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PNS -- Torgerud > Exam 3: Thoracic Spinal Nerves, Lumbar Spinal Nerves, Lumbar Plexus > Flashcards

Exam 3: Thoracic Spinal Nerves, Lumbar Spinal Nerves, Lumbar Plexus Flashcards

1
Q

How many pairs of thoracic nerve roots are there?

A

12 pairs

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2
Q

What will each mixed thoracic spinal nerve divide into?

A

posterior and anterior primary ramus

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3
Q

What will the posterior primary ramus of a thoracic spinal nerve divide into? What type of information do they carry?

A

Medial branch–> motor and sensory function

lateral branch –> motor and sensory function

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4
Q

What do the medial branches of the posterior primary rami of a thoracic spinal nerves supply?

A

Motor:

  • Semispinalis (T1-T6)
  • Longissimus (T7-T12)
  • Multifidi (T7-T12)

Sensory:
- skin paraspinally to T1-T12

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5
Q

Describe how the size of the lateral branches of the posterior ramus of the thoracic spinal nerves changes.

A

lateral branches increase in size from superior to inferior (b/c more inferior costal angles get further apart and therefore supply more = more fibers)

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6
Q

What do the lateral branches of the posterior primary rami of thoracic spinal nerves supply?

A

Motor at all levels to:

  • longissimus
  • iliocostalis
  • levator costarum

Sensory:
- skin near costal angles

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7
Q

What course do the Anterior primary rami of thoracic spinal nerve generally follow?

A

the course of the rib above the nerve

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8
Q

Besdies the intercostal nerve, what will the anterior primary ramus of T1 additionally contribute to?

A

brachial plexus and a smaller branch will form the first intercostal nerve

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9
Q

Besides the intercostal nerve, what will the anterior primary rami of T2 (sometimes T1) additionally contribute to?

A

the intercostobrachial nerve

communicates with medial cutaneous nerve of the arm –branch off medial cord of brachial plexus

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10
Q

What will each intercostal nerve give off? What is supplied?

A

a lateral cutaneous branch –> which divides into an:

  • anterior branch of lateral cutaneous nerve
  • posterior branch of lateral cutaneous nerve
  • —-> supplies overlying skin
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11
Q

What do intercostal nerves terminate as? What do they supply?

A

Anterior Cutaneous branches…an:

  • Medial Branch of Anterior Cutaneous nerve
  • Lateral Branch of Anterior Cutaneous nerve
  • –> supply skin close to midline
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12
Q

What levels of the thoracic have intercostal nerves associated with them? What is the name of any that do not follow this pattern?

A

T1-T11 have intercostal nerves

T12 is called subcostal nerve

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13
Q

What muscles do the intercostal nerves supply as they course along their adjacent ribs?

A
  1. Internal intercostals
  2. External intercostals
  3. Innermost intercostals
  4. Serratus posterior
  5. Transversus thoracis
  6. Transverse abdominal (T7-11)
  7. Internal Abdominal oblique (T7-11)
  8. External abdominal oblique (T7-11)
  9. Rectus abdominus (T7-11)
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14
Q

Besides muscles, what else will the intercostal nerves also supply?

A

adjacent blood vessels, bones (ribs), joints, and ligaments

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15
Q

Which is the largest of the thoracic nerves?

A

the Subcostal Nerve (T12 nerve)

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16
Q

What else does the Subcostal nerve contribute to in addition to following a similar course to the intercostal nerves?

A

the lumbar plexus

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17
Q

What skin may the Subcostal nerve supply? Via what nerves?

A

skin close to the spine as far inferior as superior buttocks via Cluneal Nerves

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18
Q

How does each thoracic nerve communicate with the sympathetic trunk?

A

by way of BOTH white and gray rami communicans

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19
Q

The gray ramus communicans is more _____, while the white ramus communicans is more______. (ass. with thoracic nerves)

A

medial

lateral

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20
Q

What type of neurons is the white ramus communicans carrying? What about the grey ramus communicans? Describe where the neurons are going.
(ass. with thoracic nerves)

A

white ramus–> myelinated preganglionic sympathetic nurons to sympathetic trunk

gray ramus–> unmyelinated postganglionic sympathetic neurons away from the sympathetic trunk to the spinal nerve

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21
Q

How many pairs of lumbar spinal nerves are there? How are they named in relationship to the vertebra?

