateral plantar nerve branches) Biceps femoris (long head) Semitendinosus Semimembranosus Tibial division of sciatic nerve Adductor magnus Tibial nerve Gastrocnemius Popliteus Soleus Tibialis posterior Flexor digitorum longus Flexor hallucis longus Medial plantar nerve Lateral plantar nerve Tibialis posterior (inverts foot) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

72 Sacral Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Short head of biceps femoris (knee flexor); see also deep fibular and superficial fibular nerves (See deep fibular and superficial fibular nerves) Common Fibular Nerve (Divides into deep fibular and superficial fibular branches) L4–S2 S3 S2 S1 L5 L4 Common fibular division of sciatic nerve Biceps femoris short head Common fibular nerve Fibularis longus Fibularis brevis Superficial fibular nerve Extensor digitorum longus Fibularis tertius Extensor digitorum brevis Tibialis anterior Deep fibular nerve Extensor hallucis longus Extensor hallucis brevis

73 Sacral Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Deep Fibular Nerve Table 16.5 Branches of the Sacral Plexus (continued) Main BranchAnterior RamiMotor InnervationCutaneous Innervation L4–S1 Anterior leg muscles (dorsiflex foot, extend toes) Dorsal interspace between first and second toes Tibialis anterior (inverts foot) Extensor hallucis longus Extensor digitorum longus Fibularis tertius Dorsum foot muscles (extend toes) Extensor hallucis brevis Extensor digitorum brevis Common fibular nerve Superficial fibular nerve Extensor digitorum longus Fibularis tertius Extensor digitorum brevis Tibialis anterior Deep fibular nerve Extensor hallucis longus Extensor hallucis brevis

74 Sacral Plexus Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Superficial Fibular NerveL5–S2Lateral leg muscles (foot evertors and plantar flexors) Fibularis longus Fibularis brevis Anteroinferior part of leg; most of dorsum of foot Common fibular nerve Fibularis longus Fibularis brevis Superficial fibular nerve

75 Reflexes Reflexes are rapid, automatic, involuntary reactions of muscles or glands to a stimulus. A stimulus is required to initiate a response to sensory input. A rapid response requires that few neurons be involved and synaptic delay be minimal. An automatic response occurs the same way every time. An involuntary response requires no intent or pre-awareness of the reflex activity.

76 Reflexes A reflex arc is the neural wiring of a single reflex. Always begins at a receptor in the PNS Communicates with the CNS Ends at a peripheral effector

77 Simple Reflex Arcs Figure 16.12

78 Reflexes A reflex arc may be: Ipsilateral—both the receptor and effector organs are on the same side Contralateral—the sensory impulses from a receptor organ cross over through the spinal cord to activate effector organs on the opposite limb

79 Reflexes Reflexes may be: Monosynaptic—sensory axons synapse directly on motor neurons, whose axons project to the effector Polysynaptic—more complex pathways that exhibit a number of synapses involving interneurons within the reflex arc

80 Monosynaptic and Polysynaptic Reflexes Figure 16.12

81 Examples of Spinal Reflexes Withdrawal reflex—polysynaptic reflex arc –Painful stimulus causes transmission of sensory information to the spinal cord. –Interneurons receive the sensory information and stimulate the motor neurons to direct flexor muscles to contract in response. –Simultaneously, antagonistic extensor muscles are inhibited so that the traumatized body part may be quickly withdrawn from the harmful stimulation.

82 Examples of Spinal Reflexes Stretch reflex—monosynaptic reflex arc –Stretch in a muscle is monitored by a stretch receptor called the muscle spindle. –When a stimulus results in the stretching of a muscle, the muscle reflexively contracts.

83 Examples of Spinal Reflexes Golgi tendon reflex: –Golgi tendon organs are nerve endings located within tendons near a muscle–tendon junction. –As a muscle contracts, force is exerted on its tendon, resulting in increased tension in the tendon and activation of the Golgi tendon organ. –Nerve impulses signal interneurons in the spinal cord, which in turn inhibit the actions of the motor neurons.

84 Stretch Reflexes Figure 16.14

85 Golgi Tendon Reflex Figure 16.15

86 Spinal Cord Development Figure 16.16


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