Neurological Anatomy

Copyright Ted Nissen 2003

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1       Cutaneous Nerves All 2

1.1        Index. 3

1.2        Cutaneous Nerves-Head 1 (31) 3

1.3        Cutaneous Nerves-Head 2 (32) 3

1.4        Cutaneous Nerves-Arms (33) 3

1.5        Cutaneous Nerves-Hands (34) 3

1.6        Cutaneous Nerves-Back (36) 3

1.7        Cutaneous Nerves-Front of Chest (36) 3

1.8        Cutaneous Nerves-Foot (35) 3

1.9        Cutaneous Nerves-Legs (35) 3

2       HEAD & NECK. 3

2.1        OLFACTORY. 3

2.2        OPTIC. 3

2.3        OCULOMOTOR. 4

2.4        TROCHELEAR. 4

2.5        TRIGEMINAL. 4

2.6        ABDUCENS. 6

2.7        FACIAL. 6

2.8        ACOUSTIC. 7

2.9        GLOSSOPHARYNGEAL. 7

2.10       VAGUS. 8

2.11       SPINAL ACCESSORY. 9

2.12       HYPOGLOSSAL. 10

2.13       LESSER OCCIPITAL. 10

2.14       GREATER AURICULAR. 11

2.15       TRANSVERSE (ANT) CUT. 12

2.16       SUPRACLAVICULAR. 13

2.17       SUPRASCAPULAR. 14

2.18       ANSA CERVICALIS (ANSA HYPOGLOSSI) 15

2.19       PHRENIC. 16

2.20       RECTUS CAPITIS LATERALIS N. 20

2.21       RECTUS CAPITIS ANTERIOR N. 21

2.22       LONGUS CAPITIS N. 22

2.23       LONGUS COLI N. 23

2.24       STERNOCLEIDOMASTOID N. 24

2.25       TRAPEZIUS N. 26

2.26       LEVATOR SCAPULAE N. 27

2.27       SCALENUS NERVES. 28

2.28       BRACHIAL PLEXUS. 29

2.29       DORSAL SCAPULAR N. 30

2.30       LONG THORACIC NERVE. 31

2.31       SUBCLAVIUS N. 32

2.32       UPPER SUBSCAPULAR N. 33

2.33       THORACODORSAL N. (MIDDLE SUBSCAPULAR N.) 34

2.34       LOWER SUBSCAPULAR N. 35

3       Arms. 36

3.1        SUPRACLAVICULAR. 36

3.2        AXILLARY (U LAT CUT N) 38

3.3        2ND THOR INTERCSL N. 39

3.4        MEDIAL BRACHIAL CUT N.(FLASH;MEDIAL CUT)(GRAY;LESSER INTERNAL CUT,N. OF WRISBERG) 40

3.5        RADIAL. 41

3.6        MUSCULOCUTANEOUS. 42

3.7        MED ANTEBRACHIAL CUT N.(FLASH;MEDIAL  CUTANEOUS N. OF FOREARM),(GRAY; INTERNAL CUT N.) 43

4       Hands. 44

4.1        ULNAR. 44

4.2        RADIAL. 45

4.3        MEDIAN NERVE. 46

4.4. 47

4.5. 47

5       HIP AND LEGS. 47

5.1        12TH THORACIC INTERCOSTAL (SUB COSTAL) 35.01. 47

5.2        Lumbar Plexus (Spinal Segments & Nerves) (61) 48

5.3        Lumbar Plexus (62) 49

5.4        Lumbar Plexus (Muscular Branches and Relationships) (63) 52

5.5        Nerves from Ventral Rami of Lumbar Plexus (64) 54

5.6        Iliohypogastric Nerve (65) (Blank) 56

5.7        ILLIOHYPOGASTRIC (65) 56

5.8        Ilio-Inquinal Nerve (66) (Blank) 58

5.9        ILLIO-INGUINAL (66) 58

5.10       Genitofemoral Nerve (67) (Blank) 60

5.11       GENITAL FEMORAL (67) 60

5.12       Nerves from Ventral Division of Ventral Rami Lumbar Plexus (68) 61

5.13       Obturator Nerve (69) (Blank) 63

5.14       OBTURATOR (69) 63

5.15       Accessory Obturator Nerve (70) (Blank) 66

5.16       ACCESSORY OBTURATOR (70) 66

5.17       Lumbar Plexus (Nerves from Dorsal Divisions-Ventral Rami (71) 67

5.18       Lateral Cutaneous Femoral Nerve (72) (Blank) 69

5.19       Femoral Nerve (Abdominal Branches) (73) (Blank) 70

5.20       Femoral Nerve (Anterior Division) (74) (Blank) 71

5.21       LAT FEM CUT (?) 71

5.22       FEMORAL NERVE (?) 72

5.23       Femoral Nerve (Posterior Division) (75) 74

5.24       Sacral Plexus (Spinal Segments & Nerves) (76) 78

5.25       Sacral Plexus (L4, L5, S1, S2, S3) (77) 79

5.26       Sacral Plexus (Nerves from Ventral Divisions of Ventral Rami) (78) 82

5.27       Sacral Plexus (Nerves from Dorsal Divisions of Ventral Rami) (79) 82

5.28       QUADRATUS FEMORIS N. (80) 83

5.29       OBTURATOR INTERNUS (81) 84

5.30       PIRIFORMIS (82) 85

5.31       SUPERIOR GLUTEAL (83) 85

5.32       INFERIOR GLUTEAL (84) 87

5.33       POSTERIOR FEMORAL CUTANEOUS (85) 88

5.34       Sciatic Nerve (86) 89

5.35       Tibial Nerve (Branches Arising between Gastrocnemius Heads) (87) 92

5.36       Tibial Nerve (Branches Arising in the Leg) (88) 96

5.37       Tibial Nerve (Medial Sural and Medial Calcanean Cutaneous Branches) (89) 98

5.38       Medial Plantar (Tibial) (90) 100

5.39       Lateral Plantar Nerve & Superficial Branch (Tibial) (91) 104

5.40       Lateral Plantar Nerve Deep Branch (Tibial) (92) 107

5.41       Common Peroneal (Fibular) Nerve (93) 109

5.42       Deep Peroneal (Anterior Tibial) Nerve (Branches Arising in the Leg) (94) 112

5.43       Deep Peroneal Medial and Lateral Terminal Branches (95) 115

5.44       Superficial Peroneal Nerve (96) 117

5.45       Superficial Peroneal Nerve Medial and Lateral Terminal Branches (97) 119

5.46       Perforating Cutaneous Nerve (98) (Blank) 122

5.47       Sacral Muscular Branches (4th Sacral) (99) (Blank) 123

5.48       Pudendal Nerve: Inferior Rectal Branch (Inferior Hemeorrhoidal Nerve) (100) (Blank) 124

5.49       Pudendal Nerve (Perineal Branch) (101) (Blank) 125

5.50       Pudendal Nerve (Dorsal Nerve of Penis or Clitoris) (102) (Blank) 126

5.51       Blank. 128

6       TORSO. 128

6.1        LATERAL PECTORAL. 128

6.2        MEDIAL PECTORAL. 129

6.3        1ST THOR INTERCSTL N. 130

6.4        2ND THOR INTRCSTL N. 132

6.5        UPPER INTERCSTL=T3-6. 133

6.6        LWR INTCSTL N.=T7-11. 134

6.7        1ST DORSAL RAMUS(SUBOCCIPITAL N) 135

6.8        2ND DOR RAMUS(GREATER OCCIPITAL N) 136

6.9        3RD DORSAL RAMUS. 137

6.10       LOWR CER DOR RAM (C4-8) 138

6.11       UPP THOR DOR RAM (T1-6) 139

6.12       LOWR THOR DOR RAM (T7-12) 140

6.13       LUMBAR DOR RAM (L1-5) 141

6.14       UPPER SACRAL DOR RAM (S1-3) 142

6.15       LWR SAC&COC DR R(ANOCOCCYGEAL N) (S4,5,C01) 143

6.16. 145

6.17. 146

 

 

 

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1    Cutaneous Nerves All

1.1  Index

1.1.1  http://www.anatomyfacts.com/Muscle/cutaneousnerves.htm

1.2  Cutaneous Nerves-Head 1 (31)

1.2.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNH1

1.3  Cutaneous Nerves-Head 2 (32)

1.3.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNH2

1.4  Cutaneous Nerves-Arms (33)

1.4.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNA

1.5  Cutaneous Nerves-Hands (34)

1.5.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNH

1.6  Cutaneous Nerves-Back (36)

1.6.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNB

1.7  Cutaneous Nerves-Front of Chest (36)

1.7.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNFC

1.8  Cutaneous Nerves-Foot (35)

1.8.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNF

1.9  Cutaneous Nerves-Legs (35)

1.9.1  http://www.anatomyfacts.com/Muscle/Illustrations.htm#CNL

2    HEAD & NECK

2.1  OLFACTORY

Back Table of Contents References

2.1.1  DESCRIPTION # 1: PATH, FUNCTION

2.1.1.1     SMELL

2.1.2  ROOTS

2.1.2.1     CN 1

2.2   OPTIC

2.2.1  DESCRIPTION # 1: PATH, FUNCTION

2.2.1.1     VISION

2.2.2  ROOTS

2.2.2.1     CN 2

2.3  OCULOMOTOR

2.3.1  DESCRIPTION # 1: PATH, FUNCTION

2.3.1.1     EYE MOVEMENTS; MOVEMENT OF EYE BALL, EYELID, CONSTRICTION OF LENS FOR NEAR VISION

2.3.2  MUSCULAR BRANCHES(OCCULO)

2.3.2.1     SUPERIOR RECTUS

2.3.2.2     INFERIOR RECTUS

2.3.2.3     MEDIAL RECTUS

2.3.2.4     INFERIOR OBLIQUE

2.3.2.5     LEVATOR PALPEBRAE SUPERIORIS

2.3.3  ROOTS

2.3.3.1     CN 3

2.4  TROCHELEAR

Back Table of Contents References

2.4.1  DESCRIPTION # 1: PATH, FUNCTION

2.4.1.1     EYE MOVEMENTS; EYE BALL MEVEMENT

2.4.2  MUSCULAR BRANCHES(TROCH)

2.4.2.1     SUPERIOR OBLIQUE

2.4.3  ROOTS

2.4.3.1     CN4

2.5  TRIGEMINAL

Back Table of Contents References

2.5.1  DESCRIPTION # 1: PATH, FUNCTION

2.5.1.1     SENSATION TO FACE, CHEWING. SUPRFICIAL SEN=PONS VAROLII, DEEP SEN= LONG TRACT OF MEDULLA,LWR SEN=SUBSTANIA GELATINOSA ROLANDO, SEMILUNAR(GASSERIAN) GANGLION=LODGED IN AN OSTEO-FIBROUS SPACE THE CAVUM MECKELII NEAR THE APEX OF THE PETROUS PORTION OF THE TEMPORAL BONE.

2.5.2   Illustration

2.5.2.1     Reference Number

2.5.2.1.1  31.01

2.5.2.2     Illustration Link

2.5.2.2.1  Trigeminal

2.5.3  NEUROLOGICAL BRANCHES

2.5.3.1     OPHTHALMIC (TRI)

2.5.3.1.1   DESCRIPTION # 1: PATH, FUNCTION
2.5.3.1.1.1 PASSES FORWARD ALONG OUTER WALL OF CAVERNOUS SINUS AND JUST BEFORE ENTERING THE ORBIT THR T SPHENOIDAL FISSURE DIVIDES IN THRE BRANCHES LACHRYMAL, FRONTAL & NASAL. IT THEN PASSES THRU SUP ORBITAL FISSURE
2.5.3.1.2   DESCRIPTION # 2: CUTANEOUS AREA, ADDITIONAL COMMENTS
2.5.3.1.2.1 U EYELID,MUCOUS LINING OF THE EYE,SKIN OF EYEBROW,EYEBALL,LACRIMAL GL,NAS CAVITY, SIDE OF NOSE, FOREHEAD,A 1/2 OF SCLP.
2.5.3.1.3  Reference Number
2.5.3.1.3.1 31.011
2.5.3.1.4  Illustration Link
2.5.3.1.4.1 Ophthalmic

2.5.3.2     MAXILLARY (TRI)

2.5.3.2.1   DESCRIPTION # 1: PATH, FUNCTION
2.5.3.2.1.1 FORAMEN ROTUNDUM
2.5.3.2.2   DESCRIPTION # 2: CUTANEOUS AREA, ADDITIONAL COMMENTS
2.5.3.2.2.1 MUCOSA OF NOSE, PALATE, PHARYNX, U TEETH, U LIPL EYELID.
2.5.3.2.3  Reference Number
2.5.3.2.3.1 31.012
2.5.3.2.4  Illustration Link
2.5.3.2.4.1 Maxillary

2.5.3.3     MANDIBULAR (TRI)

2.5.3.3.1   DESCRIPTION # 1: PATH, FUNCTION
2.5.3.3.1.1 FORAMEN OVALE
2.5.3.3.2   DESCRIPTION # 2: CUTANEOUS AREA, ADDITIONAL COMMENTS
2.5.3.3.2.1 A 2/3 TOUGUE L TEETH, SKIN O MANDIBLE,CHECK & MUCOSA,SIDE O HEAD IN F OF EAR,
2.5.3.3.3  Reference Number
2.5.3.3.3.1 31.011
2.5.3.3.4  Illustration Link
2.5.3.3.4.1 Mandibular

2.5.4  MUSCULAR BRANCHES (MANDIBULAR)

2.5.4.1     MASSETER

2.5.4.2     TEMPORALIS

2.5.4.3     MEDIAL PTERYGOID

2.5.4.4     LATERAL PTERYGOID

2.5.4.5     TENSOR VELI PALATINI

2.5.4.6     DIGASTRIC (ANTERIOR BELLY)

2.5.4.7     MYLOHYOID

2.5.5  ROOTS

2.5.5.1     CN 5

2.6  ABDUCENS

Back Table of Contents References

2.6.1  DESCRIPTION # 1: PATH, FUNCTION

EYE MOVEMENTS; EYE BALL MEVEMENT

2.6.2  MUSCULAR BRANCHES(ABDUCENS)

2.6.2.1     LATERAL RECTUS

2.6.3  ROOTS

2.6.3.1     CN 6

2.7  FACIAL

Back Table of Contents References

2.7.1  DESCRIPTION # 1: PATH, FUNCTION

FACIAL EXPRESSION, TASTE,SALIVA SECRETION, TEARS.

2.7.2  MUSCULAR BRANCHES (FACIAL)

2.7.2.1     FRONTALIS (EPICRANIUS 1)

2.7.2.2     OCCIPITALIS (EPICRANIUS 2)

2.7.2.3     ORBICULARIS ORIS

2.7.2.4     ZYGOMATICUS MAJOR

2.7.2.5     LEVATOR LABIL SUPERIORIS

2.7.2.6     DEPRESSOR LABII INFERIORIS

2.7.2.7     BUCCINATOR

2.7.2.8     MENTALIS

2.7.2.9     PLATYSMA

2.7.2.10  RISORIUS

2.7.2.11  ORBICULARIS OCULI

2.7.2.12  CORRUGATOR SUPERCILLI

2.7.2.13  STYLOHYOID

2.7.2.14  DIAGASTRIC (POSTERIOR BELLY)

2.7.2.15  STAPEDIUS

2.7.3  CUTANEOUS (FACIAL)

2.7.3.1     DESCRIPTION # 1: PATH, FUNCTION

TASTE IN ANTERIOR TWO-THIRDS OF TONGUE. SENSATION TO SOFT PALATE. INNERVATION OF SALIVARY GLANDS.

2.7.4  ROOTS

2.7.4.1     CN 7

2.8  ACOUSTIC

2.8.1  DESCRIPTION # 1: PATH, FUNCTION

HEARING, EQUILIBRIUM

2.8.2  ROOTS

2.8.2.1     CN 8

2.9  GLOSSOPHARYNGEAL

Back Table of Contents References

2.9.1  DESCRIPTION # 1: PATH, FUNCTION

TASTE, SPEECH

2.9.2  MUSCULAR BRANCHES(GLOSSO)

2.9.2.1     STYLOPHARYNGEUS

2.9.3  CUTANEOUS(GLOSSO)

TASTE IN POSTERIOR 2/3 RDS OF TONGUE. SENSATION TO FAUCES, TONSILS, PHARYNX, AND SOFT PALATE.

2.9.4  ROOTS

2.9.4.1     CN 9

2.10 VAGUS

Back Table of Contents References

2.10.1              DESCRIPTION # 1: PATH, FUNCTION

PARASYMPATHETIC, VISERAL MUSCLE MOVEMENT, SENSATION FROM ORGANS

2.10.2              CUTANEOUS(VAGUS)

SENSORY FIBERS TO SKIN IN BACK OF AURICLE, POSTERIOR PORTION OF EXTERNAL ACOUSTIC MEATUS, PHARYNX, LARYNX, THORACIC AND ABDOMINAL VISCERA.

