E4- Regional Neuroanatomy : Upper Flashcards
A positional word that means near the front end of the body, especially in the region of the nose and mouth.
- Rostral
A positional word that means at or near the tail or the posterior part of the body.
- Caudal/Caudad
Cephalad
- Word used to refer to something superior and anterior of the body.
similar to rostral
Describe the anatomical position.
- Face forward
- Standing up straight
- Palms out on the anterior plane
- Thumbs extend laterally
A word that describes something sensory and peripheral. Something that might feel pain.
- Cutaneous
The other conduction in the peripheral system will be motor.
A term that describes bundles of neurons and axons outside the CNS.
- Nerve
vs tract
A term that describes bundles of neurons and axons within the CNS.
- Tracts
vs nerve
What is a ganglia?
- Bundles of cell bodies in the peripheral nervous system
vs nuclei
What is a nuclei?
- Bundle of cell bodies within the CNS.
vs ganglia
_______ come together to make a Root.
- Rootlets
- individual bundles of neurons coming out of spinal cord
***
Where is the spinal ganglion located?
- Within the posterior root
The junction of the posterior root and anterior root will be called the ________.
- Spinal Nerve
- This point will be the start of the Peripheral Nervous System
The anterior of the spinal cord will be connected to the ______ system.
- Motor System (Efferent)
The posterior of the spinal cord will be connected to the ______ system.
- Sensory System (Afferent)
What will be the first branch off of spinal nerve?
Function?
- Posterior Ramus
- sensory component for backside (posterior)
What will be the second projection of the spinal nerve?
Function?
- Anterior Ramus
- motor output, sensory input, + branch of the autonomic nervous system.
Of the two spinal nerve projections, which one is larger?
- Anterior Ramus
How does the Anterior Ramus connect to the sympathetic chain (sympathetic ganglion)?
- Gray Ramus Communicans (proximal)
- White Ramus Communicans (distal)
Chain = inside of thorax, neck, abdomen
Route from rootlet to sympathetic chain
- Rootlet root spinal nerve posterior / anterior rami gray / white rami communicons sympathetic chain
How is sacrum different from rest of spine?
- superior spine = spinal nerves out of intervertebral foramen
- sacrum = posterior rami out posterior foramina ,, anterior rami out anterior sacral foramina
Explain why the left sympathetic chain is more posterior and lateral on the spinal column than the right.
- The aorta sits on the left side of the vertebral body and pushes the left sympathetic chain (left spinal ganglia) posteriorly and laterally during development.
What are the branches of the posterior ramus?
- Medial branch of the Posterior Rami
- Lateral branch of the Posterior Rami
Primarilysensory
What are the branches of the anterior ramus?
- Anterior Cutaneous Branch - front + midline
- Lateral Cutaneous Branch - sides
What is another name for the anterior ramus?
- Intercostal nerve
The intercostal nerve usually sits INFERIOR its correspondivng rib cage.
What is the subcostal nerve?
Intercostal nerves below the true ribs of rib cage
rib 10-12
Spinal nerve C8 exits from _________ (above/below) vertebrae C7.
- Below
Spinal nerve C1 through C7 exit from _______ (above/below) its corresponding cervical vertebrae.
- Above
The thoracic spinal nerves T1 to T12 exit from ______- (above/below) the corresponding thoracic vertebrae.
- Below
The spinal nerves L1 to L5 exit from ______- (above/below) the corresponding lumbar vertebrae.
- Below
Spinal Nerve Pairs:
- Cervical
- Thoracic
- Lumbar
- Sacral
- Coccygeal
- 8 pairs of Cervical Spinal Nerves
- 12 pairs of Thoracic Spinal Nerves
- 5 pairs of Lumbar Spinal Nerves
- 5 pairs of Sacral Spinal Nerves
- 1 pair of Coccygeal Spinal Nerves
- 31 pairs total
Where do the cervical spinal nerves provide sensory innervation to?
- Most of the head and upper extremities
Where do the thoracic spinal nerves provide sensory innervation to?
- Portion of the upper extremity
- Large portion of the torso
Where do the lumbar and sacral spinal nerves provide sensory innervation to?
