Copyright © 2010 Pearson Education, Inc. Figure 13.6
CervicalnervesC1 – C8
ThoracicnervesT1 – T12
LumbarnervesL1 – L5
Sacral nervesS1 – S5
Coccygeal nerve Co1
Cervical plexus
Intercostalnerves
Cervicalenlargement
Lumbarenlargement
Cauda equina
Brachial plexus
Lumbar plexus
Sacral plexus
Copyright © 2010 Pearson Education, Inc. Figure 13.7 (a)
Dorsal rootganglion
Gray matterWhite matterVentral rootDorsal root
Dorsal andventral rootlets of spinal nerve
Dorsal ramusof spinal nerveVentral ramusof spinal nerve
Sympathetic trunkganglion
Spinal nerveRami communicantes
Anterior view showing spinal cord, associated nerves, and vertebrae. The dorsal and ventral roots arise medially as rootlets and join laterally to form the spinal nerve.
Copyright © 2010 Pearson Education, Inc. Figure 13.7 (b)
Dorsal ramus
Ventral ramus
Intercostal nerve
Spinal nerve
Rami communicantesDorsal rootganglion Dorsal rootVentral root
Sympathetic trunkganglion
Sternum
(b) Cross section of thorax showing the main roots and branches of a spinal nerve.
Branches of intercostalnerve
• Lateral cutaneous• Anterior cutaneous
Copyright © 2010 Pearson Education, Inc.
Cervical Plexus
• Formed by ventral rami of C1–C4
• Innervates skin and muscles of the neck, ear, back of head, and shoulders
• Phrenic nerve• Major motor and sensory nerve of the
diaphragm (receives fibers from C3–C5)
Copyright © 2010 Pearson Education, Inc. Figure 13.8
Hypoglossalnerve (XII)
C1
C2
C3
C4
C5
Segmentalbranches
Lesser occipitalnerveGreater auricularnerve
Ansa cervicalis
Phrenic nerveSupraclavicularnerves
Accessory nerve (XI)
Transversecervical nerve
Ventralrami:
Ventral rami
Copyright © 2010 Pearson Education, Inc. Table 13.3
Copyright © 2010 Pearson Education, Inc.
Brachial Plexus
• Formed by ventral rami of C5–C8 and T1 (and often C4 and T2)
• It gives rise to the nerves that innervate the upper limb
• Major branches of this plexus:
• Roots—five ventral rami (C5–T1)
• Trunks—upper, middle, and lower
• Divisions—anterior and posterior
• Cords—lateral, medial, and posterior
Copyright © 2010 Pearson Education, Inc. Figure 13.9 (a)
Upper
Middle Trunks
Lower
Roots (ventral rami):
Upper subscapularLower subscapularThoracodorsalMedial cutaneousnerves of the armand forearm
Long thoracicMedial pectoralLateral pectoral
Nerve tosubclaviusSuprascapular
Dorsal scapular
Posteriordivisions
Anteriordivisions
Lateral
PosteriorCords
Medial
AxillaryMusculo-cutaneousRadialMedianUlnar
Posteriordivisions
Trunks Roots
C4
C5
C6
C7
C8
T1
(a) Roots (rami C5 – T1), trunks, divisions, and cords
Copyright © 2010 Pearson Education, Inc. Figure 13.9 (d)
Anteriordivisions
(d) Flowchart summarizing relationships within the brachial plexus
Major terminalbranches(peripheral nerves)
Cords Divisions Trunks Roots(ventralrami)
MusculocutaneousMedianUlnarRadialAxillary
AnteriorPosteriorAnteriorPosterior
PosteriorAnterior
Upper
Middle
Lower
LateralMedial
Posterior
Posteriordivisions
Trunks Roots
C5
C6
C7
C8
T1
Copyright © 2010 Pearson Education, Inc. Figure 13.9 (c)
Median nerve
Musculocutaneous nerveRadial nerveHumerus
Ulna
Ulnar nerveMedian nerve
Radius
Radial nerve (superficial branch)
Superficial branch of ulnar nerveDorsal branch of ulnar nerve
Digital branch of ulnar nerveMuscular branchDigital branch
(c) The major nerves of the upper limb
Axillarynerve
Anteriordivisions
Posteriordivisions
Trunks Roots
Copyright © 2010 Pearson Education, Inc. Table 13.4
Copyright © 2010 Pearson Education, Inc.
Lumbar Plexus
• Arises from L1–L4
• Innervates the thigh, abdominal wall, and psoas muscle
• Femoral nerve—innervates quadriceps and skin of anterior thigh and medial surface of leg
• Obturator nerve—passes through obturator foramen to innervate adductor muscles
Copyright © 2010 Pearson Education, Inc. Figure 13.10
(a) Ventral rami and major branches of the lumbar plexus
Iliohypogastric
L1
L2
L3
L4
L5
IlioinguinalGenitofemoral
Lateral femoralcutaneousObturatorFemoralLumbosacraltrunk
Lateral femoralcutaneous
Anterior femoralcutaneousSaphenous
Obturator
IliohypogastricIlioinguinalFemoral
Ventral rami Ventralrami:
(b) Distribution of the major nerves from the lumbar plexus to the lower limb
Copyright © 2010 Pearson Education, Inc. Table 13.5
Copyright © 2010 Pearson Education, Inc.
Sacral Plexus
• Arises from L4–S4
• Serves the buttock, lower limb, pelvic structures, and perineum
• Sciatic nerve• Longest and thickest nerve of the body
• Innervates the hamstring muscles, adductor magnus, and most muscles in the leg and foot
• Composed of two nerves: tibial and common fibular
Copyright © 2010 Pearson Education, Inc. Figure 13.11 (a)
SuperiorglutealLumbosacraltrunkInferiorgluteal
CommonfibularTibialPosteriorfemoralcutaneousPudendalSciatic
Ventral rami and major branches of the sacral plexus
L4
L5
S1
S2
S3
S4
S5Co1
Ventral rami Ventral rami:
Copyright © 2010 Pearson Education, Inc. Figure 13.11 (b)
Superior glutealInferior gluteal
Common fibular
Deep fibularSuperficial fibularPlantar branches
TibialSural (cut)
Posterior femoralcutaneous
PudendalSciatic
(b) Distribution of the major nerves from the sacral plexus to the lower limb
Copyright © 2010 Pearson Education, Inc. Table 13.6
Copyright © 2010 Pearson Education, Inc.
Innervation of Skin
• Dermatome: area of skin innervated by cutaneous branches of a single spinal nerve
• All spinal nerves except C1 participate in dermatomes
• Dermatomes overlap, so destruction of a single spinal nerve will not cause complete numbness
Copyright © 2010 Pearson Education, Inc. Figure 13.12
C2C3
C4
C5T1
T2
T2T3T4T5
C6
C8C7 C7
C6
T6T7T8T9T10T11T12L1S2S3
L1
L2
L3
L4
L5
L2
L3
L4
L5
S1
C5
C6
C8
T2
C5
C6
S1
Anterior view
C2
C3C4C5C6C7C8
C8 C8
C7 C7
T1T2T3T4T5T6T7T8T9
T10
T11T12
L1L2 L3
S1(b) Posterior view
L5S2S1
S1
S3
S2 S1S2
S4S5
L5L5
L4L5L5
L4
C6 C6
C5
L4
L3
L2
L1
L4
Copyright © 2010 Pearson Education, Inc.
Innervation of Joints
• Hilton’s law: Any nerve serving a muscle that produces movement at a joint also innervates the joint and the skin over the joint