2.10.3              RECURRENT LARYNGEAL(VAGUS)

2.10.3.1  MUSCULAR BRANCHES(RECURR LARG)

2.10.3.1.1         POSTERIOR CRICOARYTENOID
2.10.3.1.2         LATERAL CRICOARYTENOID
2.10.3.1.3         ARYTENOID
2.10.3.1.4         THYROARYTENOID

2.10.4              EXTERNAL LARYNGEAL(VAGUS)

2.10.4.1  MUSCULAR BRANCHES(EXTER LARG)

2.10.4.1.1         CRICOTHYROID

2.10.5              PHARYNGEAL BRANCH(VAGUS)

2.10.5.1  MUSCULAR BRANCHES(PHARYN)

2.10.5.1.1         INFERIOR CONSTRICTOR

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.2         MIDDLE CONSTRICTOR

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.3         SUPERIOR CONSTRICTOR

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.4         PALATOGLOSSUS

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.5         SALPINGOPHARYNGEUS

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.6         PALATOPHARYNGEUS

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.7         LEVATOR VELI PALATINI

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.8         MUSCULUS UVULAE

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.9         PALATOGLOSSUS

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.5.1.10      PALATOPHARYNGEUS

ADDITIONAL INNERVATION: WITH FILIMENTS FROM SPINAL ACCESSARY NERVE WHICH TRAVELS THRU PHARYNGEAL PLEXUS.

2.10.6              ROOTS

2.10.6.1  CN 10

2.10.7              References

2.10.7.1   

2.11 SPINAL ACCESSORY

Back Table of Contents References

2.11.1              DESCRIPTION # 1: PATH, FUNCTION

SWALLOWING, MOVEMENT OF HEAD

2.11.2              ROOTS

2.11.2.1   CN11

2.11.3              MUSCULAR BRANCHES(SPINL ACCES)

2.11.3.1  STERNOCLEIDOMASTOID

2.11.3.1.1         CARD= 21
2.11.3.1.2         INNERVATION
2.11.3.1.2.1           (XI(C1-5) MOTOR)

2.11.3.2  TRAPEZIUS

2.11.3.2.1         CARD= 22
2.11.3.2.2         INNERVATION
2.11.3.2.2.1           (XI(C1-5) MOTOR)

2.12 HYPOGLOSSAL

Back Table of Contents References

2.12.1              DESCRIPTION # 1: PATH, FUNCTION

MOVEMENT OF TONGUE DURNING SPEECH AND SWALLOWING.

2.12.2              ROOTS

2.12.2.1  CN12

2.12.3              MUSCULAR BRANCHES(HYPO)

2.12.3.1  GENIOGLOSSUS

2.12.3.2  STYLOGLOSSUS

2.12.3.3  HYOGLOSSUS

2.12.3.4  STYLOHYOID

2.12.3.5  MYHLOHYOID

2.12.3.6  OMOHYOID(INFERIOR BELLY)

2.12.3.7  THYROHYOID(DECENDING HYPOGLOSSAL)

2.12.3.8  GENIOHYOID

2.12.3.9  INTRINSIC MUS OF TONGUE

2.13 LESSER OCCIPITAL

Back Table of Contents References

2.13.1              DESCRIPTION # 1: PATH, FUNCTION-LESIONS

A FOCAL LESION WILL RESULT IN PARESTHESIA OR LACK OF SENSATION TO THE SKIN DESCRIBED IN THE CUTANEOUS SECTION OF THIS NERVE.

2.13.2              DESCRIPTION # 2: CUTANEOUS AREA, ADDITIONAL COMMENTS

MID NECK ALONG THE P BORDER OF SCM &PRT O MASTOID PRO A T SCALP BEH T LWAR & UPPER MEDIAN PRT O AURICLE.

2.13.3              ROOTS

2.13.3.1  C2-C3

2.13.3.2  SPINAL NERVE

2.13.3.3  VENTRAL

2.13.4              NUMBER

2.13.4.1  32.01

2.13.5              CARD

2.13.5.1  9

2.14 GREATER AURICULAR

Back Table of Contents References

2.14.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.14.1.1  .

2.14.2              NUMBER

2.14.2.1  35

2.14.3              REFERENCE

2.14.3.1   

2.14.4              ROOTS

2.14.4.1   

2.14.4.2  Lumbar Plexus

2.14.4.3  VENTRAL

2.14.5              DIVISION

2.14.5.1  Dorsal Ventral

2.14.5.2   

2.14.6              CUTANEOUS BRANCHES

2.14.6.1   

2.14.6.1.1          

2.14.6.2   

2.14.6.2.1         .

2.14.7              ARTICULAR BRANCHES

2.14.7.1   

2.14.7.1.1          

2.14.8              MUSCULAR BRANCHES

2.14.8.1   

2.14.8.2   

2.14.8.3   

2.14.8.4   

2.14.8.5   

2.14.8.6   

2.15 TRANSVERSE (ANT) CUT

Back Table of Contents References

2.15.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.15.1.1  .

2.15.2              NUMBER

2.15.2.1  35

2.15.3              REFERENCE

2.15.3.1   

2.15.4              ROOTS

2.15.4.1   

2.15.4.2  Lumbar Plexus

2.15.4.3  VENTRAL

2.15.5              DIVISION

2.15.5.1  Dorsal Ventral

2.15.5.2   

2.15.6              CUTANEOUS BRANCHES

2.15.6.1   

2.15.6.1.1          

2.15.6.2   

2.15.6.2.1         .

2.15.7              ARTICULAR BRANCHES

2.15.7.1   

2.15.7.1.1          

2.15.8              MUSCULAR BRANCHES

2.15.8.1   

2.15.8.2   

2.15.8.3   

2.15.8.4   

2.15.8.5   

2.15.8.6   

2.16 SUPRACLAVICULAR

Back Table of Contents References

2.16.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.16.1.1  .

2.16.2              NUMBER

2.16.2.1  35

2.16.3              REFERENCE

2.16.3.1   

2.16.4              ROOTS

2.16.4.1   

2.16.4.2  Lumbar Plexus

2.16.4.3  VENTRAL

2.16.5              DIVISION

2.16.5.1  Dorsal Ventral

2.16.5.2   

2.16.6              CUTANEOUS BRANCHES

2.16.6.1   

2.16.6.1.1          

2.16.6.2   

2.16.6.2.1         .

2.16.7              ARTICULAR BRANCHES

2.16.7.1   

2.16.7.1.1          

2.16.8              MUSCULAR BRANCHES

2.16.8.1   

2.16.8.2   

2.16.8.3   

2.16.8.4   

2.16.8.5   

2.16.8.6   

2.17 SUPRASCAPULAR

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2.17.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.17.1.1  .

2.17.2              NUMBER

2.17.2.1  35

2.17.3              REFERENCE

2.17.3.1   

2.17.4              ROOTS

2.17.4.1   

2.17.4.2  Lumbar Plexus

2.17.4.3  VENTRAL

2.17.5              DIVISION

2.17.5.1  Dorsal Ventral

2.17.5.2   

2.17.6              CUTANEOUS BRANCHES

2.17.6.1   

2.17.6.1.1          

2.17.6.2   

2.17.6.2.1         .

2.17.7              ARTICULAR BRANCHES

2.17.7.1   

2.17.7.1.1          

2.17.8              MUSCULAR BRANCHES

2.17.8.1   

2.17.8.2   

2.17.8.3   

2.17.8.4   

2.17.8.5   

2.17.8.6   

2.18 ANSA CERVICALIS (ANSA HYPOGLOSSI)

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2.18.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.18.1.1  .

2.18.2              NUMBER

2.18.2.1  35

2.18.3              REFERENCE

2.18.3.1   

2.18.4              ROOTS

2.18.4.1   

2.18.4.2  Lumbar Plexus

2.18.4.3  VENTRAL

2.18.5              DIVISION

2.18.5.1  Dorsal Ventral

2.18.5.2   

2.18.6              CUTANEOUS BRANCHES

2.18.6.1   

2.18.6.1.1          

2.18.6.2   

2.18.6.2.1         .

2.18.7              ARTICULAR BRANCHES

2.18.7.1   

2.18.7.1.1          

2.18.8              MUSCULAR BRANCHES

2.18.8.1   

2.18.8.2   

2.18.8.3   

2.18.8.4   

2.18.8.5   

2.18.8.6   

2.19 PHRENIC (phrenic19)

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2.19.1              Spinal Roots C3, C4, & C5

2.19.1.1  .

2.19.2              Cutaneous Branches

2.19.2.1  None

2.19.3              Sensory Branches

2.19.3.1  The anterior, anterolateral and posterior branches supply Proprioceptive endings in the diaphragm, parietal peritoneum of the diaphragm, and diaphragmatic pleura related to the central tendon and musculature.

2.19.4              Muscular Branches-To the Diaphragm divided into three branches

2.19.4.1  A=Anterior (sternal) branches

2.19.4.1.1         Supply the muscular fibers anterior to the central tendon.

2.19.4.2  B=Anterolateral branches

2.19.4.2.1         Supply the muscular fibers anterior to the lateral leaf of the central tendon

2.19.4.3  C=Posterior branches

2.19.4.3.1         Supply the muscular fibers posterior to the central tendon, including the crural fibers.

2.19.5              Articular Branches

2.19.5.1  None

2.19.6              Lesions

2.19.6.1  Complete section of the phrenic nerve will produce paralysis and atrophy of corresponding part of the diaphragm. Unilateral lesion: few or no symptoms may be exhibited. Bilateral lesion: usually from damage to the cervical spinal cords. Presents as severe dyspnea (difficult or laboured respiration-shortness of breath) upon slightest exertion, over activity of accessory respiratory muscles, difficulty in coughing and sneezing and atrophy of diaphragm. If an accessory phrenic nerve exists and escapes damage the paralysis will be incomplete.

2.19.7              Note

2.19.7.1  An accessory phrenic nerve would branch from the nerve to the subclavius or ansa cervicalis.

2.19.8              Path Description

2.19.8.1  The Phrenic Nerve (n. phrenicus; internal respiratory nerve of Bell) contains motor and sensory fibers in the proportion of about two to one. It arises chiefly from the fourth cervical nerve, but receives a branch from the third and another from the fifth; (the fibers from the fifth occasionally come through the nerve to the Subclavius.) It descends to the root of the neck, running obliquely across the front of the Scalenus anterior, and beneath the Sternocleidomastoideus, the inferior belly of the Omohyoideus, and the transverse cervical and transverse scapular vessels. It next passes in front of the first part of the subclavian artery, between it and the subclavian vein, and, as it enters the thorax, crosses the internal mammary artery near its origin. Within the thorax, it descends nearly vertically in front of the root of the lung, and then between the pericardium and the mediastinal pleura, to the diaphragm, where it divides into branches, which pierce that muscle, and are distributed to its under surface. In the thorax it is accompanied by the pericardiacophrenic branch of the internal mammary artery.

2.19.8.2    The two phrenic nerves differ in their length, and also in their relations at the upper part of the thorax.    22

2.19.8.3    The right nerve is situated more deeply, and is shorter and more vertical in direction than the left; it lies lateral to the right innominate vein and superior vena cava.    23

2.19.8.4    The left nerve is rather longer than the right, from the inclination of the heart to the left side, and from the diaphragm being lower on this than on the right side. At the root of the neck it is crossed by the thoracic duct; in the superior mediastinal cavity it lies between the left common carotid and left subclavian arteries, and crosses superficial to the vagus on the left side of the arch of the aorta.

2.19.8.1  Each nerve supplies filaments to the pericardium and pleura, and at the root of the neck is joined by a filament from the sympathetic, and, occasionally, by one from the ansa hypoglossi. Branches have been described as passing to the peritoneum.   

2.19.8.2    From the right nerve, one or two filaments pass to join in a small phrenic ganglion with phrenic branches of the celiac plexus; and branches from this ganglion are distributed to the falciform and coronary ligaments of the liver, the suprarenal gland, inferior vena cava, and right atrium. From the left nerve, filaments pass to join the phrenic branches of the celiac plexus, but without any ganglionic enlargement; and a twig is distributed to the left adrenal gland  (suprarenal gland).

2.19.8.3  The phrenic nerve arises from the third, fourth, and fifth cervical spinal nerves (C3-C5). It provides motor innervation to the diaphragm and is thus responsible for the act of breathing. In addition, it provides sensory innervation for many components of the mediastinum and pleura, as well as the upper abdomen, especially the liver and gall bladder. Pain arising from structures served by the phrenic nerve is often "referred" to other somatic regions served by spinal nerves C3-C5. For instance, angina pectoris classically is felt both in the chest and in the left arm. Likewise, a liver abscess close to the diaphragm will be felt in the right shoulder.

2.19.8.4  Both phrenic nerves run from C3, C4 and C5 along the anterior scalene muscle deep to the carotid sheath. The right phrenic nerve passes over the right brachiocephalic artery, the subclavian vein, and the superior vena cava and then crosses the root of the right lung and then leaves the thorax by passing through the vena cava hiatus opening in the diaphragm at the level of T10. The right phrenic nerve passes over the right atrium. The left phrenic nerve passes over the left ventricle and pierces the diaphragm separately.

2.19.8.5  Both these nerves supply motor fibres to the diaphragm and sensory fibres to the fibrous pericardium, mediastinal pleura and diaphragmatic peritoneum.

2.19.8.6  Irritation of the phrenic nerve leads to the Hiccup Reflex, which is due to spasms of the diaphram pushing air that hits the closed folds of the glottis.

2.19.1              Functional Anatomy

2.19.1.1  The Phrenic Nerve contains twice as many motor nerve fibers as sensory fibers. The Phrenic Nerve arises mostly from fourth cervical nerve (C4), but receives a branch from the third (C3) and another from the fifth (C5). The phrenic nerve http://en.wikipedia.org/wiki/Phrenic_nerve forms from both the cervical http://www.bartleby.com/107/illus804.html   and Brachial Plexus http://www.bartleby.com/107/illus807.html.  The motor fibers send nerve impulses from the brain (efferent) to the diaphragm muscle, which then tightens. When the diaphragm muscle contracts it increases the volume of the cavity in which the lungs are contained. This expands the lungs and allows you to take a deep breath, cough, or sneeze. If the phrenic nerve is completely cut (Complete section) it becomes very difficult to breathe (Dyspnea (difficult or laboured respiration)). The afferent sensory fibers of the Phrenic Nerve send impulses to the spinal cord from the following structures; to the hearts pericardium and pleura of the lungs, Mediastinum (non-delineated group of structures in the thorax (chest)), inferior vena cava, and right atrium, peritoneum (smooth transparent serous membrane that lines the cavity of the abdomen), falciform and coronary ligaments of the liver, and adrenal gland (suprarenal gland). Some references indicate phrenic sensory  nerve connections to the gall bladder (although one references mentions=no specifics are given http://en.wikipedia.org/wiki/Phrenic_nerve), capsule of the liver, and pancreas (As he stated in his article). I will then assume that these do not exist until otherwise informed. The phrenic nerve sensory fibers will refer pain from the aforementioned structures it supplies to other somatic regions also supplied by the nerve roots that form the phrenic nerve (C3-5). Dermatomal, sclerotomal and or proprioceptive pain referral is possible. For example heart disease (angina pectoris) may be felt in the chest and or down the left arm. Liver or Gall bladder problems near the diaphragm may be felt in the right shoulder. Pain in the shoulder or down the arm from irritated visceral structures does not constitute prima facie evidence for phrenic nerve transmission of psychological stress nor does it necessarily imply a role in more complex Orthopedic, muscular and or skeletal problems.

2.19.2              Theory WARNING LABEL; I am not a neurologist and THIS IS A THEORY. When I’m not sure about something I will mark it with a (?=not sure)

2.19.2.1  The sensory fibers of the phrenic nerve supply structures, which are related to increased exertion e.g. the heart, membranes in the chest (Mediastinum), abdominal membranes attached to the diaphragm (?), ligaments which are attached to the diaphragm (?), and endocrine glands, which give us the energy for exertion. The phrenic nerve forms a reflex arc with its motor nerves in the spinal cord (?). It does not need to be connected to the higher brain to function properly and therefore does not serve as a conduit to disperse the stress of negative thinking. The primary function of the phrenic nerves Proprioceptive sensory fibers is to tell its motor nerves when we are exerting ourselves; running walking fighting ect so as to give more juice to the diaphragm (to increase O2 delivery). If the heart is pumping away because we are on the last 100 yards of a killer marathon this feedback loop is just what the doctor ordered. Its very much like an automatic pilot that instantly without your conscious thought initiates a reflex arc with the motor fibers in the spinal cord (?) to increase contraction of the diaphragm muscle during heavy exertion. The function of the phrenic nerve as primarily a motor nerve is evident in its neuroanatomy with twice as many motor fibers as sensory fibers. None of its motor or sensory fibers are connected with rotator cuff, capsule of the shoulder, ligaments or muscles of the neck ect. Because the phrenic nerve forms from the cervical and brachial plexus (A plexus looks like macramé done by someone with severe ADHD) and I am not intimately familiar with the neuroanatomy of these structures so it is not clear to me if some connection exists to the accessory nerve (Cranial Nerve). I will assume there is no connection until otherwise informed. Therefore there is no mind body connection with the phrenic nerve serving as a conduit displacing psychological stress. Further because the motor portion of the phrenic doesn’t innervate any of the sacs and tubes mentioned by Dr Alexander in his article [1] there can be no cringing of sacs & shortening of tubes. The motor portion of the phrenic nerve only innervates to the diaphragm muscle at least according to all of the anatomical books I’ve looked at. I realize it feels that way when you are anxious. Perhaps there are other explanations but the phrenic circuit is not one of them. Perhaps though there are other connections, which I do not have the neuroanatomical knowledge to explore. I believe (?) the shoulder joint capsule both its tendons and perhaps connective tissue are innervated dermatomally, sclerotomally (area of bone innervated by a single spinal segment), and perhaps proprioceptivly (sensory nerves embedded with connective tissue/muscle to provide joint positional information) by the C5 nerve. I don’t think this should affect the simple reflex arc between the motor and sensory fibers of the phrenic nerve whose primary purpose is to increase contraction of the diaphragm during heavy exertion. I will assume it does not unless otherwise informed.