A

five pairs; named for vertebra above the nerve

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22
Q

What does each lumbar nerve root divide into?

A

anterior primary ramus and a posterior primary ramus

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23
Q

When the posterior primary ramus of the lumbar nerve travels posteriorly, what will it divide into and why type of fibers do they carry?

A

Medial branch–> motor
Lateral branches –> motor

(MOTOR ONLY)

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24
Q

What makes the posterior primary rami of lumbar nerves different than those of thoracic and cervical nerves?

A

only carries MOTOR info; whereas C and T’s carry sensory and motor

recall– T12 will supply skin over lumbar spine

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25
Q

What does the medial branch and lateral branch of the posterior primary rami of lumbar nerves supply?

A

medial branch–> multifidi

lateral branch–> erector spinae group

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26
Q

What do the anterior primary rami of lumbar spinal nerves contribute to?

A

lumbar plexus –> L1-L4

sacral plexus –> L4 and L5

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27
Q

Do the lumbar nerves have communication with the sympathetic trunk?

A

yes– there are usually 4 lumbar sympathetic ganglia

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28
Q

How many lumbar sympathetic ganglia are there?

A

usually 4

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29
Q

What lumbar spinal nerves will have association white rami communicans? Which will have gray rami communicans?

A

white rami communicans–> L1, L2, and (sometimes L3)

grey rami communicans –> ALL lumbar nerves

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30
Q

What forms the lumbar plexus?

A

anterior primary rami of L1-L3 and part of L4

also receives contribution from T12 via communication with L1 nerve

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31
Q

What lumbar nerve roots is the quadratus lumborum supplied by?

A

L1, L2, L3, L4

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32
Q

What lumbar nerve roots is psoas minor supplied by?

A

L1

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33
Q

What lumbar nerve roots is psoas major supplied by?

A

L2, L3, L4

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34
Q

What are the Muscular Branches from the anterior rami of lumbar spinal nerves supplying?

A

quadratus lumborum –> L1-L4
psoas minor–> L1
psoas major –> L2-L4

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35
Q

What are the six major nerves of the Lumbar Plexus?

A
  1. Iliohypogastric Nerve (T12, L1)
  2. Ilioinguinal Nerve (T12, L1)
  3. Genitofemoral Nerve (L1, L2)
  4. Lateral Cutaneous Nerve of the Thigh (L2,L3)
  5. Femoral Nerve (L2,L3,L4)
  6. Obturator Nerve (L2,L3,L4)
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36
Q

Describe the path of the iliohypogastric nerve.

A

Travels anterior and inferior b/w quadratus lumborum and the kidney

then through the transverse abdominal muscle

then travels b/w the internal abdominal oblique

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37
Q

What branch does the iliohypogastric nerve give off? What does it supply?

A

Lateral Cutaneous Branch –> posterolateral gluteal region

38
Q

What does the iliohypogastric nerve continue as? What does that supply?

A

the Anterior Cutaneous Branch–> skin of pubic

39
Q

What muscles does the iliohypogastric nerve supply?

A
  1. internal abdominal oblique

2. Transverse abdominal

40
Q

Overall, what does the iliohypogastric nerve supply?

A

Motor:
- internal abdominal oblique
- transverse abdominal
Sensory:
- posterolateral gluteal region (via Lateral cutaneous branch)
- skin of the pubic region (via Anterior Cutaneous branch)

41
Q

What nerve fibers make up the iliohypogastic nerve?

A

T12 and L1 (motor and sensory)

42
Q

What nerve fibers make up the ilioinguinal nerve?

A

T12 and L1 (motor and sensory)

43
Q

Describe the path of the ilioinguinal nerve.

A

Similar to iliohypogastric nerve–> but enters/ goes through the inguinal canal and leaves the canal via the superficial inguinal ring a–> and travels with the spermatic cord (round lig. in females)

44
Q

What muscles does the ilioinguinal nerve supply?

