1. The Spinal Nerves SHANDONG UNIVERSITY Liu Zhiyu

2. General description 31 pairs spinal nerves:  Cervical nerves—8 pairs (C1-C8)  Thoracic nerves—12 pairs (T1-T12)  Lumbar nerves—5 pairs (L1-L5)  Sacral nerves—5 pairs (S1-S5)  Coccygeal nerves—1 pair (Co1)

3. Formation: each spinal nerve is formed by union of anterior and posterior roots at intervertebral foramen  The anterior root － contains motor fibers for skeletal muscles. Those from T1 to L2 contain sympathetic fibers; S2 to S4 also contain parasympathetic fibers.  The posterior root － contains sensory fibers whose cell bodies are in the spinal ganglion. General Description

4. Functional Components of Spinal Nerves Somatic efferent nerve fibers (SE): fibers that transmit motor impulses from spinal cord to skeletal muscles. Visceral efferent nerve fibers (VE): fibers that transmit motor impulses from spinal cord to smooth muscles, cardiac muscle and glands. Somatic afferent nerve fibers (SA): fibers that transmit exteroceptive and proprioceptive impulses from body to spinal cord Visceral afferent nerve fibers (VA): fibers that transmit interoceptive impulses from the viscera to spinal cord

5. Branches of spinal nerves Anterior branch Posterior branch Communicating branch Meningeal branch

6. Cervical plexus Formation: formed by anterior rami of C1-C4 spinal nerves Position: lies in front of the origin of levator scapulae and scalenus medius and deep to the superior part of the sternocleidomastoid C1 C2 C3 C4

7. Branches of Cervical Plexus Cutaneous branches:  Lesser occipital  Great auricular  Transverse nerve of neck  Supraclavicular nerves Emerge around middle of posterior border of sternocleidomastoid, to supply skin of neck and scalp between auricle and external occipital protuberance

8. Branches of Cervical Plexus Phrenic nerve Arises from anterior rami of C3-C5 (motor and sensory) Runs vertically downward across the front of the scalenus anterior Enters the thorax by passing betweem the subclavian a. and v.

9. Branches of Cervical Plexus Phrenic nerve Accompanied by pericardiophrenic vessels and passes anterior to lung roots between mediastinal pleura and pericardium to supply motor and sensory innervation to diaphragm Sensory fibers supply to pleurae, pericardium and peritoneum of diaphragm; usually right phrenic nerve may be distributed on live, gallbladder and biliary system.

10. Brachial Plexus Formation: Formed by anterior rami of C5- C8 and T1 spinal nerves Position: Passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form three cords

11. Main branche of brachial plexus Lateral cord  musculocutaneous n.  lateral root of median n. Medial cord  medial root of median n.  ulnar n. Posterior cord  radial n.  axillary n.

12. Main Branche of Brachial Plexus Musculocutaneous nerve Origin: arises from the lateral cord of the brachial plexus. Distribution:  Biceps brachii  Brachalis BBC nerve  Coracobrachialis  Skin on anterior aspect of forearm

13. Main Branche of Brachial Plexus Median nerve Origin: arises from the medial and lateral cord of the brachial plexus. Muscular branches:  Flexor of forearm except brachioradialis flexor carpi ulnaris and ulnar half of flexor digitorum profundus  Thenar except adductor pollicis, first two lumbricals Cutaneous branches ：  Skin of thenar, central part of palm,  Palmar aspect of radial three and one- half fingers, including middle and distal fingers on dorsum Injury: Apehand

14. Main Branche of Brachial Plexus Ulnar nerve Origin: arises from the medial cord of the brachial plexus. Muscular branches: Flexor carpi ulnaris, ulnar half of flexor digitorum profundus, hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; Cutaneous branches ： Skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingers Injury: clawhand

15. Radial nerve Origin: arise from the posterior cord of the brachial plexus Course: Winds around the back of the arm in the spinal groove of the back of the humerus between the heads of the triceps. It pierces the lateral fascial septum above the elbow and divides into superficial and deep branches.

16. Radial nerve Distribution:  Extensor muscles of arm and forearm, brachioradialis;  skin on back of arm, forearm, and radial side of dorsum of hand and radial two and one- half fingers Injury: wristdrop

17. Main Branche of Brachial Plexus Axillary Origin: arises from the posterior cord of the brachial plexus. Distribution: Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of arm Injury: result in deltoid andteres minor paralysis (loss of shoulser abdution and weel external rotation) with loss of sensation over the deltoid

18. Anterior branches of thoracic nerves Intercostal nerves (anterior rami of T1- T11) Subcostal nerve (anterior ramus of T12) Distribution: distributed to intercostales and anterolateral abdominal muscles, skin of thoracic and abdominal wall, parietal pleura and peritoneum

19. Segmental Innervation of Skin Adjacent dermatomes overlap considerably, so that to produce a region of complete anesthesia at least three contiguous spinal nerves have to be sectioned.

20. Segmental Innervation of Skin Dermatome: the area of skin supplied by a single nerve, and, therefore, a single segment of the spinal cord. On the trunk the dermatomes extend round the body from the posterior to the anterior median plane. T2 Sternal angle T4 Nipple T6 Xiphoid process T8 Costal arch T10 Umbilicus T12 Midpoint between umbilicus and symphysis pubis

21. Lumbar plexus Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4 L1 L2 L3 L4

22. Main branche of lumbar plexus Position: lies within substance of psoas major Branches  Iliohypogastric  Ilioinguinal  Lateral femoral cutaneous  Femoral  Obturator  Genitofemoral

23. Branches of Lumbar Plexus Femoral nerve passes deep to inguinal ligament; supplies anterior thigh muscles (quadriceps, sartorius and pectineus), hip and knee joint, and skin on anteromedial side of thigh, saphenous nerve is distributed to skin of medial side of leg and foot Obturator nerve Enters thigh through obturator foramen; supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh

24. Sacral Plexus Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves Position: lies in pelvic cavity, anterior to sacrum and piriformis L5 L4 S1 S2 S3 S4 S5 Co

25. Main branches of sacral plexus Superior gluteal n. Inferior gluteal n. Pudendal n. Posterior femoral cutaneou n. Sciatic n.

26. Branches of Sacral Plexus Sciatic nerve Leaves pelvis through infrapiriform foramen to enter gluteal region, runs inferiorly laterally deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, lying deep to long head of biceps femoris, normally divided into tibial and common peroneal nerves just above popliteal fossa; innervates semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

27. Branches of Sacral Plexus Tibial nerve Decends through popliteal fossa and lies on popliteus; then runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves; supplies posterior muscles of leg and knee joint

28. Branches of Sacral Plexus Common peroneal nerve Arises at apex of popliteal fossa and follows medial border of biceps femoris and its tendon; passes over posterior aspect of head of fibula and then winds around neck of fibula, deep to peroneus longus, where it divides into deep and superficial peroneal nerves

29. Branches of Sacral Plexus Deep peroneal nerve  Arises between peroneus longus and neck of fibula; descends on interosseous membrane and enters dorsum of foot  Supplies anterior muscles of leg, and skin of first interdigital cleft Superficial peroneal nerve  Arises between peroneus longus and neck of fibula and descends in lateral compartment of leg  Supplies peroneus longus and brevis and skin on anterior surface of leg and dorsum of foot