2.19.3              Hypothesis

2.19.3.1  Complete section of the sensory fibers of the phrenic nerve will significantly decrease aerobic capacity during heavy exertion.

2.19.4              Literature Review

2.19.4.1  I’m thinking a literature review rather than an experiment simply because nobody I know would raise their hand to volunteer to have the sensory fibers of their phrenic nerve cut. I am quite sure no one would volunteer his or her pet hamster, dog, or cat for this experiment either. So a review of the scientific literature is in order to determine the aerobic capacity of people or animals that have a damaged phrenic sensory nerve.

2.19.5              Gray’s Anatomy and other references

2.19.5.1  Discussion

2.19.5.1.1         Cervical Nerves
2.19.5.1.1.1           http://www.bartleby.com/107/210.html
2.19.5.1.2         Brachial Plexus
2.19.5.1.2.1           http://www.bartleby.com/107/210.html#i807
2.19.5.1.3         Diaphragm
2.19.5.1.3.1           http://www.bartleby.com/107/illus391.html
2.19.5.1.3.2           Diaphragm

2.19.5.2  Illustrations

2.19.5.2.1         Thoracic Cavity (or chest cavity)
2.19.5.2.1.1           http://www.bartleby.com/107/illus806.html
2.19.5.2.2         Cervical Plexus
2.19.5.2.2.1           http://www.bartleby.com/107/illus804.html
2.19.5.2.3         Brachial Plexus
2.19.5.2.3.1           http://www.bartleby.com/107/illus807.html
2.19.5.2.4         Vagus Nerve
2.19.5.2.4.1           http://www.bartleby.com/107/205.html
2.19.5.2.5         Sympathetic Nervous System
2.19.5.2.5.1           http://www.bartleby.com/107/214.html
2.19.5.2.6         Diaphragm
2.19.5.2.6.1           http://www.bartleby.com/107/illus391.html

2.19.6              Number

2.19.6.1  32.05

2.19.7              Reference

2.19.7.1  19

2.19.8              Illustration

2.19.8.1  19

2.1  RECTUS CAPITIS LATERALIS N.

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2.1.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.1.1.1     .

2.1.2  NUMBER

2.1.2.1     35

2.1.3  REFERENCE

2.1.3.1      

2.1.4  ROOTS

2.1.4.1      

2.1.4.2     Lumbar Plexus

2.1.4.3     VENTRAL

2.1.5  DIVISION

2.1.5.1     Dorsal Ventral

2.1.5.2      

2.1.6  CUTANEOUS BRANCHES

2.1.6.1      

2.1.6.1.1   

2.1.6.2      

2.1.6.2.1  .

2.1.7  ARTICULAR BRANCHES

2.1.7.1      

2.1.7.1.1   

2.1.8  MUSCULAR BRANCHES

2.1.8.1      

2.1.8.2      

2.1.8.3      

2.1.8.4      

2.1.8.5      

2.1.8.6      

2.2  RECTUS CAPITIS ANTERIOR N.

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2.2.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.2.1.1     .

2.2.2  NUMBER

2.2.2.1     35

2.2.3  REFERENCE

2.2.3.1      

2.2.4  ROOTS

2.2.4.1      

2.2.4.2     Lumbar Plexus

2.2.4.3     VENTRAL

2.2.5  DIVISION

2.2.5.1     Dorsal Ventral

2.2.5.2      

2.2.6  CUTANEOUS BRANCHES

2.2.6.1      

2.2.6.1.1   

2.2.6.2      

2.2.6.2.1  .

2.2.7  ARTICULAR BRANCHES

2.2.7.1      

2.2.7.1.1   

2.2.8  MUSCULAR BRANCHES

2.2.8.1      

2.2.8.2      

2.2.8.3      

2.2.8.4      

2.2.8.5      

2.2.8.6      

2.3  LONGUS CAPITIS N

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2.3.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.3.1.1     .

2.3.2  NUMBER

2.3.2.1     35

2.3.3  REFERENCE

2.3.3.1      

2.3.4  ROOTS

2.3.4.1      

2.3.4.2     Lumbar Plexus

2.3.4.3     VENTRAL

2.3.5  DIVISION

2.3.5.1     Dorsal Ventral

2.3.5.2      

2.3.6  CUTANEOUS BRANCHES

2.3.6.1      

2.3.6.1.1   

2.3.6.2      

2.3.6.2.1  .

2.3.7  ARTICULAR BRANCHES

2.3.7.1      

2.3.7.1.1   

2.3.8  MUSCULAR BRANCHES

2.3.8.1      

2.3.8.2      

2.3.8.3      

2.3.8.4      

2.3.8.5      

2.3.8.6      

2.4  LONGUS COLI N.

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2.4.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.4.1.1     .

2.4.2  NUMBER

2.4.2.1     35

2.4.3  REFERENCE

2.4.3.1      

2.4.4  ROOTS

2.4.4.1      

2.4.4.2     Lumbar Plexus

2.4.4.3     VENTRAL

2.4.5  DIVISION

2.4.5.1     Dorsal Ventral

2.4.5.2      

2.4.6  CUTANEOUS BRANCHES

2.4.6.1      

2.4.6.1.1   

2.4.6.2      

2.4.6.2.1  .

2.4.7  ARTICULAR BRANCHES

2.4.7.1      

2.4.7.1.1   

2.4.8  MUSCULAR BRANCHES

2.4.8.1      

2.4.8.2      

2.4.8.3      

2.4.8.4      

2.4.8.5      

2.4.8.6      

2.5  STERNOCLEIDOMASTOID N.

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2.5.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.5.1.1     .

2.5.2  NUMBER

2.5.2.1     35

2.5.3  REFERENCE

2.5.3.1      

2.5.4  ROOTS

2.5.4.1      

2.5.4.2     Lumbar Plexus

2.5.4.3     VENTRAL

2.5.5  DIVISION

2.5.5.1     Dorsal Ventral

2.5.5.2      

2.5.6  CUTANEOUS BRANCHES

2.5.6.1      

2.5.6.1.1   

2.5.6.2      

2.5.6.2.1  .

2.5.7  ARTICULAR BRANCHES

2.5.7.1      

2.5.7.1.1   

2.5.8  MUSCULAR BRANCHES

2.5.8.1      

2.5.8.2      

2.5.8.3      

2.5.8.4      

2.5.8.5      

2.5.8.6      

2.6  TRAPEZIUS N.

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2.6.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.6.1.1     .

2.6.2  NUMBER

2.6.2.1     35

2.6.3  REFERENCE

2.6.3.1      

2.6.4  ROOTS

2.6.4.1      

2.6.4.2     Lumbar Plexus

2.6.4.3     VENTRAL

2.6.5  DIVISION

2.6.5.1     Dorsal Ventral

2.6.5.2      

2.6.6  CUTANEOUS BRANCHES

2.6.6.1      

2.6.6.1.1   

2.6.6.2      

2.6.6.2.1  .

2.6.7  ARTICULAR BRANCHES

2.6.7.1      

2.6.7.1.1   

2.6.8  MUSCULAR BRANCHES

2.6.8.1      

2.6.8.2      

2.6.8.3      

2.6.8.4      

2.6.8.5      

2.6.8.6      

2.7  LEVATOR SCAPULAE N.

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2.7.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.7.1.1     .

2.7.2  NUMBER

2.7.2.1     35

2.7.3  REFERENCE

2.7.3.1      

2.7.4  ROOTS

2.7.4.1      

2.7.4.2     Lumbar Plexus

2.7.4.3     VENTRAL

2.7.5  DIVISION

2.7.5.1     Dorsal Ventral

2.7.5.2      

2.7.6  CUTANEOUS BRANCHES

2.7.6.1      

2.7.6.1.1   

2.7.6.2      

2.7.6.2.1  .

2.7.7  ARTICULAR BRANCHES

2.7.7.1      

2.7.7.1.1   

2.7.8  MUSCULAR BRANCHES

2.7.8.1      

2.7.8.2      

2.7.8.3      

2.7.8.4      

2.7.8.5      

2.7.8.6      

2.8  SCALENUS NERVES.

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2.8.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.8.1.1     .

2.8.2  NUMBER

2.8.2.1     35

2.8.3  REFERENCE

2.8.3.1      

2.8.4  ROOTS

2.8.4.1      

2.8.4.2     Lumbar Plexus

2.8.4.3     VENTRAL

2.8.5  DIVISION

2.8.5.1     Dorsal Ventral

2.8.5.2      

2.8.6  CUTANEOUS BRANCHES

2.8.6.1      

2.8.6.1.1   

2.8.6.2      

2.8.6.2.1  .

2.8.7  ARTICULAR BRANCHES

2.8.7.1      

2.8.7.1.1   

2.8.8  MUSCULAR BRANCHES

2.8.8.1      

2.8.8.2      

2.8.8.3      

2.8.8.4      

2.8.8.5      

2.8.8.6      

2.9  BRACHIAL PLEXUS

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2.9.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.9.1.1     .

2.9.2  NUMBER

2.9.2.1     35

2.9.3  REFERENCE

2.9.3.1      

2.9.4  ROOTS

2.9.4.1      

2.9.4.2     Lumbar Plexus

2.9.4.3     VENTRAL

2.9.5  DIVISION

2.9.5.1     Dorsal Ventral

2.9.5.2      

2.9.6  CUTANEOUS BRANCHES

2.9.6.1      

2.9.6.1.1   

2.9.6.2      

2.9.6.2.1  .

2.9.7  ARTICULAR BRANCHES

2.9.7.1      

2.9.7.1.1   

2.9.8  MUSCULAR BRANCHES

2.9.8.1      

2.9.8.2      

2.9.8.3      

2.9.8.4      

2.9.8.5      

2.9.8.6      

2.10 DORSAL SCAPULAR N.

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2.10.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.10.1.1  .

2.10.2              NUMBER

2.10.2.1  35

2.10.3              REFERENCE

2.10.3.1   

2.10.4              ROOTS

2.10.4.1   

2.10.4.2  Lumbar Plexus

2.10.4.3  VENTRAL

2.10.5              DIVISION

2.10.5.1  Dorsal Ventral

2.10.5.2   

2.10.6              CUTANEOUS BRANCHES

2.10.6.1   

2.10.6.1.1          

2.10.6.2   

2.10.6.2.1         .

2.10.7              ARTICULAR BRANCHES

2.10.7.1   

2.10.7.1.1          

2.10.8              MUSCULAR BRANCHES

2.10.8.1   

2.10.8.2   

2.10.8.3   

2.10.8.4   

2.10.8.5   

2.10.8.6   

2.11 LONG THORACIC NERVE

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2.11.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.11.1.1  .

2.11.2              NUMBER

2.11.2.1  35

2.11.3              REFERENCE

2.11.3.1   

2.11.4              ROOTS

2.11.4.1   

2.11.4.2  Lumbar Plexus

2.11.4.3  VENTRAL

2.11.5              DIVISION

2.11.5.1  Dorsal Ventral

2.11.5.2   

2.11.6              CUTANEOUS BRANCHES

2.11.6.1   

2.11.6.1.1          

2.11.6.2   

2.11.6.2.1         .

2.11.7              ARTICULAR BRANCHES

2.11.7.1   

2.11.7.1.1          

2.11.8              MUSCULAR BRANCHES

2.11.8.1   

2.11.8.2   

2.11.8.3   

2.11.8.4   

2.11.8.5   

2.11.8.6   

2.12 SUBCLAVIUS N.

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2.12.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.12.1.1  .

2.12.2              NUMBER

2.12.2.1  35

2.12.3              REFERENCE

2.12.3.1   

2.12.4              ROOTS

2.12.4.1   

2.12.4.2  Lumbar Plexus

2.12.4.3  VENTRAL

2.12.5              DIVISION

2.12.5.1  Dorsal Ventral

2.12.5.2   

2.12.6              CUTANEOUS BRANCHES

2.12.6.1   

2.12.6.1.1          

2.12.6.2   

2.12.6.2.1         .

2.12.7              ARTICULAR BRANCHES

2.12.7.1   

2.12.7.1.1          

2.12.8              MUSCULAR BRANCHES

2.12.8.1   

2.12.8.2   

2.12.8.3   

2.12.8.4   

2.12.8.5   

2.12.8.6   

2.13 UPPER SUBSCAPULAR N.

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2.13.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.13.1.1  .

2.13.2              NUMBER

2.13.2.1  35

2.13.3              REFERENCE

2.13.3.1   

2.13.4              ROOTS

2.13.4.1   

2.13.4.2  Lumbar Plexus

2.13.4.3  VENTRAL

2.13.5              DIVISION

2.13.5.1  Dorsal Ventral

2.13.5.2   

2.13.6              CUTANEOUS BRANCHES

2.13.6.1   

2.13.6.1.1          

2.13.6.2   

2.13.6.2.1         .

2.13.7              ARTICULAR BRANCHES

2.13.7.1   

2.13.7.1.1          

2.13.8              MUSCULAR BRANCHES

2.13.8.1   

2.13.8.2   

2.13.8.3   

2.13.8.4   

2.13.8.5   

2.13.8.6   

2.14 THORACODORSAL N. (MIDDLE SUBSCAPULAR N.)

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2.14.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.14.1.1  .

2.14.2              NUMBER

2.14.2.1  35

2.14.3              REFERENCE

2.14.3.1   

2.14.4              ROOTS

2.14.4.1   

2.14.4.2  Lumbar Plexus

2.14.4.3  VENTRAL

2.14.5              DIVISION

2.14.5.1  Dorsal Ventral

2.14.5.2   

2.14.6              CUTANEOUS BRANCHES

2.14.6.1   

2.14.6.1.1          

2.14.6.2   

2.14.6.2.1         .

2.14.7              ARTICULAR BRANCHES

2.14.7.1   

2.14.7.1.1          

2.14.8              MUSCULAR BRANCHES

2.14.8.1   

2.14.8.2   

2.14.8.3   

2.14.8.4   

2.14.8.5   

2.14.8.6   

2.15 LOWER SUBSCAPULAR N.

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2.15.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.15.1.1  .

2.15.2              NUMBER

2.15.2.1  35

2.15.3              REFERENCE

2.15.3.1   

2.15.4              ROOTS

2.15.4.1   

2.15.4.2  Lumbar Plexus

2.15.4.3  VENTRAL

2.15.5              DIVISION

2.15.5.1  Dorsal Ventral

2.15.5.2   

2.15.6              CUTANEOUS BRANCHES

2.15.6.1   

2.15.6.1.1          

2.15.6.2   

2.15.6.2.1         .

2.15.7              ARTICULAR BRANCHES

2.15.7.1   

2.15.7.1.1          

2.15.8              MUSCULAR BRANCHES

2.15.8.1   

2.15.8.2   

2.15.8.3   

2.15.8.4   

2.15.8.5   

2.15.8.6   

1    Arms

1.1  SUPRACLAVICULAR

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1.1.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.1.1.1     .

1.1.2  NUMBER

1.1.2.1     35

1.1.3  REFERENCE

1.1.3.1      

1.1.4  ROOTS

1.1.4.1      

1.1.4.2     Lumbar Plexus

1.1.4.3     VENTRAL

1.1.5  DIVISION

1.1.5.1     Dorsal Ventral

1.1.5.2      

1.1.6  CUTANEOUS BRANCHES

1.1.6.1      

1.1.6.1.1   

1.1.6.2      

1.1.6.2.1  .

1.1.7  ARTICULAR BRANCHES

1.1.7.1      

1.1.7.1.1   

1.1.8  MUSCULAR BRANCHES

1.1.8.1      

1.1.8.2      

1.1.8.3      

1.1.8.4      

1.1.8.5      

1.1.8.6      

1.2  AXILLARY (U LAT CUT N)

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1.2.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.2.1.1     .

1.2.2  NUMBER

1.2.2.1     35

1.2.3  REFERENCE

1.2.3.1      

1.2.4  ROOTS

1.2.4.1      

1.2.4.2     Lumbar Plexus

1.2.4.3     VENTRAL

1.2.5  DIVISION

1.2.5.1     Dorsal Ventral

1.2.5.2      

1.2.6  CUTANEOUS BRANCHES

1.2.6.1      

1.2.6.1.1   

1.2.6.2      

1.2.6.2.1  .

1.2.7  ARTICULAR BRANCHES

1.2.7.1      

1.2.7.1.1   

1.2.8  MUSCULAR BRANCHES

1.2.8.1      

1.2.8.2      

1.2.8.3      

1.2.8.4      

1.2.8.5      

1.2.8.6      

1.3  2ND THOR INTERCSL N

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1.3.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.3.1.1     .

1.3.2  NUMBER

1.3.2.1     35

1.3.3  REFERENCE

1.3.3.1      

1.3.4  ROOTS

1.3.4.1      

1.3.4.2     Lumbar Plexus

1.3.4.3     VENTRAL

1.3.5  DIVISION

1.3.5.1     Dorsal Ventral

1.3.5.2      

1.3.6  CUTANEOUS BRANCHES

1.3.6.1      

1.3.6.1.1   

1.3.6.2      

1.3.6.2.1  .