A
  1. internal abdominal oblique
  2. transverse abdominal

(same as iliohypogastric nerve)

45
Q

What sensory supply does the ilioinguinal nerve have?

A
  • skin of upper medial thigh
  • base of penis
  • anterior scrotum
    or
  • mon pubis
  • labium majus
46
Q

What fibers does the genitofemoral nerve contain?

A

L1 and L2 (motor and sensory)

47
Q

What muscles does the genitofemoral nerve pass through? Then what does it do?

A

goes anteriorward throught psoas major muscle–> then divides into a Genital Branch and a Femoral Branch

48
Q

What are the branches of the genitofemoral nerve?

A
  1. Genital Branch (M and S)

2. Femoral Branch (S)

49
Q

What is the path of the Genital Branch of the Genitofemoral nerve? What does it supply?

A

enters and travels through the inguinal canal
Motor–> cremaster muscle
Sensory –> skin of superior anterior scrotum (males) and skin of mons pubis and labium majus (females)

(sensory overlap with ilioinguinal N.)

50
Q

What is the Cremasteric reflex?

A

scrap skin on medial thigh and the testicle should rise up

51
Q

What is the path of the femoral branch of the genitofemoral nerve? What does it supply?

A

passes into thigh posterior to inguinal ligament and supplies skin of upper anterior thigh

52
Q

What fibers does the Lateral Cutaneous Nerve of the Thigh contain?

A

L2 and L3 (sensory)

53
Q

What does the Lateral Cutaneous Nerve of the Thigh of the Lumbar plexus supply?

A

skin of lateral thigh, superior to knee

54
Q

How does it leave the abdominal cavity and what is the path of the Lateral Cutaneous nerve of the thigh?

A

leaves abdominal cavity by passing under the inguinal ligament–> travels anterior to Sartorius and through the tensor fascia lata to reach the skin

55
Q

What fibers does the Femoral Nerve of the lumbar plexus contain?

A

L2, L3, L4 (motor and sensory)

56
Q

What is the largest branch of the lumbar plexus?

A

Femoral Nerve (L2,3,4)

57
Q

Describe the path of the femoral nerve of the lumbar plexus.

A

forms posterior to psoas major and emerges lateral to psoas major and anterior to iliacus–> passes posterior to inguinal ligament –> enters femoral triangle just lateral to femoral artery –> runs inferior and medially through adductor canal –> and into the leg, medially to the knee

58
Q

Where are the two places the femoral nerve, of the lumbar plexus, only gives off branches?

A

in abdomen and the femoral triangle

59
Q

What muscles does the femoral nerve give off muscular branches to in the abdomen?

A

iliacus and pectineus

also sends some fibers to the femoral artery

60
Q

What does the femoral nerve do once it is beyond the inguinal ligament?

A

divides into:

Anterior Divison and Posterior Division

61
Q

How many and what nerves does the anterior division of the femoral nerve gives rise to?

A
  1. intermediate cutaneous nerve of the thigh (S)
  2. medial cutaneous nerve of the thigh (S)
  3. nerve to the sartorius (M)
62
Q

What does the Intermediate cutaneous nerve of the thigh, from the anterior division of the femoral nerve, do and supply??

A

branches into two branches and supplies skin on:

  • anterior thigh down to knee
  • –> lateral branch will communicate with the Femoral Branch of the genitofemoral nerve
63
Q

As it crosses anterior to the femoral artery, what does the Medial Cutaneous nerve of the thigh, from the anterior division of the femoral nerve, supply?

A

skin of:

  • medial thigh
  • medial knee
  • knee across to lateral side of the patella
  • -> some supply skin of medial thigh via communications with Saphenous Nerve
64
Q

What does the Nerve to the sartorius supply?

A

(from anterior division of femoral nerve)

- sartorius muscle

65
Q

What does the posterior division of the Femoral nerve gives rise to?

A
  1. Muscular Branches
  2. Vascular Branches
  3. Articular Branches to knee joint

–> then continues into leg as Saphenous Nerve

66
Q

What does the posterior division of the femoral nerve end up continuing into the leg as?

A

the Saphenous Nerve

67
Q

What do the muscular branches of the posterior division of the femoral nerve, given off in the femoral triangle supply?

