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Peripheral Nerves- The Mystery of the Braids

Peripheral Nerves- The Mystery of the Braids. Neuroanatomy: A Clinician’s Review: CHRMC Spring 2007 Bernadette Gillick, MS, PT. Brachial Plexus “Simplified”. Dorsal Scapular Nerve Suprascapular Nerve Nerve to Subclavius Lateral Pectoral Nerve Axillary Nerve Radial Nerve

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Peripheral Nerves- The Mystery of the Braids

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  1. Peripheral Nerves- The Mystery of the Braids • Neuroanatomy: A Clinician’s Review: CHRMC • Spring 2007 • Bernadette Gillick, MS, PT

  2. Brachial Plexus “Simplified” • Dorsal Scapular Nerve • Suprascapular Nerve • Nerve to Subclavius • Lateral Pectoral Nerve • Axillary Nerve • Radial Nerve • Thoracodorsal Nerve • Subscapular Nerve • Medial Pectoral Nerve • Medial Cutaneous Nerve- Arm and Forearm • Musculocutaneous Nerve • Median Nerve • Ulnar Nerve

  3. Nerves acting on the Thumb

  4. Radial- Abductor Pollicis Longus

  5. Ulnar- Adductor Pollicis

  6. Median- Flexor Pollicis Longus and Brevis (sup head)

  7. Lumbar Plexus “Simplified” • Iliohypogastric Nerve • Ilioinguinal Nerve • Genitofemoral Nerve • Lateral Femoral Cutaneous Nerve • Femoral Nerve • Obturator Nerve • Saphenous Nerve • Superior Gluteal Nerve • Inferior Gluteal Nerve • Sciatic Nerve • Common Peroneal Nerve • Superficial Peroneal Nerve • Deep Peroneal Nerve • Tibial Nerve • Sural Nerve • Posterior Femoral Cutaneous • Pudendal Nerve

  8. Dermatomes and Myotomes • Dermatome- sensory region of skin innervated by a nerve root • Myotome- muscles innervated by a single nerve root

  9. 28 Total Dermatomes • Two aspects - absent, impaired, normal • Pin Prick (why?) • Light Touch (why?) • Proprioception- absent, impaired, normal • Same one joint on each extremity • Index finger and Great Toe

  10. Common Dermatomal Levels • Remember – Sensation on Chest and Back skips from C4 to T2 as the upper extremities are represented. C4 also dips low on the anterior or ventral neck.

  11. Common Dermatomal Levels • C5- Shoulder • C6- Lateral Arm and Digits 1&2 • C7- Middle Digit • C8- Digits 4 & 5

  12. Common Dermatomal Levels • Nipples- T4 • Umbilicus- T10

  13. Common Dermatomal Levels • L4- Anteromedial Shin • L5- Anterolateral Shin, dorsum of foot to big toe

  14. Common Dermatomal Levels • S1- 5th toe, lateral foot, sole and calf • S2, S3, S4 innervate the perineal area in a “saddle-like” distribution

  15. ASIA, 2006

  16. ASIA, 2006

  17. Common Dermatomal Levels • Face- Trigeminal nerve • Head- C2 via the greater and lesser occipital nerves

  18. Multiple Segments Innervating • Biceps • ECRL • Triceps ASIA, 2006

  19. Myotomes • Helpful to have memorized at least one muscle that gets major innervation from each nerve root

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