1.3.7  ARTICULAR BRANCHES

1.3.7.1      

1.3.7.1.1   

1.3.8  MUSCULAR BRANCHES

1.3.8.1      

1.3.8.2      

1.3.8.3      

1.3.8.4      

1.3.8.5      

1.3.8.6      

1.4  MEDIAL BRACHIAL CUT N.(FLASH;MEDIAL CUT)(GRAY;LESSER INTERNAL CUT,N. OF WRISBERG)

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1.4.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.4.1.1     .

1.4.2  NUMBER

1.4.2.1     35

1.4.3  REFERENCE

1.4.3.1      

1.4.4  ROOTS

1.4.4.1      

1.4.4.2     Lumbar Plexus

1.4.4.3     VENTRAL

1.4.5  DIVISION

1.4.5.1     Dorsal Ventral

1.4.5.2      

1.4.6  CUTANEOUS BRANCHES

1.4.6.1      

1.4.6.1.1   

1.4.6.2      

1.4.6.2.1  .

1.4.7  ARTICULAR BRANCHES

1.4.7.1      

1.4.7.1.1   

1.4.8  MUSCULAR BRANCHES

1.4.8.1      

1.4.8.2      

1.4.8.3      

1.4.8.4      

1.4.8.5      

1.4.8.6      

1.5  RADIAL

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1.5.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.5.1.1     .

1.5.2  NUMBER

1.5.2.1     35

1.5.3  REFERENCE

1.5.3.1      

1.5.4  ROOTS

1.5.4.1      

1.5.4.2     Lumbar Plexus

1.5.4.3     VENTRAL

1.5.5  DIVISION

1.5.5.1     Dorsal Ventral

1.5.5.2      

1.5.6  CUTANEOUS BRANCHES

1.5.6.1      

1.5.6.1.1   

1.5.6.2      

1.5.6.2.1  .

1.5.7  ARTICULAR BRANCHES

1.5.7.1      

1.5.7.1.1   

1.5.8  MUSCULAR BRANCHES

1.5.8.1      

1.5.8.2      

1.5.8.3      

1.5.8.4      

1.5.8.5      

1.5.8.6      

1.6  MUSCULOCUTANEOUS

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1.6.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.6.1.1     .

1.6.2  NUMBER

1.6.2.1     35

1.6.3  REFERENCE

1.6.3.1      

1.6.4  ROOTS

1.6.4.1      

1.6.4.2     Lumbar Plexus

1.6.4.3     VENTRAL

1.6.5  DIVISION

1.6.5.1     Dorsal Ventral

1.6.5.2      

1.6.6  CUTANEOUS BRANCHES

1.6.6.1      

1.6.6.1.1   

1.6.6.2      

1.6.6.2.1  .

1.6.7  ARTICULAR BRANCHES

1.6.7.1      

1.6.7.1.1   

1.6.8  MUSCULAR BRANCHES

1.6.8.1      

1.6.8.2      

1.6.8.3      

1.6.8.4      

1.6.8.5      

1.6.8.6      

1.7  MED ANTEBRACHIAL CUT N.(FLASH;MEDIAL  CUTANEOUS N. OF FOREARM),(GRAY; INTERNAL CUT N.)

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1.7.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

1.7.1.1     .

1.7.2  NUMBER

1.7.2.1     35

1.7.3  REFERENCE

1.7.3.1      

1.7.4  ROOTS

1.7.4.1      

1.7.4.2     Lumbar Plexus

1.7.4.3     VENTRAL

1.7.5  DIVISION

1.7.5.1     Dorsal Ventral

1.7.5.2      

1.7.6  CUTANEOUS BRANCHES

1.7.6.1      

1.7.6.1.1   

1.7.6.2      

1.7.6.2.1  .

1.7.7  ARTICULAR BRANCHES

1.7.7.1      

1.7.7.1.1   

1.7.8  MUSCULAR BRANCHES

1.7.8.1      

1.7.8.2      

1.7.8.3      

1.7.8.4      

1.7.8.5      

1.7.8.6      

2    Hands

2.1  ULNAR

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2.1.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.1.1.1     .

2.1.2  NUMBER

2.1.2.1     35

2.1.3  REFERENCE

2.1.3.1      

2.1.4  ROOTS

2.1.4.1      

2.1.4.2     Lumbar Plexus

2.1.4.3     VENTRAL

2.1.5  DIVISION

2.1.5.1     Dorsal Ventral

2.1.5.2      

2.1.6  CUTANEOUS BRANCHES

2.1.6.1      

2.1.6.1.1   

2.1.6.2      

2.1.6.2.1  .

2.1.7  ARTICULAR BRANCHES

2.1.7.1      

2.1.7.1.1   

2.1.8  MUSCULAR BRANCHES

2.1.8.1      

2.1.8.2      

2.1.8.3      

2.1.8.4      

2.1.8.5      

2.1.8.6      

2.2  RADIAL

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2.2.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.2.1.1     .

2.2.2  NUMBER

2.2.2.1     35

2.2.3  REFERENCE

2.2.3.1      

2.2.4  ROOTS

2.2.4.1      

2.2.4.2     Lumbar Plexus

2.2.4.3     VENTRAL

2.2.5  DIVISION

2.2.5.1     Dorsal Ventral

2.2.5.2      

2.2.6  CUTANEOUS BRANCHES

2.2.6.1      

2.2.6.1.1   

2.2.6.2      

2.2.6.2.1  .

2.2.7  ARTICULAR BRANCHES

2.2.7.1      

2.2.7.1.1   

2.2.8  MUSCULAR BRANCHES

2.2.8.1      

2.2.8.2      

2.2.8.3      

2.2.8.4      

2.2.8.5      

2.2.8.6      

2.3  MEDIAN NERVE

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2.3.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

2.3.1.1     .

2.3.2  NUMBER

2.3.2.1     35

2.3.3  REFERENCE

2.3.3.1      

2.3.4  ROOTS

2.3.4.1      

2.3.4.2     Lumbar Plexus

2.3.4.3     VENTRAL

2.3.5  DIVISION

2.3.5.1     Dorsal Ventral

2.3.5.2      

2.3.6  CUTANEOUS BRANCHES

2.3.6.1      

2.3.6.1.1   

2.3.6.2      

2.3.6.2.1  .

2.3.7  ARTICULAR BRANCHES

2.3.7.1      

2.3.7.1.1   

2.3.8  MUSCULAR BRANCHES

2.3.8.1      

2.3.8.2      

2.3.8.3      

2.3.8.4      

2.3.8.5      

2.3.8.6      

2.4   

2.5   

3    HIP AND LEGS

3.1  12TH THORACIC INTERCOSTAL (SUB COSTAL) 35.01

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3.1.1  DESCRIPTION # 1: PATH, FUNCTION-LESIONS

3.1.1.1     A FOCAL LESION TO THE SUBCOSTAL NERVE WOULD NOT SIGNIFICANTLY WEAKEN THE QUADRATUS LUMBORUM BUT WOULD PARALYZE THE PYRAMIDALIS AND WEAKEN THE LOWER ABDOMINAL MUSCLES PRESENTING "BEAVOR'S SIGN". THIS COULD ALSO PRESENT A BULGING OF THE LOWER ABDOMEN.

3.1.2  DESCRIPTION # 2: CUTANEOUS AREA, ADDITIONAL COMMENTS

3.1.2.1     T12 IS OFTEN CONSIDERED PART OF THE LUMBAR PLEXUS.

3.1.3  CUTANEOUS BRANCHES (12TH THOR)

3.1.3.1     LATERAL CUTANEOUS (CUT B) 35.011

3.1.3.1.1  ANTEROLATERAL GLUTEAL SKIN SOME FILAMENTS REACHING THE SKIN OVER THE GREATER TROCHANTER

3.1.3.2     ANTERIOR CUTANEOUS(CUT BR) 35.012

3.1.3.2.1  SKIN OF SUPRAPUBIC AREA.

3.1.4  Articular Branches

3.1.4.1     ARTICULAR(12 THOR)

3.1.4.1.1  12TH COSTOVERTEBRAL(ART)

3.1.5  ROOTS

3.1.5.1     T12

3.1.5.2     SPINAL NERVE

3.1.5.3     VENTRAL

3.1.6  MUSCULAR BRANCHES (12TH THORACIC)

3.1.6.1     QUADRATUS LUMBORUM  T12-L3,(L4)

3.1.6.2     TRANSVERSE ABDOMINAL T7-L1

3.1.6.3     INTERNAL OBLIQUE ABDOMINAL T7-L1

3.1.6.4     EXTERNAL OBLIQUE ABDOMINAL T5-T12

3.1.6.4.1  T12 LATERAL CUTANEOUS BRANCH SUPPLIES THE LOWER SLIP

3.1.6.5     RECTUS ABDOMINAL (T5),T6-T12

3.1.6.6     PYRAMIDALIS T12

3.1.7  NUMBER

3.1.7.1     35.01

3.1.8  REFERANCE

3.1.8.1     50

3.2  Lumbar Plexus (Spinal Segments & Nerves) (61)

3.2.1  Spinal Segments

3.2.1.1    

3.2.2  Nerves

3.2.2.1    

3.2.3  Reference

3.2.3.1     61

3.3  Lumbar Plexus (62)

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3.3.1  Spinal Roots

3.3.1.1     L 1, L2, L3, L4 ventral rami with a ramus from T12

3.3.1.1.1  They descend laterally into the psoas major. The first three and most of the fourth form the lumbar plexus. The rest of L4 splits to join L5 forming the Lumbosacral trunk

3.3.2  Named Branches

3.3.2.1     A=Muscular branches / T12, L 1-L4.

3.3.2.2     B=Iliohypogastric nerve / T12, L 1.

3.3.2.3     C=llio-inguinal nerve / L 1.

3.3.2.4     D=Genitofemoral nerve / L 1, L2.

3.3.3  From Ventral Divisions

3.3.3.1     E=Obturator nerve / L2-L4.

3.3.3.2     F=Accessory Obturator nerve / L3, L4

3.3.4  From Dorsal Divisions

3.3.4.1     G=Lateral femoral cutaneous nerve / L4, L5.

3.3.4.2     H=Femoral nerve / L2-L4.

3.3.4.3     I=Lumbosacral trunk to sacral plexus / L4, L5.

3.3.5  Cutaneous Branches

3.3.5.1     The areas of cutaneous innervation are designated by the letters as described above

3.3.6  Lesions

3.3.6.1     Injury to the lumbar roots or the cauda equina related to L 1, L2, L3 can result from neurofibromas, meningiomas or other malignant disease. Disc herniations, although less common, can produce focal lesions of the lumbar roots. Injury to L1 results in weakness of abdominal musculature and paresthesias to the skin region of the greater trochanter and upper groin. Injury to L2 produces weak hip flexion, due to deficits in psoas major and iliacus, and paresthesias to skin of anterior thigh. Injury to L3 results in weak adduction of leg and reduced knee jerk reflex and paresthesias to skin of anterior thigh (femoral nerve), anteromedial knee, leg and foot (saphenous nerve). Injury to L4 is the most common lesion of the lumbar plexus and typically results from a herniated intervertebral disc between L4 and L5 or degenerative arthritis (spondylosis) in the spine. Deficits resemble those of L3 except that cutaneous fibers for the anterior thigh (via the femoral nerve) survive. Deficits to tibialis anterior and posterior will result in a "foot drop" via L4 lumbosacral trunk deficit.

3.3.7  Path Description

3.3.7.1     The lumbar plexus is formed by the loops of communication between the anterior divisions of the first three and the greater part of the fourth lumbar nerves; the first lumbar often receives a branch from the last thoracic nerve. It is situated in the posterior part of the Psoas major, in front of the transverse processes of the lumbar vertebra. The mode in which the plexus is arranged varies in different subjects. It differs from the brachial plexus in not forming an intricate interlacement, but the several nerves of distribution arise from one or more of the spinal nerves, in the following manner: the first lumbar nerve, frequently supplemented by a twig from the last thoracic, splits into an upper and lower branch; the upper and larger branch divides into the Iliohypogastric and ilioinguinal nerves; the lower and smaller branch unites with a branch of the second lumbar to form the Genitofemoral nerve. The remainder of the second nerve, and the third and fourth nerves, divide into ventral and dorsal divisions. The ventral division of the second unites with the ventral divisions of the third and fourth nerves to form the Obturator nerve. The dorsal divisions of the second and third nerves divide into two branches, a smaller branch from each uniting to form the lateral femoral cutaneous nerve, and a larger branch from each joining with the dorsal division of the fourth nerve to form the femoral nerve. The accessory Obturator, when it exists, is formed by the union of two small branches given off from the third and fourth nerves.

3.3.8  Gray’s Anatomy

3.3.8.1     http://www.bartleby.com/107/212.html

3.3.8.2     Illustrations

3.3.8.2.1  http://www.bartleby.com/107/illus822.html
3.3.8.2.2  http://www.bartleby.com/107/illus823.html
3.3.8.2.3  http://www.bartleby.com/107/illus824.html

3.3.9  Number

3.3.9.1      

3.3.10              Reference

3.3.10.1  62

3.3.11              Illustration

3.3.11.1 

3.4  Lumbar Plexus (Muscular Branches and Relationships) (63)

3.4.1  Spinal Roots

3.4.1.1     T12, L 1, L2, L3, L4 Ventral rami

3.4.2  Named Branches

3.4.2.1     None

3.4.3  Muscular Branches

3.4.3.1     A=Quadratus lumborum / T12, L 1-L3.

3.4.3.2     B=Psoas minor / L 1.

3.4.3.3     C=Psoas major / L 1-L3

3.4.4  Articular Branches

3.4.4.1     None

3.4.5  Cutaneous Branches

3.4.5.1     None

3.4.6  Lumbar Plexus Relations

3.4.6.1     The whole lumbar plexus pierces the psoas major, divides into branches exiting from the:

3.4.6.2     Lateral Border of Psoas

3.4.6.2.1  D=Iliohypogastric nerve.
3.4.6.2.2  E=llio-inguinal nerve.
3.4.6.2.3  F=Lateral femoral cutaneous nerve.
3.4.6.2.4  G=Femoral nerve.

3.4.6.3     Anterolateral Border of Psoas

3.4.6.3.1  H=Genitofemoral nerve

3.4.6.4     Anteromedial Border of Psoas

3.4.6.4.1  I=Obturator nerve.
3.4.6.4.2  J=Accessory Obturator nerve (if present).
3.4.6.4.3  K=Upper root of lumbosacral trunk

3.4.7  Lesions

3.4.7.1     Root lesions to L2, L3 can weaken the psoas major, however, L2 provides the greatest affect. Presents as weakness or inability to flex the hip. Paresthesia or loss of sensation to the anterior proximal thigh (femoral nerve L2) could further specify the root damage as L2 rather than L1.

3.4.8  Gray’s Anatomy

3.4.8.1     http://www.bartleby.com/107/212.html

3.4.9  Number

3.4.9.1      

3.4.10              Reference

3.4.10.1  63

3.4.11              Illustration

3.4.11.1 

3.5  Nerves from Ventral Rami of Lumbar Plexus (64)

3.5.1  Illustration A

3.5.1.1    

3.5.2  Illustration B

3.5.2.1    

3.5.3  Number

3.5.3.1      

3.5.4  Reference

3.5.4.1     64

3.6  Iliohypogastric Nerve (65) (Blank)

3.6.1  Spinal Roots

3.6.1.1      

3.6.2  Named Branches

3.6.2.1      

3.6.3  Muscular Branches

3.6.3.1      

3.6.4  Articular Branches

3.6.4.1      

3.6.5  Cutaneous Branches

3.6.5.1      

3.6.6  Lesions

3.6.6.1      

3.6.7  Gray’s Anatomy

3.6.7.1     http://www.bartleby.com/107/212.html

3.6.8  Number

3.6.8.1      

3.6.9  Reference

3.6.9.1      

3.6.10              Illustration

3.6.10.1   

3.7  ILLIOHYPOGASTRIC (65)

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3.7.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.7.1.1     . EXITS THROUGH THE LATERAL BORDER OF THE PSOAS MAJOR. INJURY TO THIS NERVE CAN RESULT FROM AN INCISION FOR AN APPENDECTOMY. PRESENTS AS A WEAKNESS IN THE ABDOMINAL AREA OF INQUINAL CANL AND PARESTHESIA OF LOSS OF SENSATION TO THE SKIN DESCRIBED IN THE CUTANEOUS SECTION FOR THIS NERVE. THE ABDONIMAL WEKNESS MAY RESULT IN THE DEVELOPMENT OF A DIRECT INQUINAL HERNIA.