A
  1. sartorius
  2. Rectus femoris
  3. vastus lateralis
  4. vastus medialis
  5. vastus intermedialis
68
Q

What is the Saphenous nerve transmitted through? What does it does once in that structure?

A

transmitted through adductor canal –> then crosses femoral artery to lay medial to the artery once they emerge from the canal

69
Q

What does the Saphenous Nerve supply?

A

(terminal nerve of posterior diviision of femoral nerve)

  • skin medial and anterior to patella
  • in leg–> skin of medial leg and foot
70
Q

What does the Saphenous Nerve travel with once it is in the leg?

A

with the Great Saphenous vein

71
Q

What are some clinical considerations associated with the Femoral Nerve?

A
  1. Patellar Reflex
  2. Sensory deficits
  3. Osgood-Schlatter Disease (not directly related to femoral N)
72
Q

What is something we could do to test the functioning of the femoral nerve?

A

test extension of leg since the femoral nerve supplies the quadriceps

73
Q

What is Osgood-Schlatter Disease? Who does it manifest in?

A

related to quads and insertion point

manifests in teenage years when not done growing, but participate in sports

74
Q

What fibers make up the Obturator nerve? Which is the principle contributor?

A

L2, L3, L4

L3 = principle contributor
L2 contribution is minimal

75
Q

How doe the Obturator nerve travel compared to the psoas major? What does it travel posterior to? How does it travel into the pelvis? How does it leave the pelvis?

A

medial to psoas major and posterior to common iliac vessels–> descends into pelvis on the obturator internus–> leaves pelvis via obturator foramen

76
Q

What does the Obturator nerve do once it leaves the obturator foramen?

A

divides into an Anterior Branch and a Posterior Branch

77
Q

How are the Anterior and Posterior Branches of the obturator nerve separated? Which muscles are they named in relationship to?

A

initially by the obturator externus and then by the adductor brevis**

adductor brevis

78
Q

How does the Anterior branch of the obturator nerve travel? What does it pass anterior and posterior to?

A 
travels inferiorly--> travels:
Anterior to:
- obturator externus
- adductor brevis
Posterior to:
- pectineus
- adductor longus
79
Q

What will the Anterior branch of the obturator nerve send some branches to communicate with? What does this form?

A

branches of the femoral nerve (medial cutaneous nerve of the thigh)–> forming the Subsartorial plexus
–> supplies skin on the medial thigh

80
Q

What forms the Subsartorial plexus and what does it supply?

A

branch off the Anterior branch of Obturator nerve and branches of the femoral nerve (the medial cutaneous nerve of the thigh)
– supplies skin over medial thigh

81
Q

What does the termination of the anterior branch of the obturator nerve supply?

A

the femoral artery

82
Q

Where does the anterior branch of the obturator nerve send articular branches to?

A

the hip joint

83
Q

What muscles does the anterior branch of the obturator nerve send fibers to?

A
  1. adductor longus
  2. gracilis
  3. pectineus
  4. adductor brevis
84
Q

What may the anterior branch of the obturator nerve send fibers to connect with? (if it is present)

A

the accessory obturator nerve

85
Q

What may the anterior branch of the obturator nerve send fibers to communicate with that would have it contributing to the skin on the upper medial side of the leg?

A
  • medial cutaneous nerve of the thigh (ass. with subssartorial plexus)
  • saphenous nerve
86
Q

What does the posterior branch of the obturator nerve travel through? What does it travel posterior and anterior to?

A

through the –> obturator externus
posterior to –> adductor brevis
anterior to –> adductor magnus

87
Q

What muscles does the posterior branch of the obturator nerve supply?

A
  1. obturator externus
  2. adductor magnus
  3. adductor brevis (if it isn’t supplied by the anterior branch)
88
Q

What does the posterior branch of the obturator nerve send articular fibers to?

A

knee joint

89
Q

If something in wrong with the obturator nerve, how would we test the muscle weakness?

A

test hip adduction

90
Q

Where would the sensory deficits associated with the obturator nerve be?

A

medial thigh, overlaps with femoral nerve

PNS -- Torgerud (17 decks)

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