- Lower extremity
Label 1
- Posterior Rootlets
Label 2
- Posterior Root (with spinal ganglion)
Label 3
- Spinal Nerve
Label 4
- Posterior Ramus
Label 5
- Anterior Ramus
Label 6
- Gray Ramus Communicans
Label 7
- White Ramus Communicans
Label 8
- Sympathetic ganglion
Label 9
- Meningeal branch
Label 10
- Anterior Root
Label 11
- Anterior Rootlets
Label 1 + 2
- Anterior Cutaneous Branch
- Lateral Cutaneous Branch
Of anterior rami
Label 3
Anterior Ramus
Label 4
- Meningeal Branch
Label 5
- Medial Branch
Label 6
- Lateral Branch
Label 7
- Posterior Ramus
Label 1
- Posterior Ramus
Label 2
- Anterior Ramus (Intercostal Nerve)
Label 3
- Lateral Cutaneous Branch
Label 4
- Anterior Cutaneous Branch
Label 1
- Medial branch
Label 2
- Lateral cutaneous branch
Label 3
- Superior clunial nerve
Label 4
- Middle clunial nerve
Label 5
- Supraclavicular nerve
Label 6
- Axillary nerve
Label 7
- Intercostal nerve (lateral cutaneous branch)
Label 8
- Iliohypogastric nerve
What dermatome landmark will be T4?
- Nipple Line
What dermatome landmark will be T6?
- Xiphoid Process
What dermatome landmark will be T10?
- Umbilicus
The anterior roots of C3, C4, and C5 combine and form the ______ nerve.
- Phrenic Nerve
Spinal Nerves C3, C4, C5 will run under what cervical vertebrae?
- Vertebrae C2, C3, and C4
Which cervical spinal nerve is not sensory?
C1 - not on dermatome
The occipital nerves are named based on what factors?
- Size and Position
For example, the Greater Occipital Nerve is very large, and it covers a large portion of the back of the head.
The Greater Occipital Nerve originates from what spinal nerve?
- Spinal Nerve C2
Superior + LARGEST
The 3rd Occipital Nerve originates from what spinal nerve?
- Spinal Nerve C3
What nerve will provide sensory innervation to the top of the shoulder?
- Supraclavicular Nerve
The Suboccipital Nerve originates from what spinal nerve?
- Spinal Nerve C1
Where does the suboccipital nerve provide sensory innervation to?
Originates from?
- It doesn’t. It is PURELY MOTOR.
- This nerve (C1) is not part of the cutaneous innervation.
- No dermatome for C1
Label 1
- Lesser occipital nerve
Label 2
- Suboccipital nerve (C1)
Label 3
- Great auricular nerve
Label 4
- Greater occipital nerve (C2)
Label 5
- 3rd Occipital Nerve
Label 6
- Supraclavicular Nerve
Label 7
- C5 Spinal Nerve of the Posterior Ramus
Label 1
- 3rd occipital nerve
Label 2
- Greater occipital nerve
Label 3
- Lesser occipital nerve
Label 4
- Great auricular nerve
The trapezius muscle is used as an accessory for ventilation. It receives input from what nerve?
- Accessory Nerve
What are the accessory muscles of exhalation?
- Abdominal Muscles
- External Oblique
- Internal Oblique
Label 1
- Supraclavicular Nerve
Label 2
- Anterior cutaneous branch
Label 3
- Lateral cutaneous branch
Label 4
- Intercostal nerve / anterior ramus
Label 5
- Iliohypogastric Nerve
The dorsal part of the spinal cord is routed through the __________.
- Posterior Ramus
Posterior Ramus C1
Nerve:
Sensory Function:
Motor Function:
Posterior Ramus C1
Nerve: Suboccipital Nerve
Sensory Function: No C1 dermatome
Motor Function: Innervates Intrinsic Nuchal Muscles
Posterior Ramus C2
Nerve:
Sensory Function:
Motor Function:
Posterior Ramus C2
Nerve: Greater occipital nerve
Sensory Function: Innervate C2 dermatome
Motor Function: Innervates Intrinsic Nuchal Muscles
Posterior Ramus C3
Nerve:
Sensory Function:
Motor Function:
Posterior Ramus C3
Nerve: 3rd occipital nerve
Sensory Function: Innervate C3 dermatome
Motor Function: Innervates Intrinsic Nuchal Muscles
MIXED nerve
Where does the Phrenic nerve originate?
from anterior rami of C3, C4, C5
What are the four nerves of the cervical plexus?
- Lesser occipital nerve (C2)
- Great auricular nerve (C2,C3)
- Transverse cervical nerve (C2,C3)
- Supraclavicular nerve (C3,C4)
A cervical plexus = C2-C4
These four nerves can arise from the anterior ramus of spinal nerve C2, C3, or C4.
Where is the origin of the supraclavicular nerve?
- Spinal Nerve C3 and C4
Where does the transverse cervical nerve provide sensory information?
- Anterior and medial part of the neck
Where is the origin of the transverse cervical nerve?
- Spinal Nerve C2 and C3
Where is the origin of the great auricular nerve?
- Spinal Nerve C2 and C3
Where is the origin of the lesser occipital nerve?
- Spinal Nerve C2
Where does the lesser occipital nerve provide sensory information?
- lateral neck to right above the earlobe
Label the nerves of the cervical plexus 1-4.