3.7.2  CUTANEOUS BRANCHES

3.7.2.1     LATERAL CUTANEOUS

3.7.2.1.1   L GLUTEAL SKIN

3.7.2.2     ANTERIOR CUTANEOUS

3.7.2.2.1  . SUPRAPUBIC SKIN (HYPOGASTRIC REGION)

3.7.3  ARTICULAR BRANCHES

3.7.3.1     NONE

3.7.3.1.1   

3.7.4  ROOTS

3.7.4.1     T12-L1

3.7.4.2     Lumbar Plexus

3.7.4.3     VENTRAL

3.7.5  MUSCULAR BRANCHES

3.7.5.1     TRANSVERSE ABDOMINIS

3.7.5.1.1  SUPPLIED BY THE VENTRAL RAMI T7-T12 AND THE ILLIOINGUINAL NERVES.

3.7.5.2     INTERNAL ABDOMINAL OBLIQUE

3.7.5.2.1  SUPPLIED BY THE VENTRAL RAMI T7-T12 AND THE ILLIOINGUINAL NERVES.

3.7.6  NUMBER

3.7.6.1     . 35 .02

3.7.7  REFERENCE

3.7.7.1     66

3.8  Ilio-Inquinal Nerve (66) (Blank)

3.8.1  Spinal Roots

3.8.1.1      

3.8.2  Named Branches

3.8.2.1      

3.8.3  Muscular Branches

3.8.3.1      

3.8.4  Articular Branches

3.8.4.1      

3.8.5  Cutaneous Branches

3.8.5.1      

3.8.6  Lesions

3.8.6.1      

3.8.7  Gray’s Anatomy

3.8.7.1     http://www.bartleby.com/107/212.html

3.8.8  Number

3.8.8.1      

3.8.9  Reference

3.8.9.1      

3.8.10              Illustration

3.8.10.1   

3.9  ILLIO-INGUINAL (66)

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3.9.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.9.1.1     . EXITS THROUGH THE LATERAL BORDER OF THE PSOAS MAJOR. INJURY TO THIS NERVE CAN RESULT BY AN INCISION FOR AN APPENDECTOMY AND HERNIORRHAPHIES, DURNING PLANNENSTIEL'S (HORIZONTAL SUPRAPUBIC) INCISIONS, OR NEPHRECTOMIES. SOMETIMES NORMAL PREGNACY AND DELIVERY CAN STRETCH THE NERVE. THE PATIENT USUALLY COMPLAINS OF PARESTHESIA OR LOSS OF S4ENSATION TO THE SKIN DECRIBED IN THE CUTANEOUS XERCTION FOR THIS NERVE. LIOHYPOGASTRIC, ILIO-INGUINAL AND GENITOFEMORAL NERVES IN AND OF THEMSELVES MAY NOT BE AS IMPORTANT AS PARESTHESIAS AND PAIN IN DISTRIBUTION. THIS BEING AN INDICATOR IDENTIFYING (LOCALIZING) SPINAL NERVE LESIONS. ALSO PAIN FROM DISEASE OF THE URETER AND RENAL PELVIS MAY REFER HERE.

3.9.2  CUTANEOUS BRANCHES

3.9.2.1     GROIN 35.031

3.9.2.1.1   PROXIMOMEDIAL SKIN OF THE THIGH(GROIN).

3.9.2.2     BASE O PENIS/MONS PUBIS 35.032

3.9.2.2.1  . IN MALES THE SKIN OVER THE PENILE ROOT AND UPPER PART OF SCROTUM. IN FEMALES, THE SKIN COVERING THE MONS PUBIS AND THE ADJOINING LABIUM MARORUS.

3.9.3  ARTICULAR BRANCHES

3.9.3.1     NONE

3.9.4  ROOTS

3.9.4.1     L1

3.9.4.2     Lumbar Plexus

3.9.4.3     VENTRAL

3.9.5  MUSCULAR BRANCHES

3.9.5.1     TRANSVERSE ABDOMINIS

3.9.5.1.1  THIS NERVE IS SUPPLIED BY THE VENTRAL RAMI T7-T12 AND THE ILLIOHYPOGASTRIC NERVES.

3.9.5.2     INTERNAL ABDOMINAL OBLIQUE

3.9.5.2.1  THIS NERVE IS SUPPLIED BY THE VENTRAL RAMI T7-T12 AND THE ILLIOHYPOGASTRIC NERVES.

3.9.6  NUMBER

3.9.6.1     . 35 .03

3.9.7  REFERENCE

3.9.7.1     67

3.10 Genitofemoral Nerve (67) (Blank)

3.10.1              Spinal Roots

3.10.1.1   

3.10.2              Named Branches

3.10.2.1   

3.10.3              Muscular Branches

3.10.3.1   

3.10.4              Articular Branches

3.10.4.1   

3.10.5              Cutaneous Branches

3.10.5.1   

3.10.6              Lesions

3.10.6.1   

3.10.7              Gray’s Anatomy

3.10.7.1  http://www.bartleby.com/107/212.html

3.10.8              Number

3.10.8.1   

3.10.9              Reference

3.10.9.1   

3.10.10           Illustration

3.10.10.1                

3.11 GENITAL FEMORAL (67)

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3.11.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.11.1.1  . SCARRING AND ADHESIONS FROM APPENDECTOMIES CAN CONSTRICT THE NERVE AND RESULT IN PARALYSIS OF THE CREMASTER MUSCLE. CREMASTERIC ACTIONS ARE NOT USUALLY VOLUNTARY, RAISING TESTES, ESSENTIAL TO TESTICULAR THERMOREGULATION. STIMULATION OF MEDIAL FEMORAL SKIN EVODES A REFLEX CONTRACTION; THIS WOULD BE LOST. HOWEVER, THIS IS NOT CONSIDERED A RELIABLETEST. PRESENTS AS A PARESTHESIA OR LOSS OF SENSATION TO THE SKIN IN THE CUTANEOUS DESCRIPTION FOR THIS NERVE.

3.11.2              NUMBER

3.11.2.1  35.04

3.11.3              REFERENCE

3.11.3.1  68

3.11.4              ROOTS

3.11.4.1  L1-L2

3.11.4.2  Lumbar Plexus

3.11.4.3  VENTRAL

3.11.5              CUTANEOUS BRANCHES

3.11.5.1  GENITAL BR 35.041

3.11.5.1.1          SUPPLIES THE SCROTAL SKIN IN MALES AND IN FEMALES THE SKIN OF THE MONS PUBIS, LABIUM MAJORUS AND PARTS OF VULVA INCLUDING THE CLITORIS, LABIA MINOR VVAGINA GREATER VESTIBULE(BARTHOLIN) GLANDS, AND BULB OF VESTIBULA.

3.11.5.2  FEMORAL BR 35.042

3.11.5.2.1         . SKIN OVER THE UPPER PART OF THE FEMORAL TRIANGLE.

3.11.6              ARTICULAR BRANCHES

3.11.6.1  NONE

3.11.7              MUSCULAR BRANCHES

3.11.7.1.1         CREMASTER

3.12 Nerves from Ventral Division of Ventral Rami Lumbar Plexus (68)

3.12.1              Illustration A

3.12.1.1 

3.12.2              Illustration B

3.12.2.1 

3.12.3              Number

3.12.3.1   

3.12.4              Reference

3.12.4.1  68

3.13 Obturator Nerve (69) (Blank)

3.13.1              Spinal Roots

3.13.1.1   

3.13.2              Named Branches

3.13.2.1   

3.13.3              Muscular Branches

3.13.3.1   

3.13.4              Articular Branches

3.13.4.1   

3.13.5              Cutaneous Branches

3.13.5.1   

3.13.6              Lesions

3.13.6.1   

3.13.7              Gray’s Anatomy

3.13.7.1  http://www.bartleby.com/107/212.html

3.13.8              Number

3.13.8.1   

3.13.9              Reference

3.13.9.1   

3.13.10           Illustration

3.13.10.1                

3.14 OBTURATOR (69)

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3.14.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.14.1.1  . L2-L4 VENTRAL DIVISION OF THE VENTRAL RAMI, EXITING THROUGH THE MEDIAL BORDER OF THE PSOAS MAJOR. BEFORE PASSING THROUGH THE OBTURATOR FORAMEN IT BIFURCATES INTO ANTERIOR AND POSTERIOR DIVISIONS.

3.14.1.2  INJURY TO THIS NERVE IS RARE. IT IS VULNERABLE TO SURGICAL DAMAGE DURING PELVIC INTRUSION TO REMOVE MALIGNANT LYMPH NODES. PRESSURE FROM A GRAVID UTERUS AND DAMAGE FROM SEVERE LABOUR IS NOT UNCOMMON. IT MAY ALSO BE IRRITATED BY DISEASE OF AN OVARY.

3.14.1.3  PRESSENTS A WEAKNESS OR INABLIITY TO STABILIZE THE HIP. PARALYSIS OF ADDUCTORS AND OBTURATOR EXTERNUS WEAKEN BY ADDUCTION AND EXTERNAL ROTATION OF THE THIGH, MAKING CROSSING OF LEGS DIFFICULT. PARESTHESIA OR LOSS OF SENSATION TO THE SKIN AREAS DESCRIBED.

3.14.1.4  HIP JOINT DISEASE MAY CAUSE REFERRED PAIN TO THE MEDIAL SIDE OF THE THIGH. THE NERVE IS SOMETIMES SEVERED TO RELIEVE ADDUCTOR SPASM IN SPASTIC PARALYSIS, PARAPLEGIA OR MULTIPLE SCLEROSIS. TO DIFFERENTIATE A FOCAL OBTURATOR NERVE LESION FROM LUMBAR ROOT LESION, TEST THE FEMORAL NERVE, WHICH IS ALSO DERIVES FROM L2-L4.

3.14.2              NUMBER

3.14.2.1  35.06

3.14.3              REFERENCE

3.14.3.1  85

3.14.4              ROOTS

3.14.4.1  S1-S2        S2-S3

3.14.4.2  Lumbar Plexus

3.14.4.3  VENTRAL

3.14.5              DIVISION

3.14.5.1  Anterior Posterior

3.14.6              ANT DIVISION(OBTURATOR) 35.061

3.14.6.1  MUSCULAR BRANCHES (Ant Div)

3.14.6.1.1.1           ADDUCTOR LONGUS L2,L3,L4
3.14.6.1.1.2           GRACILLIS L2,L3
3.14.6.1.1.3           ADDUCTOR BREVIS  L3,L4

3.14.6.1.1.3.1SOMETIMES FROM POSTERIOR BRANCH OF OBTURATOR NERVE ALSO

3.14.6.1.1.4           PECTINEUS  L2,L3

3.14.6.1.1.4.1THIS USUALLY RECEIVES FROM THE FEMORAL NERVE OR SOMETIMES THE ACCESSORY OBTURATOR NERVE WHEN PRESENT

3.14.6.1.1.5            

3.14.6.2  ARTICULAR BRANCHES(ANT DIV)

3.14.6.2.1         HIP

3.14.6.3   CUTANEOUS BRANCHES(ANT DIV)

3.14.6.3.1         TO THE SKIN ON THE MEDIAL SIDE OF THIGH.

3.14.7              POSTERIOR DIVISION(OBTURATOR)

3.14.7.1  MUSCULAR BRANCHES (Posterior Div)

3.14.7.1.1         OBTURATOR EXXTERNUS L3,L4
3.14.7.1.2         ABDUCTOR MAGNUS (PROXIMAL HORIZONTAL) L2,L3,L4
3.14.7.1.2.1           THE DISTAL (ISCHIOCONDYLAR) MUSCULAR FIBERS ARE SUPPLIED BY TIBIAL DIVISION OF SCIATIC NERVE.
3.14.7.1.3         ADDUCTOR BREVIS (SOMETIMES) L3,L4

3.14.7.2  ARTICULAR BRANCHES(POST DIV)

3.14.7.2.1         KNEE (SOMETIMES ABSENT)

3.15 Accessory Obturator Nerve (70) (Blank)

3.15.1              Spinal Roots

3.15.1.1   

3.15.2              Named Branches

3.15.2.1   

3.15.3              Muscular Branches

3.15.3.1   

3.15.4              Articular Branches

3.15.4.1   

3.15.5              Cutaneous Branches

3.15.5.1   

3.15.6              Lesions

3.15.6.1   

3.15.7              Gray’s Anatomy

3.15.7.1  http://www.bartleby.com/107/212.html

3.15.8              Number

3.15.8.1   

3.15.9              Reference

3.15.9.1   

3.15.10           Illustration

3.15.10.1                

3.16 ACCESSORY OBTURATOR (70)

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3.16.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.16.1.1  . EXITING THROUGH THE MEDIAL BOARDER OF PSOAS MAJOR. THIS NERVE IS PRESENT ABOUT 30% OF THE TIME WITH VARIATIONS.

3.16.1.2  IF PRESENT AND INJURED IT COULD MINIMALLY WEKEN ADDUCTION AND FLEXION OF THE HIP JOINT.

3.16.2              NUMBER

3.16.2.1  None

3.16.3              REFERENCE

3.16.3.1  71

3.16.4              ROOTS

3.16.4.1  L3, L4

3.16.4.2  Lumbar Plexus

3.16.4.3  VENTRAL

3.16.5              DIVISION

3.16.5.1  None

3.16.6              CUTANEOUS BRANCHES

3.16.6.1  None

3.16.7              ARTICULAR BRANCHES

3.16.7.1  None

3.16.7.1.1          

3.16.8              MUSCULAR BRANCHES

3.16.8.1  PECTINEUS

3.16.8.1.1         THE PECTINEUS MAY BE DIVIDED INTO ANTERIOR AND POSTERIOR STRATA. THE ACCESSORY OBTURATOR OR OBTURATOR NERVES SUPPLYING THE POSTERIOR STRATUM; THE FEMORAL NERVE SUPPLIES THE ANTERIOR STRATUM.

3.16.8.2  ADDUCTOR LONGUS  (SOMETIMES)

3.17 Lumbar Plexus (Nerves from Dorsal Divisions-Ventral Rami (71)

3.17.1              Illustration # A

3.17.1.1 

3.17.2              Illustration # B

3.17.2.1 

3.17.3              REFERENCE

3.17.3.1  71

3.18 Lateral Cutaneous Femoral Nerve (72) (Blank)

3.18.1              Spinal Roots

3.18.1.1   

3.18.2              Named Branches

3.18.2.1   

3.18.3              Muscular Branches

3.18.3.1   

3.18.4              Articular Branches

3.18.4.1   

3.18.5              Cutaneous Branches

3.18.5.1   

3.18.6              Lesions

3.18.6.1   

3.18.7              Gray’s Anatomy

3.18.7.1  http://www.bartleby.com/107/212.html

3.18.8              Number

3.18.8.1   

3.18.9              Reference

3.18.9.1   

3.18.10           Illustration

3.18.10.1                

3.19 Femoral Nerve (Abdominal Branches) (73) (Blank)

3.19.1              Spinal Roots

3.19.1.1   

3.19.2              Named Branches

3.19.2.1   

3.19.3              Muscular Branches

3.19.3.1   

3.19.4              Articular Branches

3.19.4.1   

3.19.5              Cutaneous Branches

3.19.5.1   

3.19.6              Lesions

3.19.6.1   

3.19.7              Gray’s Anatomy

3.19.7.1  http://www.bartleby.com/107/212.html

3.19.8              Number

3.19.8.1   

3.19.9              Reference

3.19.9.1   

3.19.10           Illustration

3.19.10.1                

3.20 Femoral Nerve (Anterior Division) (74) (Blank)

3.20.1              Spinal Roots

3.20.1.1   

3.20.2              Named Branches

3.20.2.1   

3.20.3              Muscular Branches

3.20.3.1   

3.20.4              Articular Branches

3.20.4.1   

3.20.5              Cutaneous Branches

3.20.5.1   

3.20.6              Lesions

3.20.6.1   

3.20.7              Gray’s Anatomy

3.20.7.1  http://www.bartleby.com/107/212.html

3.20.8              Number

3.20.8.1   

3.20.9              Reference

3.20.9.1   

3.20.10           Illustration

3.20.10.1                

3.21 LAT FEM CUT (?)

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3.21.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.21.1.1  . L2-3 DORSAL DIVISION FROM THE VENTRAL RAMI EXITING THROUGH THE LATYERAL BAORDER OF PSOAS MAJOR.

3.21.1.2  PRESENTS AS PARESTHESIA OR LOSS OF SENSATION TO THE SKIN AREA DESCRIBED.

3.21.2              NUMBER

3.21.2.1  35.07

3.21.3              REFERENCE

3.21.3.1  73

3.21.4              ROOTS

3.21.4.1  L2, L3

3.21.4.2  Lumbar Plexus

3.21.4.3  VENTRAL

3.21.5              DIVISION

3.21.5.1  Dorsal

3.21.6              CUTANEOUS BRANCHES

3.21.6.1  ANTERIOR 35.071

3.21.6.1.1          SUPPLIES THE SKIN OF THE ANTEROLATERAL THIGH AS FAR DISTAL AS THE KNEE AND FORMS PART OF PATELLAR PLEXUS.

3.21.6.2  POSTERIOR 35.072

3.21.6.2.1         . SUPPLIES THE SKIN OF THE LATERAL THIGH FROM THE GREATER TROCHANTER TO ABOUT THE MID-THIGH: IT MAY ALSO SUPPLY SOME OF THE GLUTEAL SKIN.

