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spinal nerve• overview• cervical plexus• brachial plexus• anterior branches of thoracic nerve• lumbar plexus• sacral plexus• the correlate anatomical basement of the spinal nerve in

jury’s location • the innervation of main joints all over the body

cranial nervevisceral nervous system

Chapter 18 peripheral nerveous system

Nervous system

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overview

cranial nerve

spinal nerve

visceral nerve

visceral nerve （ automatic nervous system)

sympathetic nerve

parasympathetic nerve

peripheral nerve

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ganglia

cranial gangliaspinal ganglia（ dorsal root ganglion）visceral motor ganglion

nerve In peripheral nervous system, the fibers assemble as nerve.

endoneural membraneEndoneuriumlamellar sheathepineurium

medullary sheath： is composed of Sch’s processes by convoluted neurons of layers.

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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)

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31 对

anterior root—motor

posterior root—nerve spinal ganglia

C 8

T 12

L 5

S 5

Co 1

Spinal cord overview (一 )the construction, subdivision and fiber ingredients

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Fiber ingredients

somatic sensory fibervisceral sensory fibersomatic motor fibervisceral motor fiber

1.Meningeal branch2. communicating branch white communicating branch, gray communicating branch3. posterior branch medial branch, lateral branch, muscular branch , cutaneous branches4. anterior branches cervical plexus ,brachial plexus, lumbar plexus ,sacral plexus

the typical branches of spinal nerve

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anterior branches of C1-4

superficial cutaneous branches —the middle point of sternomastoid’s posterior border

cervical plexus

the composition and position of cervical plexus

branches of cervical plexus

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)

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5. diaphragmatic nerve(C3－ C5)

muscular branch dominate the muscle of deep layer, levator scapulae and infrahyoid muscles group

ansa cervicalis(loop of hypoglossal nerve)

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C5-8, anterior branches of T1scalene fissure

brachial plexus

the construction and position of brachial plexus

the branches of brachial plexus

1. long thoracic nerve(C5－ C7) serratus anterior 2. thoracodorsal nerve(C6－ C8) latissimus dorsi muscle3. axillary nerve(C5－ C6) 4. musculocutaneous nerve(C5－ C7)

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5. median nerve(C6－ T1) 6. ulnar nerve(C8,T１ ) 7. radial nerve(C5－ T１ )

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M median nerveU ulnar nerveR radial nerve

the innervation of skin of hand

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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 )

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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

12 pairs the 1st to 11th intercostal nerve the 12th subcostal nerve

the anterior branch of thoracic nerve

cutaneous branches lateral cutaneous branch anterior cutaneous branch

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The segmental distribution of anterior branch of thoracic nerve

T2 areal is at the level of sternal angleT4 areal is at the level of mammary papillaT6 areal is at the level of xiphisternal synchondrosisT8 areal is at the level of costal arch（ between umbilicus and xiphoid process）T10 areal is at the level of umbilicusT12 areal is at the level of middle point of line of umbilicus and pubic symphysis

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T12 L1-3.4

lumbar plexus

the constitution and position of lumbar plexus

the branches of lumbar plexus 1. iliohypogastric nerve(T12,L1)2. ilioinguinal nerve(L1) 3. lateral femoral cutaneous nerve(L ２ - ３ ) 4. femoral nerve(L ２ -L4) 5. obturator nerve(L ２ -L4) 6. genitofemoral nerve(L1,L ２ )

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L4.5 S1-5 Co1

sacral plexus the constitution and position of sacral plexus

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)

superior gluteal nerveinferior gluteal nerve

posterior femoral cutaneous nerve

pudendal nerve

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5. sciatic nerve(L4 L5 S1-S3) (1) tibial nerve(L4,L5,S1-S3)

medial plantar nerve lateral plantar nerve

medial plantar nerve

lateral plantar nerve

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(2) common peroneal nerve(L4, L5, S1, S2) superficial peroneal nerve deep peroneal nerve

deep peroneal nerve

superficial peroneal nerve

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the related anatomical basement of the injury location of spinal cord

the segmental regularity of the distribution of spinal cord

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the muscles detected for clinical affection and its innervation

the motor related muscles for level diagnosis of upper limb nerveand its innervation

motor the name of muscles nerve nerve segment

abduction of shoulder deltoid axillary nerve

C5

bending ofelbow biceps brachii musculocutaneous n

erve C5,C6

extending wrist of radialis

extensor carpi radialis muscle radial nerve C6

extending wrist of radialis

extending elbow flexion of finger abduction of thumb

triceps brachiiflexor pollicis longus， flexor digitorum profundusabductor pollicis brevisfirst dorsal interossei

radial nervemedian nervemedian nerveulnar nerve

C7

C8

T1

C8,T1

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The related muscles detected for level diagnosis of lower limb nerve and its innervation

motor name of muscle nerve nerve segment

flexion ofhip bone iliopsoas muscle femoral nerve L1,L2

adduction ofhip bone ator of thigh obturator nerve L2,L3

extention ofknee quadriceps femoris femoral nerve L3,L 4

dorsiflexion anterior tibial deep peroneal L4

of ankle muscle nervecross-foot tibialis posterior tibial nerve L4,L 5

strephexopodia peroneus longus superficial peroneus brevis peroneal nerve L5,S

1genuflex biceps femoris sciatic nerve S1plantar flexion of ankle triceps surae tibial nerve S1,S 2