- 1: Lesser occipital nerve
- 2: Great auricular nerve
- 3: Transverse cervical nerve
- 4: Supraclavicular nerve
Label the nerve that best corresponds with 1-4.
- 1: Transverse cervical nerve
- 2: Lesser occipital nerve
- 3: Great auricular nerve
- 4 : Supraclavicular nerve
What neck muscle does the phrenic nerve sit on?
Next to?
- Anterior Scalene Muscle
- Middle Scalene muscle
- Rides in groove bw
Where are the two proximal connection points of the sternocleidomastoid muscle?
- Connection point on at the sternum
- Connection point on the clavicle - extends lateral + posterior
What are the spinal nerves that contribute to the brachial plexus?
- Spinal Nerve C5, C6, C7, C8, and T1
- Anterior Rami of the Spinal Nerves
What is the potential space between the anterior and middle scalene muscle called?
Why is this potential space important?
- Interscalene space
- This space can be utilized to perform a scalene brachial plexus block
Mneumonic to remember splitting of brachial plexus
Randy Travis Drinks Cold Beer
* Anterior Rami Trunks Divisions Cords branches
What are the trunks of the brachial plexus?
- Upper: Rami C5 + C6
- Middle: Rami C7
- Lower: Rami C8 and T1
What are the divisions of the brachial plexus?
-
6 Divisions, each trunk forms one anterior and one posterior division.
o Ea trunk splits into two forming anterior + posterior divisions
o Upper trunk anterior + posterior division
o Middle trunk anterior + posterior division
o Lower trunk anterior + posterior division
The divisions combine to form ______.
Name them.
- CORDS
- 3 posterior divisions combine to form Posterior Cord
- 2 anterior divisions from upper + middle trunk combine to form Lateral Cord
o C5-C7 - 1 anterior division from C8-T1 forms the Medial Cord
What components are in the supraclavicular regions of the brachial plexus?
- Anterior Rami (C5-T1)
- The Trunks (Upper, Middle, Lower)
- The Divisions (6 divisions)
What components are in the infraclavicular regions of the brachial plexus?
- Lateral Cord
- Posterior Cord
- Medial Cord
The posterior cord splits to give us what two nerves?
- Axillary nerve
- Radial nerve
The lateral cord splits to give us what two nerves?
- Musculocutaneous nerve
- Lateral Root (a portion of the median nerve)
The lateral root will combine with the median root to form what nerve?
- Median Nerve
The medial cord splits to give us what two nerves?
- Ulnar Nerve
- Median Root (a portion of the median nerve)
What two nerves does the median nerve sit between?
- Ulnar Nerve
- Radial Nerve
5 Terminal Brachial Plexus Nerves
Which ones are smaller vs. larger
small = axillary + musculocutaneous
larger = radial, median, ulnar
Mneumonic for Brachial Plexus
- YOUTUBE VIDEO :: 3 musketeers ,, 2 were assassinated – 4 men , 5 rats , 3 unicorns
o # fingers C5-T1
o 3 = musculocutaneous
o 2 = axillary
o 4 = median
o 5 = radial
o 3 = ulnar
The axillary nerve has what cervical spinal nerve origins?
- C5
- C6
The radial nerve has what cervical spinal nerve origins?
- C5
- C6
- C7
- C8
- T1
The ulnar nerve has what cervical spinal nerve origins?
- C7
- C8
- T1
The median nerve has what cervical spinal nerve origins?
- C6
- C7
- C8
- T1
The musculocutaneous nerve has what cervical spinal nerve origins?
- C5
- C6
- C7
What sensory branch is innervated by the axillary nerve?
- Superior lateral brachial cutaneous (lateral deltoid)
What are the anterior cutaneous regions that the radial nerve innervates?
- Lateral Superior Thumb
- Lateral Anterior Biceps/Triceps
What are the posterior cutaneous regions that the radial nerve innervates?
- Lateral Posterior Triceps
- Middle Posterior Forearm
- Posterior Thumb and First 2 Fingers
What sensory branch is innervated by the musculocutaneous nerve?
- Lateral Antebrachial Cutaneous Nerve (anterior lateral forearm)
- Very small posterior of the posterior forearm
What are the anterior cutaneous regions that the ulnar nerve innervates?
- Medial palmer surface of last two fingers
- Anterior medial wrist
What are the posterior cutaneous regions that the ulnar nerve innervates?
- Medial Posterior Wrist
- Most of the last 2 Fingers
What are the posterior cutaneous regions that the median nerve innervates?
- Posterior fingertips of first two digits
- Proper palmar digital nerves
What are the anterior cutaneous regions that the median nerve innervates?
- Most of the palm
- Anterior thumb
- Anterior surface of first two fingers
- Small section of the anterior wrist
- Palmar branch of the median nerve
- Common and proper palmar digital nerve
Label 1
- Anterior Cutaneous Branch