3.21.7              ARTICULAR BRANCHES

3.21.7.1  None

3.21.8              MUSCULAR BRANCHES

3.21.8.1  None

3.22 FEMORAL NERVE (?)

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3.22.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.22.1.1  . Femoral nerve: injuries to the femoral nerve are usually due to trauma in the area of the femoral triangle. however, a tubercular abscess involving the psoas muscles can cause nerve compression, and disease from intervertebral lumbar discs and sacroiliac joints may cause spasm of the Iliopsoas, a Hematoma in the psoas muscle or beneath the iliacus fascia, can compress the femoral nerve between the inguinal ligament and the iliac bone. consequently, the iliacus and pectineus muscles could be weakened or paralysed, presenting as weak hip flexion. see also lesions of femoral nerve, anterior and posterior divisions, for further deficits.  femoral nerve(anterior div): injury to the anterior division of the femoral nerve alone would result in paralysis of the Sartorius muscle, presenting as weak knee flexion and contributing to instability of the anteromedial knee. Additionally, decreased strength in hip adduction, lateral rotation and flexion may bve seen. paresthesia or loss of sensation also occurs in the skin areas described above. a lesion proximal to the ingunal ligament would affect paralysis to both the anterior and posterior branches. femoral nerve(post div): (posterior branch); injury to the posterior branch of the femoral nerve is usually a result of trauma to the femoral triangle. this would produce wek hip flexion due to paralysis of rectus Femoris. knee extension will be all but obliterated due to paralysis to the entire quadriceps group; loss of patella tendon reflex is also seen. to isolate focal femoral nerve lseion from lumbar root, test the Obturator nerve, both derive from l2-l4. often both obturator and femoral nerves are affected. (saphenous nerv); trauma is the typical cause of injury to the saphenous nerve. it is in particular danger during operations on varicose veins, and the infrapatellar granch can be damaged during knee surgery. injury will present paresthesia or loss of sensation to the skin areas described above. l4 is the  primary root of the saphenous nerve. for focal differential diagnosis, check hip adductors (obturator enrve) and the Tibialis anterior (common Peroneal nerve) for l4 radiculopathy as opposed to femoral focal neuropathy.

3.22.1.2   

3.22.2              NUMBER

3.22.2.1  35.08

3.22.3              REFERENCE

3.22.3.1  74 75 76

3.22.4              ROOTS

3.22.4.1  L2, L3, L4

3.22.4.2  Lumbar Plexus

3.22.4.3  VENTRAL

3.22.5              DIVISION

3.22.5.1  Dorsal

3.22.6              FEMORAL (ANT DIV)(FEM N.) 35.081

3.22.6.1  CUTANEOUS BRANCHES

3.22.6.1.1         INTERMED FEM CUT L2, L3 35.0811
3.22.6.1.1.1            L2 & L3 divides into medial and lateral branches
3.22.6.1.1.2           MEDIAL (Intermediate Femoral Cutaneous) 35.08111

3.22.6.1.1.2.1Supplies the anteromedial thigh as far distal as the knee and terminating the the patellar plexus

3.22.6.1.1.3           . LATERAL(INT FEM CUT)   35.08112

3.22.6.1.1.3.1Supplies the anterolateral thigh as far distal as the knee and terminating the the patellar plexus

3.22.6.1.2         MEDIAL FEM CUT L2, L3 35.0812
3.22.6.1.2.1           L2 & L3 SENDS A FEW RAMI TO SUPPLY THE SKIN (SEE NEXT COLLUM). THE NERVE THEN DIVIDES INO ANTERIOR AND POSTERIOR.
3.22.6.1.2.2           SKIN OF THE MEDIAL SIDE OF THE THIGH.
3.22.6.1.2.3           ANTERIOR(MED FEM CUT) 35.08121

3.22.6.1.2.3.1SKIN OVER THE SARTORIUS BEYOND THE MID-THIGH.

3.22.6.1.2.4           POSTERIOR(MED FEM CUT) 35.08122

3.22.6.1.2.4.1SKIN OVER THE ANTEROMEDIAL AND POSTEROMEDIAL ASPECTS OF THE KNEE AS FAR DISTAL AS THE LEG, FORMING PQART OF THE PATTELLAR PLEXUS.

3.22.6.2  ARTICULAR BRANCHES

3.22.6.2.1         None

3.22.6.3  MUSCULAR BRANCHES (FEM ANT DIV)

3.22.6.3.1         SARTORIUS L2, L3
3.22.6.3.1.1           Arising in common with the lateral branch of intermediate femoral cutaneous nerve

3.22.7              FEMORAL(ABDOMINAL BRANCHES)(FEM N.)

3.22.7.1  MUSCULAR BRANCHES(FEM ABD B)

3.22.7.1.1         ILLIACUS L2, L3
3.22.7.1.2         PECTINEUS L2, L3
3.22.7.1.2.1           THE PECTINEUS MAY ALSO BE SUP[PLIED BY THE OBTURATOR AND OR ACCESSORY OBTURATOR NERVES.

3.23 Femoral Nerve (Posterior Division) (75)

3.23.1              Spinal Roots

3.23.1.1  L2, L3, L4

3.23.1.1.1         Dorsal divisions of the ventral rami. It exits through he lateral border of the psoas major, passing deep to, and branching distal to, the inguinal ligament.

3.23.2              Named Branches

3.23.2.1  A=Anterior division of femoral nerve

3.23.3              Muscular Branches

3.23.3.1  B=Rectus femoris / L2, L3, L4.

3.23.3.2  C=Vastus Lateralis / L2, L3, L4.

3.23.3.3  D=Vastus Medialis / L2, L3, L4.

3.23.3.4  E=Vastus Intermedius / L2, L3, L4.

3.23.3.5  F=Articular genus, from a branch to Vastus Intermedius

3.23.4              Articular Branches

3.23.4.1  G=To the hip from a branch to rectus femoris.

3.23.4.2  H=Three branches to knee (lateral, medial and intermediate) from the Vastus muscles of the same name

3.23.5              Cutaneous Branches

3.23.5.1  I=Saphenous nerve / L3, L4

3.23.5.1.1         Path Description
3.23.5.1.1.1           Summary

3.23.5.1.1.1.1Enters adductor canal and emerges on the medial side of the knee forming part of the patellar plexus. Between sartorius and gracilis it becomes cutaneous, supplying the skin over the medial tibial border to the ankle and medial side of the foot.

3.23.5.1.1.2           Detailed

3.23.5.1.1.2.1The Saphenous Nerve (n. saphenous; long or internal saphenous nerve) (Fig. 827) is the largest cutaneous branch of the femoral nerve. It approaches the femoral artery where this vessel passes beneath the Sartorius, and lies in front of it, behind the aponeurotic covering of the adductor canal, as far as the opening in the lower part of the Adductor magnus. Here it quits the artery, and emerges from behind the lower edge of the aponeurotic covering of the canal; it descends vertically along the medial side of the knee behind the Sartorius, pierces the fascia lata, between the tendons of the Sartorius and Gracilis, and becomes subcutaneous. The nerve then passes along the tibial side of the leg, accompanied by the great saphenous vein, descends behind the medial border of the tibia, and, at the lower third of the leg, divides into two branches: one continues its course along the margin of the tibia, and ends at the ankle; the other passes in front of the ankle, and is distributed to the skin on the medial side of the foot, as far as the ball of the great toe, communicating with the medial branch of the superficial peroneal nerve.

3.23.5.2  J=Infrapatellar branch

3.23.5.2.1         Supplies prepatellar skin with branches to patellar plexus.

3.23.6              Lesions

3.23.6.1  : To Posterior branch

3.23.6.1.1         Injury to the posterior branch of the femoral nerve is usually a result of trauma to the femoral triangle. This would produce weak hip flexion due to paralysis of rectus femoris. Knee extension will be all but obliterated due to paralysis to the entire quadriceps group; loss of patella tendon reflex is also seen. To isolate focal femoral nerve lesion from lumbar root, test the Obturator nerve; both derive from L2-L4. Often both Obturator and femoral nerves are affected

3.23.6.2  . To Saphenous nerve

3.23.6.2.1         Trauma is the typical cause of injury to the Saphenous nerve. It is in particular danger during operations on varicose veins, and the Infrapatellar branch can be damaged during knee surgery. Injury will present paresthesia or loss of sensation to the skin areas as described above. L4 is primary root of Saphenous nerve. For focal differential diagnosis, check hip adductors (Obturator nerve) and the tibialis anterior (common peroneal nerve) for L4 Radiculopathy as opposed to femoral focal neuropathy.

3.23.7              Path Description

3.23.7.1  The Femoral Nerve (n. femoralis; anterior crural nerve) (Fig. 827), the largest branch of the lumbar plexus, arises from the dorsal divisions of the second, third, and fourth lumbar nerves. It descends through the fibers of the Psoas major, emerging from the muscle at the lower part of its lateral border, and passes down between it and the Iliacus, behind the iliac fascia; it then runs beneath the inguinal ligament, into the thigh, and splits into an anterior and a posterior division. Under the inguinal ligament, it is separated from the femoral artery by a portion of the Psoas major.  

3.23.7.2    Within the abdomen the femoral nerve gives off small branches to the Iliacus, and a branch, which is distributed upon the upper part of the femoral artery; the latter branch may arise in the thigh.

3.23.7.3    In the thigh the anterior division of the femoral nerve gives off anterior cutaneous and muscular branches. The anterior cutaneous branches comprise the intermediate and medial cutaneous nerves (Fig. 825).

3.23.8              Gray’s Anatomy

3.23.8.1  http://www.bartleby.com/107/212.html

3.23.8.2  Illustrations

3.23.8.2.1         http://www.bartleby.com/107/illus827.html
3.23.8.2.2         http://www.bartleby.com/107/illus825.html

3.23.9              Number

3.23.9.1  35.082

3.23.10           Reference

3.23.10.1               75

3.23.11           Illustration

3.23.11.1               75

3.24 Sacral Plexus (Spinal Segments & Nerves) (76)

3.24.1              Spinal Segments

3.24.1.1 

3.24.2              Nerves

3.24.2.1 

3.24.3              Number

3.24.3.1   

3.24.4              Reference

3.24.4.1  76

3.25 Sacral Plexus (L4, L5, S1, S2, S3) (77)

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3.25.1              Named Branches

3.25.1.1  A=Nerve to quadratus femoris I L4, L5, S1.

3.25.1.2  B=Nerve to Obturator Internus; L5, S1, S2.

3.25.1.3  C=Nerve to Piriformis; S1, S2.

3.25.1.4  D=Superior Gluteal nerve; L4, L5, S1.

3.25.1.5  E=Inferior Gluteal nerve; L5, S1, S2.

3.25.1.6  F=Posterior femoral cutaneous nerve; S1-S3.

3.25.1.7  G=Sciatic nerve; L4, L5, S1-S3.

3.25.1.8  H=Tibial division; L4, L5, S1-S3.

3.25.1.9  I=Common peroneal; L4, L5, S1, S2.

3.25.2              Cutaneous Branches

3.25.2.1  J=Sural nerve; L5, S1, S2.

3.25.2.2  K=Medial calcanean; S1, S2.

3.25.2.3  L=Medial plantar nerve; L4, L5.

3.25.2.4  M=Lateral plantar nerve; S1, S2.

3.25.2.5  N=Lateral sural nerve; L4, L5, S1.

3.25.2.6  0=Medial terminal branch of deep peroneal; S1, S2.

3.25.2.7  P=Superficial peroneal segments

3.25.3              Lesions

3.25.3.1  : Injury to L4 (lumbosacral trunk):

3.25.3.1.1         Produces weak knee extension (Obturator nerve) with reduced patellar tendon reflex and paresthesia to the skin of the medial leg (femoral and saphenous nerves), weak hip adduction (sciatic nerve), "foot drop" from loss of tibialis anterior and posterior (tibial and deep peroneal nerves) and paresthesias to the skin of the medial side of the sole of the foot (medial plantar nerve).

3.25.3.2  Injury to L5: "Trendelenburg's sign" (superior Gluteal nerve),

3.25.3.2.1         Weak knee flexion (tibial nerve), weak dorsiflexion ("foot drop") and eversion of foot at the subtalar and intertarsal joints weak extension of toes and paresthesias to the skin of lateral leg, Dorsum of foot and middle sole of foot (common, deep and superficial peroneal nerves).

3.25.3.3  Injury to S1:

3.25.3.3.1         Weak hip extension (tibial nerve), plantarflexion and toe flexion (deep peroneal nerve)

3.25.3.4  Injury of S2-Sj

3.25.3.4.1         Paresthesia to skin of posterior thigh and leg (posterior femoral cutaneous nerve), weak plantar flexion and inversion of foot weak flexion adduction/abduction of toe (tibial nerve), and loss of voluntary control of pelvic floor and anal sphincter (pudendal nerve)

3.25.4              Path Description

3.25.4.1  The sacral plexus is formed by the lumbosacral trunk, the anterior division of the first, and portions of the anterior divisions of the second and third sacral nerves.

3.25.4.2    The lumbosacral trunk comprises the whole of the anterior division of the fifth and a part of that of the fourth lumbar nerve; it appears at the medial margin of the Psoas major and runs downward over the pelvic brim to join the first sacral nerve. The anterior division of the third sacral nerve divides into an upper and a lower branch, the former entering the sacral and the latter the pudendal plexus.  

3.25.4.3    The nerves forming the sacral plexus converge toward the lower part of the greater sciatic foramen, and unite to form a flattened band, from the anterior and posterior surfaces of which several branches arise. The band itself is continued as the sciatic nerve. which splits on the back of the thigh into the tibial and common peroneal nerves; these two nerves sometimes arise separately from the plexus, and in all cases their independence can be shown by dissection. 

3.25.4.4  Relation

3.25.4.4.1         The sacral plexus lies on the back of the pelvis between the Piriformis and the pelvic fascia (Fig. 829); in front of it are the hypogastric vessels, the ureter and the sigmoid colon. The superior gluteal vessels run between the lumbosacral trunk and the first sacral nerve, and the inferior gluteal vessels between the second and third sacral nerves.  
3.25.4.4.2           All the nerves entering the plexus, with the exception of the third sacral, split into ventral and dorsal divisions,

3.25.5              Gray’s Anatomy

3.25.5.1  http://www.bartleby.com/107/213.html

3.25.5.2  Illustration

3.25.5.2.1         http://www.bartleby.com/107/illus828.html
3.25.5.2.2         http://www.bartleby.com/107/illus829.html

3.25.6              Number

3.25.6.1  ?

3.25.7              Reference

3.25.7.1  77

3.25.8              Illustration

3.25.8.1 

3.26 Sacral Plexus (Nerves from Ventral Divisions of Ventral Rami) (78)

3.26.1              Illustration # A

3.26.1.1 

3.26.2              Illustration # B

3.26.2.1 

3.26.3              Number

3.26.3.1  ?

3.26.4              Reference

3.26.4.1  78

3.27 Sacral Plexus (Nerves from Dorsal Divisions of Ventral Rami) (79)

3.27.1              Illustration # A

3.27.1.1 

3.27.2              Illustration # B

3.27.2.1 

3.27.3              Number

3.27.3.1  ?

3.27.4              Reference

3.27.4.1  79

3.28 QUADRATUS FEMORIS N. (80)

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3.28.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.28.1.1  . Very seldom injured by itself. a focal loss of this nerve would weaken external rotation of the extended thigh. posssible causes are trauma, hip dislocation, or malignant tumors arising from the pelvis, abdomen, or retroperitoneal structures. a herniated intervertebral disc or bony abnormalities from degenerative arthritis (spondyliosis) can also compress the lumbosacral trunk. each of the donditions above could show multiple deficits pertaining to l4 and l5. all nerves exiting from pelvic cavity may be vulnerable to these same traumas/etiologies; depending on the actual location various effects are seen.

3.28.2              NUMBER

3.28.2.1  None

3.28.3              REFERENCE

3.28.3.1  80

3.28.4              ROOTS

3.28.4.1  L4,L5,S1

3.28.4.2  Sacral Plexus

3.28.4.3  VENTRAL

3.28.5              DIVISION

3.28.5.1  Ventral

3.28.6              CUTANEOUS BRANCHES

3.28.6.1  None

3.28.7              ARTICULAR BRANCHES

3.28.7.1  HIP

3.28.8              MUSCULAR BRANCHES

3.28.8.1  QUADRATUS FEMORIS L4-S1

3.28.8.2  GEMEILUS INFERIOR L4-S1

3.29 OBTURATOR INTERNUS (81)

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3.29.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.29.1.1  . VERY SELDOM INJURED BY ITSELF. A FOCAL LOSS OF THIS NERVE WOULD WEAKEN EXTERNAL ROTATION OF THE EXTENDED THIGH AND ABDUCTION OF THE FLEXED HIP. POSSIBLE CAUSES ARE TRAUMA, HIP DISLOCATION OR MALIGNANT TUMORS ARISING FROM PELVIC, ABDOMINAL OR RETROPERITONEAL STRUCTURES. A HERNIATED INTERVERTEBRAL DISC OR BONY ABNORMALITIES FROM DEGENERATIVE ARTHRITIS (SPONDYLOSIS) CAN COMPRESS LUMBOSACRAL TRUNK ROOTS OR CAUDA EQUINA. ALL OF WHICH WOULD SHOW MULITIPLE DEFICITS PERTQAINING TO L-L5. ALL NERVES EXITING FROM PELVIC CAVITY MAY BE VULNERABLE TO THESE SAME TRAMAS/ETIOLOGIES, DEPENDING ON DISTRIBUTION VARIOUS EFFECTS ARE SEEN.

3.29.2              NUMBER

3.29.2.1   

3.29.3              REFERENCE

3.29.3.1  81

3.29.4              ROOTS

3.29.4.1  L5-S2

3.29.4.2  Sacral Plexus

3.29.4.3  VENTRAL

3.29.5              DIVISION

3.29.5.1  Ventral

3.29.6              CUTANEOUS BRANCHES

3.29.6.1  None

3.29.7              ARTICULAR BRANCHES

3.29.7.1  None

3.29.8              MUSCULAR BRANCHES (OBTUR INTER)

3.29.8.1  OBTURATOR INTERNUS L5-S2

3.29.8.2  GEMEILUS SUPERIOR L5-S2

3.30 PIRIFORMIS (82)

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3.30.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.30.1.1  . FOCAL LOSS OF THIS NERVE WOULD PARALYZE THE PIRIFORMIS MUSCLE, RESULTIN IN WEAK LATERL ROTATION OF THE EXTENDED HIP AND ABDUCTION OF THE FLEXED HIP.

3.30.2              NUMBER

3.30.2.1  None

3.30.3              REFERENCE

3.30.3.1  82

3.30.4              ROOTS

3.30.4.1  S1-S2

3.30.4.2  Sacral Plexus

3.30.4.3  VENTRAL

3.30.5              DIVISION

3.30.5.1  Dorsal

3.30.6              CUTANEOUS BRANCHES

3.30.6.1  None

3.30.7              ARTICULAR BRANCHES

3.30.7.1  None

3.30.8              MUSCULAR BRANCHES

3.30.8.1  PIRIFORMIS L5-S2

3.31 SUPERIOR GLUTEAL (83)

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3.31.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.31.1.1  . THIS IS THE ONLY NERVE TO PASS THROUGH THE GREATER SCIATIC FORAMEN ABOVE THE PIRIFORMIS MUSCLE, SO IT MAY BE DAMAGED WHEN OTHER NERVES ARE SPARED; SUPERIOR GHLUTEAL NERVE IS RARELY INJURED ALONE. A RARE MISPLACEN INJECTION MAY BE AT FAULT. A FOCAL LESION WOULD RESULT IN THE PARALYSIS OF THE GLUTEUS MEDIUS AND MINIMUS AND TENSOR FASCIA LATAE MUSCLES. ALL ARE ABDUCTORS OF THE HIP AND THE ANTERIOR FIBERS OF THE GLUTEAL MUSCLES INTERNALLY ROTATE HIP/THIGH. THE GLUTEAL MUSCLES ARE ESSENTIAL FOR STABILIZING THE TRUNK WHEN THE OPPOSITE FOOT IS RAISED WHILE STANDING OR IN WALKING. A LESION PRESENT S AS A DROPPING OF THE PELVIS TO OPPOSITE SIDE WHEN THE AFFECTED LIMB IS ELEVATED (I.E. TRENDELENBURG'S SIGN OR GAIT). A SIMILAR GAIT OCCURS IN UNILATERAL POSTERIOR DISLOCATION OF THEHIP OR A PAINFUL SACROILIAC JOINT BOTH LEADING TO TRENDELENBURG'S SIGN THROUGH INABILITY OR REFLEX INHIBITION OF GLUTEUS MEDIUS AND MINIMUS ACTION.

3.31.2              NUMBER

3.31.2.1   

3.31.3              REFERENCE

3.31.3.1  83

3.31.4              ROOTS

3.31.4.1  L4-S1

3.31.4.2  Sacral Plexus

3.31.4.3  VENTRAL

3.31.5              DIVISION

3.31.5.1  Dorsal

3.31.6              CUTANEOUS BRANCHES

3.31.6.1  None

3.31.7              ARTICULAR BRANCHES

3.31.7.1  ARTICULAR BRANCH(S. GLUTEAL)

3.31.7.1.1         SACROILIAC

3.31.8              SUPERIOR BRANCH(S. GLUTEAL)

3.31.8.1  MUSCULAR BRANCHES

3.31.8.1.1         GLUTEUS MEDIUS L5-S1
3.31.8.1.2         GLUTEUS MINIMUS L5-S1
3.31.8.1.2.1           RARE
3.31.8.1.3          

3.31.9              INFERIOR BRANCH(S. GLUTEAL)

3.31.9.1  MUSCULAR BRANCHES

3.31.9.1.1         GLUTEUS MEDIUS L5-S1
3.31.9.1.2         GLUTEUS MINIMUS L5-S1
3.31.9.1.3         TENSOR FASCIA LATA L4-S1

3.32 INFERIOR GLUTEAL (84)

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3.32.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.32.1.1  . The inferior gluteal nerve is injured more ferquently than the superior gluteal nerve, and is almost never damaged without associated lesions of the sciatic, pudendal, or posterior femoral cutaneous nerves of the thigh. Focal lesions would present weakness to extend the flexed hip, causing difficulty in climbing stairs, standing from a seated position, and running or jumping.

3.32.2              NUMBER

3.32.2.1  None

3.32.3              REFERENCE

3.32.3.1  84

3.32.4              ROOTS

3.32.4.1  L5-S2

3.32.4.2  Sacral Plexus

3.32.4.3  VENTRAL

3.32.5              DIVISION

3.32.5.1  Dorsal

3.32.6              CUTANEOUS BRANCHES

3.32.6.1  None

3.32.7              ARTICULAR BRANCHES

3.32.7.1   

3.32.7.1.1          

3.32.8              MUSCULAR BRANCHES

3.32.8.1  GLUTEUS MAXIMUS L5-S2

3.32.8.1.1         Deep surface after exiting greater sciatic foramen descending around the pirformis muscle.

3.33 POSTERIOR FEMORAL CUTANEOUS (85)

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3.33.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

3.33.1.1  . AFOCAL LESION TH THIS NERVE WILL PRODUCE PARESTHESIA OR LOSS OF SENSATION TO THE SKIN AREA OF THIS NERVE. PROLONGED BICYCLE RIDING CAN COMPRESS THE CLUNEAL BRANCHES RESULTING IN TEMPORARY NUMBNESS OF THE ARES SUPPLIED.

3.33.2              NUMBER

3.33.2.1  35.05

3.33.3              REFERENCE

3.33.3.1  85

3.33.4              ROOTS

3.33.4.1  S1-S2        S2-S3

3.33.4.2  Sacral Plexus

3.33.4.3  VENTRAL

3.33.5              DIVISION

3.33.5.1  Dorsal Ventral

3.33.6              CUTANEOUS BRANCHES

3.33.6.1  INFERIOR CLUNEAL(GLUTEAL)

3.33.6.1.1         3 OR 4 BRANCHES CURL AROUND THE LOWERBORDER OF THE GLUTEUS MAXIMUS
3.33.6.1.2          Supplies SKIN OVER INFERIOR ASPEXT OF BUTTOCKS (LOWER MEDIAL AUADRANT OF BUTTOCKS).

3.33.6.2  PERINEAL

3.33.6.2.1         . SUPEROMEDIAL SKIN OF THE THIGH BELOW THE ISCHIAL TUBEROSITY TO THE SUPERFICIAL PERINEAL FAXCIA SUPPLYING THE POSTERIOR SCROTAL OR LABIAL SKIN.
3.33.6.2.2         COMMUNICATING(PERINEAL)
3.33.6.2.2.1           PUDENDAL(COM)

3.33.6.2.2.1.1 

3.33.6.3  BACK O THIGH BR

3.33.6.3.1         SUPERFICIAL TO THE LONGG HEAD OF THE BICEPS FEMORIS WITH NUMEROUS BRANCHES FROM BOTH SIDES OF IT.
3.33.6.3.2         SUPPLIES THE SKIN OF THE BACK AND MEDIAL THIGH, THE POPLITEAL FOSSA AND THE PROXIMAL PART OF THE BACK OF THE LEG.

3.33.7              ARTICULAR BRANCHES

3.33.7.1  NONE

3.33.8              MUSCULAR BRANCHES

3.33.8.1  NONE

3.34 Sciatic Nerve (86)

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3.34.1              Spinal Roots

3.34.1.1  A=Tibial division (Ventral division): L4, LS, S1, S2, S3

3.34.1.1.1         Through the ventral division of the sacral plexus

3.34.1.2  B=Common peroneal (fibular) division (Dorsal division): L4, LS, S1, S2

3.34.1.2.1         Through the dorsal division of the sacral plexus

3.34.2              Muscular Branches

3.34.2.1  C= Biceps femoris (short head) common peroneal LS, S1, S2

3.34.2.2  D= Biceps femoris (long head) tibial division LS, 51, S2, S3

3.34.2.3  E= Semitendinosus / tibial division, L5, 51, S2

3.34.2.4  F= Semimembranosus / tibial division, LS, S1, S2

3.34.2.5  G= Adductor magnus / tibial division, L4

3.34.3              Note

3.34.3.1  The horizontal fibers of the adductor magnus are supplied by the Obturator nerve L2-L4

3.34.4              Articular Branches

3.34.4.1  To the hip joint

3.34.5              Cutaneous Branches

3.34.5.1  8ee cutaneous branches of tibia and common peroneal divisions of the sciatic nerve

3.34.6              Lesions

3.34.6.1  Trauma, fractures or posterior dislocations of the hip (coxal) joint, and attempts to repair them, often damage this nerve. Damage is common in vehicle accidents with impact to the knees, thus causing the head of the femur through the acetabulum. More common would be: herniated intervertebral disc, misplaced injection or Osteoarthritis of spine or sacroiliac joint. A complete lesion produces total paralysis of the hamstrings and of all muscles below the knee, with additional weakness to adductor magnus. A sensory loss will also occur in the distributions of the tibia and common peroneal nerves leaving only the Saphenous nerve distribution below the knee joint. A partial lesion of the lateral trunk, i.e., the source of the common peroneal nerve, is more common of the two. . Care must. be taken to distinguish from a focal lesion of the common peroneal nerves  (Note: See lesions for both tibia and common peroneal nerves).

3.34.7              Path Description

3.34.7.1  The Sciatic (n. ischiadicus; great sciatic nerve) (Fig. 832) supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot. It is the largest nerve in the body, measuring 2 cm. in breadth, and is the continuation of the flattened band of the sacral plexus. It passes out of the pelvis through the greater sciatic foramen, below the Piriformis muscle. It descends between the greater trochanter of the femur and the tuberosity of the ischium, and along the back of the thigh to about its lower third, where it divides into two large branches, the tibial and common peroneal nerves. This division may take place at any point between the sacral plexus and the lower third of the thigh. When it occurs at the plexus, the common peroneal nerve usually pierces the Piriformis.

3.34.7.2    In the upper part of its course the nerve rests upon the posterior surface of the ischium, the nerve to the Quadratus femoris, the Obturator internus and Gemelli, and the Quadratus femoris; it is accompanied by the posterior femoral cutaneous nerve and the inferior gluteal artery, and is covered by the Glutæus maximus. Lower down, it lies upon the Adductor magnus, and is crossed obliquely by the long head of the Biceps femoris.    

3.34.7.3    The nerve gives off articular and muscular branches.   

3.34.7.4    The articular branches (rami articulares) arise from the upper part of the nerve and supply the hip-joint, perforating the posterior part of its capsule; they are sometimes derived from the sacral plexus.   

3.34.7.5    The muscular branches (rami musculares) are distributed to the Biceps femoris, Semitendinosus, Semimembranosus, and Adductor magnus. The nerve to the short head of the Biceps femoris comes from the common peroneal part of the sciatic, while the other muscular branches arise from the tibial portion, as may be seen in those cases where there is a high division of the sciatic nerve.

3.34.8              Gray’s Anatomy

3.34.8.1  http://www.bartleby.com/107/213.html

3.34.8.2  Illustrations

3.34.8.2.1         http://www.bartleby.com/107/illus832.html

3.34.9              Number

3.34.9.1   

3.34.10           Reference

3.34.10.1               86

3.34.11           Illustration

3.34.11.1              

3.35 Tibial Nerve (Branches Arising between Gastrocnemius Heads) (87)

Back Table of Contents References

3.35.1              Spinal Roots L4, L5, S1, S2, S3

3.35.1.1  Through the ventral divisions from the lumbar and sacral ventral rami of the sacral plexus.

3.35.2              Cutaneous Branches

3.35.2.1  A=Medial Cutaneous Sural Nerve

3.35.2.1.1         Descends superficially between the heads of the gastrocnemius muscle and is joined by the lateral sural or communicating branches from the common peroneal nerve; supplies the posterolateral skin of the distal third of the calf and lateral side of foot and little toe.

3.35.3              Muscular Branches

3.35.3.1  B=Gastrocnemius, lateral head / S1, 52.

3.35.3.2  C=Gastrocnemius, medial head / S1, 52.

3.35.3.3  D=Plantaris / S1, 52.

3.35.3.4  E=Soleus / 51, S2.

3.35.3.5  F=Popliteus / L4, L5, 51.

3.35.3.6  G=Tibialis posterior / L4, L5

3.35.3.6.1         From branch to Popliteus

3.35.4              Articular Branches

3.35.4.1  H=Three branches to the knee joint (genicular).

3.35.4.2  I=Tibiofibular, interosseous and distal tibiofibular joints via branches to the Popliteus muscle.

3.35.5              Note

3.35.5.1  See sural and medial calcaneal branches of the tibial nerve

3.35.6              Lesions

3.35.6.1  Sacral plexus and sciatic nerve injuries usually involve tibial fibers; distal focal lesions, although rare, are less likely than common peroneal nerve lesions due to deeper tibial nerve pathway. Trauma is the most likely etiology of focal tibial paralysis. Presents as weak knee flexion due to paralysis of the gastrocnemius (a secondary action of this muscle). This action is saved by the hamstrings. Loss of plantar flexion, and supination of foot due to paralysis of the posterior compartment musculature of the leg. Peroneus longus and brevis would be the only muscles left for plantar flexion (superficial peroneal nerve). Further, there is an inability to flex, adduct/abduct the toes, due to paralysis of all intrinsic plantar foot muscles (medial and lateral plantar nerves). Paresthesia or loss of sensation to plantar nerve distribution would also occur.

3.35.7              Path Description

3.35.7.1  The Tibial Nerve (n. tibialis; internal popliteal nerve) (Fig. 832) the larger of the two terminal branches of the sciatic, arises from the anterior branches of the fourth and fifth lumbar and first, second, and third sacral nerves. It descends along the back of the thigh and through the middle of the popliteal fossa, to the lower part of the Popliteus muscle, where it passes with the popliteal artery beneath the arch of the Soleus. It then runs along the back of the leg with the posterior tibial vessels to the interval between the medial malleolus and the heel, where it divides beneath the laciniate ligament into the medial and lateral plantar nerves. In the thigh it is overlapped by the hamstring muscles above, and then becomes more superficial, and lies lateral to, and some distance from, the popliteal vessels;opposite the knee-joint, it is in close relation with these vessels, and crosses to the medial side of the artery. In the leg it is covered in the upper part of its course by the muscles of the calf; lower down by the skin, the superficial and deep fasciæ. It is placed on the deep muscles, and lies at first to the medial side of the posterior tibial artery, but soon crosses that vessel and descends on its lateral side as far as the ankle. In the lower third of the leg it runs parallel with the medial margin of the tendo calcaneus.

3.35.7.2  The branches of this nerve are: articular, muscular, medial sural cutaneous, medial calcaneal, medial and lateral plantar.    23

3.35.7.3    Articular branches (rami articulares), usually three in number, supply the knee-joint; two of these accompany the superior and inferior medial genicular arteries; and a third, the middle genicular artery. Just above the bifurcation of the nerve an articular branch is given off to the ankle-joint.    24

3.35.7.4    Muscular branches (rami musculares), four or five in number, arise from the nerve as it lies between the two heads of the Gastrocnemius muscle; they supply that muscle, and the Plantaris, Soleus, and Popliteus. The branch for the Popliteus turns around the lower border and is distributed to the deep surface of the muscle. Lower down, muscular branches arise separately or by a common trunk and supply the Soleus, Tibialis posterior, Flexor digitorum longus, and Flexor hallucis longus; the branch to the last muscle accompanies the peroneal artery; that to the Soleus enters the deep surface of the muscle.

3.35.7.5   

3.35.8              Gray’s Anatomy

3.35.8.1  http://www.bartleby.com/107/213.html

3.35.8.2  Illustrations

3.35.8.2.1         http://www.bartleby.com/107/illus832.html
3.35.8.2.2         http://www.bartleby.com/107/illus830.html
3.35.8.2.3         http://www.bartleby.com/107/illus831.html

3.35.9              NUMBER

3.35.9.1  35.10

3.35.10           REFERENCE

3.35.10.1               87

3.35.11           Illustration

3.35.11.1               ``

3.36 Tibial Nerve (Branches Arising in the Leg) (88)

3.36.1              Spinal Roots L4, L5, S1, S2, S3

3.36.1.1  Through ventral divisions from the lumbar and sacral ventral rami of the sacral plexus

3.36.2              Named Branches

3.36.2.1  A=Medial calcanean nerve

3.36.2.2  B=Medial plantar nerve

3.36.2.3  C=Lateral plantar nerve

3.36.2.4  D=Sural nerve

3.36.2.4.1         Path Description
3.36.2.4.1.1           The sural nerve (n. suralis; short saphenous nerve), formed by the junction of the medial sural cutaneous with the peroneal anastomotic branch, passes downward near the lateral margin of the tendo calcaneus, lying close to the small saphenous vein, to the interval between the lateral malleolus and the calcaneus. It runs forward below the lateral malleolus, and is continued as the lateral dorsal cutaneous nerve along the lateral side of the foot and little toe, communicating on the dorsum of the foot with the intermediate dorsal cutaneous nerve, a branch of the superficial peroneal. In the leg, its branches communicate with those of the posterior femoral cutaneous.
3.36.2.4.2         Illustration
3.36.2.4.2.1           http://www.bartleby.com/107/illus831.html

3.36.3              Muscular Branches

3.36.3.1  E=Soleus / S1, S2

3.36.3.1.1         To it's deep surface.

3.36.3.2  F=Tibialis posterior / L4, L5

3.36.3.3  G=Flexor digitorum longus / S2, S3

3.36.3.4  H=Flexor hallucis longus / S2, S3

3.36.4              Articular Branches

3.36.4.1  : To the ankle before it bifurcates as medial and lateral plantar nerves

3.36.5              Cutaneous Branches

3.36.5.1  The medial calcanean nerve supplies the skin of the heal and medial side of the sole (See also sural and medial calcanean nerves).

3.36.6              Lesions

3.36.6.1  Injury to the tibial nerve is uncommon due to its deep location in the calf. A focal lesion would present weakness in plantar flexion. Plantar flexion is not lost if gastrocnemius is intact. Paralysis of the deep posterior crural muscles would present weakness in foot inversion; this movement is saved by the tibialis anterior (deep peroneal nerve). Flexion, adduction and abduction of toes would be lost due to distal innervation of the same nerve branches to plantar foot. Patient will be, unable to stand on tip toes (Note: See also medial and lateral plantar nerves)

3.36.7              Gray’s Anatomy

3.36.7.1  http://www.bartleby.com/107/213.html

3.36.8              NUMBER

3.36.8.1  35.10

3.36.9              REFERENCE

3.36.9.1  88

3.36.10           Illustration

3.36.10.1              

3.37 Tibial Nerve (Medial Sural and Medial Calcanean Cutaneous Branches) (89)

3.37.1              Spinal Roots

3.37.1.1  L5 S1 S2 (Sural Nerve) S1 S2 (Medial Calcanean Nerve)

3.37.1.1.1         Both branches are via the ventral divisions from the lumbar and sacral ventral rami of the sacral plexus through the sciatic nerve as the sural and medial Calcanean branches of the tibial nerve, respectively

3.37.1.2  NUMBER

3.37.1.2.1         35.101

3.37.1.3  REFERENCE

3.37.1.3.1         89

3.37.2              Muscular Branches

3.37.2.1  None

3.37.3              Articular Branches

3.37.3.1  None

3.37.4              Cutaneous Branches

3.37.4.1  A=Medial Sural Cutaneous Nerve L5 S1 S2

3.37.4.1.1         Descends superficially between the heads of the gastrocnemius and is joined by the communicating branch of the lateral sural nerve of common peroneal nerve. Supplies the posterolateral skin of the distal third of the calf and the lateral side of the foot and little toe The communicating branch may descend separately, and join medial sural as far distal as the heel.

3.37.4.2  B=Medial Calcaneal Nerve S1 S2

3.37.4.2.1         Arises proximal to the tarsal tunnel, perforating the flexor retinaculum (laciniate ligament ) to supply the skin of the medial side of the plantar surface of the foot and heel.

3.37.5              Gray’s Anatomy

3.37.5.1  http://www.bartleby.com/107/213.html

3.37.5.2  Illustration

3.37.5.2.1         http://www.bartleby.com/107/illus832.html

3.37.6              NUMBER

3.37.6.1  35.102

3.37.7              REFERENCE

3.37.7.1  89

3.37.8              Lesions

3.37.8.1  Presents as Paresthesia or loss of sensation to the skin described above. Testing these areas can help in differential diagnosis of focal tibial lesions

3.37.9              Illustration

3.37.9.1 

3.38 Medial Plantar (Tibial) (90)

3.38.1              NUMBER

3.38.1.1  35.103

3.38.2              REFERENCE

3.38.2.1  90

3.38.3              SPINAL ROOTS

3.38.3.1  L4, L5, S1, S2, S3 through ventral divisions from the ventral sacral rami of the sacral plexus through the sciatic nerve as the medial terminal branch of the tibial nerve

3.38.4              Named Branches

3.38.4.1  A= Hallucial medial Digital nerve

3.38.4.2  B=Common Plantar Digital Nerves

3.38.4.3  C=Proper plantar digital nerves

3.38.5              Muscular Branches

3.38.5.1  D=Abductor Hallucis

3.38.5.1.1         S2 S3

3.38.5.2  E=Flexor Digitorum Brevis

3.38.5.2.1         S2 S3

3.38.5.3  F=Flexor Hallucis Brevis

3.38.5.3.1         S2 S3
3.38.5.3.2         From the Hallucial medial digital nerve

3.38.5.4  G=1st Lumbrical

3.38.5.4.1         S2, S3
3.38.5.4.2         From the 1st common plantar digital nerve. The rest of the Lumbricals are supplied by the deep branch of the lateral plantar nerve.

3.38.6              ARTICULAR BRANCHES(MED PLANTAR)

3.38.6.1  To the tarsus and metatarsus. Each proper digital nerve provides articular branches to it’s respective phalangeal joints

3.38.7              Cutaneous Branches

3.38.7.1  L4 L5 supply the skin of the medial side of the sole of the foot. Each proper digital nerve provides cutaneous branches to its’s respective phalanx with a dorsal branch to around the nail. The terminal branches supply the ball of the toes.

3.38.8              Lesions

3.38.8.1  Tarsal tunnel syndrome (Jogger’s foot)

3.38.8.1.1         Damage to the tibial nerve within the tarsal tunnel can occur due to external pressure from foot wear and/or thickened flexor retinaculum.
3.38.8.1.2         Trauma and dislocations can produce the same results.
3.38.8.1.3         Either or both plantar nerves can be affected, but usually the medial plantar nerve. Focal medial plantar nerve injury presents weak toe flexion and inability to abduct the big toe. Additionally, pain and Paresthesia or loss of sensation to the skin described above will occur. If sensory loss affects the heel, the calcaneal sensory nerve is involved, therefore the lesion must be proximal to the tarsal tunnel.

3.38.9              Path Description

3.38.9.1  The medial plantar nerve (n. plantaris medialis; internal plantar nerve) (Fig. 833), the larger of the two terminal divisions of the tibial nerve, accompanies the medial plantar artery. From its origin under the laciniate ligament it passes under cover of the Abductor hallucis, and, appearing between this muscle and the Flexor digitorum brevis, gives off a proper digital plantar nerve and finally divides opposite the bases of the metatarsal bones into three common digital plantar nerves.    29

3.38.9.2    

3.38.9.3  BRANCHES.—The branches of the medial plantar nerve are: (1) cutaneous, (2) muscular, (3) articular, (4) a proper digital nerve to the medial side of the great toe, and (5) three common digital nerves.    30

3.38.9.4    The cutaneous branches pierce the plantar aponeurosis between the Abductor hallucis and the Flexor digitorum brevis and are distributed to the skin of the sole of the foot.    31

3.38.9.5    The muscular branches supply the Abductor hallucis, the Flexor digitorum brevis, the Flexor hallucis brevis, and the first Lumbricalis; those for the Abductor hallucis and Flexor digitorum brevis arise from the trunk of the nerve near its origin and enter the deep surfaces of the muscles; the branch of the Flexor hallucis brevis springs from the proper digital nerve to the medial side of the great toe, and that for the first Lumbricalis from the first common digital nerve.    32

3.38.9.6    The articular branches supply the articulations of the tarsus and metatarsus.    33

3.38.9.7    The proper digital nerve of the great toe (nn. digitales plantares proprii; plantar digital branches) supplies the Flexor hallucis brevis and the skin on the medial side of the great toe.    34

3.38.9.8    The three common digital nerves (nn. digitales plantares communes) pass between the divisions of the plantar aponeurosis, and each splits into two proper digital nerves—those of the first common digital nerve supply the adjacent sides of the great and second toes; those of the second, the adjacent sides of the second and third toes; and those of the third, the adjacent sides of the third and fourth toes. The third common digital nerve receives a communicating branch from the lateral plantar nerve; the first gives a twig to the first Lumbricalis. Each proper digital nerve gives off cutaneous and articular filaments; and opposite the last phalanx sends upward a dorsal branch, which supplies the structures around the nail, the continuation of the nerve being distributed to the ball of the toe. It will be observed that these digital nerves are similar in their distribution to those of the median nerve in the hand.

3.38.10           Gray’s Anatomy

3.38.10.1               http://www.bartleby.com/107/213.html

3.38.10.2               Illustration

3.38.10.2.1      http://www.bartleby.com/107/illus833.html
3.38.10.2.2      http://www.bartleby.com/107/illus834.html

3.38.11           Illustration

3.38.11.1              

3.39 Lateral Plantar Nerve & Superficial Branch (Tibial) (91)

3.39.1              NUMBER

3.39.1.1  35.104

3.39.2              REFERENCE

3.39.2.1  91

3.39.3              Spinal Roots

3.39.3.1  L4 L5 S1 S2 S3

3.39.3.2  Through ventral divisions of the sacral plexus through the sciatic nerve as the lateral terminal branch of the tibial nerve.

3.39.4              Named Branches

3.39.4.1  A=Superficial Branch

3.39.4.2  B=Deep Branch

3.39.4.3  C=Common Plantar Digital Nerves

3.39.4.4  D=Proper Plantar Digital Nerves

3.39.5              Muscular Branches

3.39.5.1  E=Quadratus Plantae

3.39.5.1.1         S2 S3

3.39.5.2  F=Abductor Digiti Minimi

3.39.5.2.1         S2 S3

3.39.5.3  G=Flexor Digiti Minimi Brevis

3.39.5.3.1         S2 S3

3.39.5.4  H=The 3rd Plantar interosseous Muscle

3.39.5.4.1         S2 S3

3.39.5.5  I=The 4th Dorsal Interosseous Muscle

3.39.5.5.1         S2 S3

3.39.6              Articular Branches

3.39.6.1  To the metatarsophalangeal and Interphalangeal joints of the 4th and 5th digits

3.39.7              Cutaneous Branches

3.39.7.1  S1, S2 supplies the dkin of the lateral part of the sole

3.39.7.2  Common and proper plantar digital nerves supply the plantar skin on the lateral side of the 4th and both sides of the 5th digit

3.39.8              Lesions

3.39.8.1  Focal lateral plantar nerve injury presents an inability to abduct the 4th and 5th digits due to paralysis of the abductor digiti minimi and the 4th dorsal interosseous muscle, respectively. A slight weakness on flexion of the small toe due to paralysis to flexor digiti minimi brevis and quadratus plantae. Loss of quadratus plantae may affect flexion of the 2nd, 3rd, and 4th toes. Paresthesia or loss of sensation to the skin described above also occurs.

3.39.9              Path Description

3.39.9.1  The Lateral Plantar Nerve (n. plantaris lateralis; external plantar nerve) (Fig. 833) supplies the skin of the fifth toe and lateral half of the fourth, as well as most of the deep muscles, its distribution being similar to that of the ulnar nerve in the hand. It passes obliquely forward with the lateral plantar artery to the lateral side of the foot, lying between the Flexor digitorum brevis and Quadratus plantæ and, in the interval between the former muscle and the Abductor digiti quinti, divides into a superficial and a deep branch. Before its division, it supplies the Quadratus plantæ and Abductor digiti quinti.    36

3.39.9.2    The superficial branch (ramus superficialis) splits into a proper and a common digital nerve; the proper digital nerve supplies the lateral side of the little toe, the Flexor digiti quinti brevis, and the two Interossei of the fourth intermetatarsal space; the common digital nerve communicates with the third common digital branch of the medial plantar nerve and divides into two proper digital nerves which supply the adjoining sides of the fourth and fifth toes.

3.39.10           Gray’s Anatomy

3.39.10.1               http://www.bartleby.com/107/213.html

3.39.10.2               Illustration

3.39.10.2.1      http://www.bartleby.com/107/illus833.html
3.39.10.2.2      http://www.bartleby.com/107/illus834.html

3.39.11           Illustration

3.39.11.1              

3.40 Lateral Plantar Nerve Deep Branch (Tibial) (92)

3.40.1              NUMBER

3.40.2              REFERENCE

3.40.2.1  92

3.40.3              Spinal Roots

3.40.3.1  S2 S3

3.40.3.2  Through ventral divisions from the sacral rami of the sacral plexus through the sciatic nerve as the deep branch fo the lateral terminal branch of the tibial nerve

3.40.4              Muscular Branches

3.40.4.1  A=Adductor Hallucis (Oblique Head)

3.40.4.1.1         S2 S3

3.40.4.2  B=Adductor Hallucis (Transverse Head)

3.40.4.2.1         S2 S3

3.40.4.3  C=1st and 2nd Plantar Interossei

3.40.4.3.1         S2 S3

3.40.4.4  D=1st, 2nd, and 3rd Lumbricals

3.40.4.4.1         S2 S3

3.40.4.5  E=1st, 2nd, and 3rd Dorsal Interossei

3.40.4.5.1         S2 S3

3.40.4.6  Note

3.40.4.6.1         The 4th dorsal interosseous and 3rd plantar interosseous, those of the 4th Intermetatarsal space and the 4th Lumbricals, are supplied by the superficial branch of the lateral plantar nerve. The 1st and 2nd dorsal Interossei may receive supply from the deep peroneal nerve also

3.40.5              Articular Branches

3.40.5.1  To the plantar Intermetatarsal and tarsometatarsal joints

3.40.6              Cutaneous Branches

3.40.6.1  None

3.40.7              Lesions

3.40.7.1  A focal injury to this nerve would be uncommon. In tarsal tunnel syndrome, the nerve compression could relate to these fibers only. Presents as a loss of adduction of the big toe. Loss of innervation to Lumbricals and Interossei may cause weakness in flexion of proximal phalanx of 2nd, 3rd and 4th toes. In addition, weakness in abduction (dorsal Interossei) and adduction (plantar Interossei) of toes.

3.40.8              Path Description

3.40.8.1  The deep branch (ramus profundus; muscular branch) accompanies the lateral plantar artery on the deep surface of the tendons of the Flexor muscles and the Adductor hallucis, and supplies all the Interossei (except those in the fourth metatarsal space), the second, third, and fourth Lumbricales, and the Adductor hallucis.

3.40.9              Gray’s Anatomy

3.40.9.1  http://www.bartleby.com/107/213.html

3.40.9.2  Illustration

3.40.9.2.1         http://www.bartleby.com/107/illus833.html
3.40.9.2.2         http://www.bartleby.com/107/illus834.html

3.40.10           Illustration

3.40.10.1              

3.41 Common Peroneal (Fibular) Nerve (93)

Back Table of Contents References

3.41.1              Spinal Roots

3.41.1.1  L4, L5, S1, S2

3.41.1.1.1         Through dorsal divisions from the lumbar and sacral ventral rami of the sacral plexus as the fibular division of the sciatic nerve

3.41.2              Named Branches

3.41.2.1  A=Deep peroneal (anterior tibial) nerve,

3.41.2.2  B=Superficial peroneal (musculocutaneous) nerve

3.41.3              Muscular Branches

3.41.3.1  None

3.41.4              Articular Branches

3.41.4.1  Three branches to the anterolateral part of the knee capsule and the proximal tibiofibular joint that pass with the following arteries

3.41.4.1.1         C=Superior lateral genicular artery
3.41.4.1.2         D=Lateral genicular artery
3.41.4.1.3         E=Anterior tibial recurrent arter,y

3.41.5              Cutaneous Branches

3.41.5.1  F=Lateral Sural Nerve

3.41.5.1.1         Summary
3.41.5.1.1.1           The lateral sural nerve (lateral cutaneous nerve of the calf, L4, L5, S1) supplies the skin of the anterior, lateral, and posterior aspects of the proximal leg. A communicating branch arises and connects with the medial sural nerve of the tibial to form sural and continues to distribute to lateral foot

3.41.5.2  The lateral sural cutaneous nerve (n. cutaneus suræ lateralis; lateral cutaneous branch) supplies the skin on the posterior and lateral surfaces of the leg; one branch, the peroneal anastomotic (n. communicans fibularis), arises near the head of the fibula, crosses the lateral head of the Gastrocnemius to the middle of the leg, and joins with the medial sural cutaneous to form the sural nerve. The peroneal anastomotic is occasionally continued down as a separate branch as far as the heel.

3.41.6              Lesions

3.41.6.1  : This is the most commonly injured nerve in the lower leg. Primary causes are from direct impact, especially at the fibular head, or by fractures of the fibula and compression from prolonged kneeling or sitting with legs crossed. Sacral plexus and sciatic nerve lesions frequently affect the common peroneal nerve. Focal lesion to this nerve would produce paresthesia or loss of sensation to the skin described above

3.41.7              Note

3.41.7.1  See deep peroneal and superficial peroneal nerves

3.41.8              Path Description

3.41.8.1  The Common Peroneal Nerve (n. peronæus communis; external popliteal nerve; peroneal nerve) (Fig. 832), about one-half the size of the tibial, is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. It descends obliquely along the lateral side of the popliteal fossa to the head of the fibula, close to the medial margin of the Biceps femoris muscle. It lies between the tendon of the Biceps femoris and lateral head of the Gastrocnemius muscle, winds around the neck of the fibula, between the Peronæus longus and the bone, and divides beneath the muscle into the superficial and deep peroneal nerves. Previous to its division it gives off articular and lateral sural cutaneous nerves.    39

3.41.8.2    The articular branches (rami articulares) are three in number; two of these accompany the superior and inferior lateral genicular arteries to the knee; the upper one occasionally arises from the trunk of the sciatic nerve. The third (recurrent) articular nerve is given off at the point of division of the common peroneal nerve; it ascends with the anterior recurrent tibial artery through the Tibialis anterior to the front of the knee.

3.41.9              Gray’s Anatomy

3.41.9.1  http://www.bartleby.com/107/213.html

3.41.9.2  Illustrations

3.41.9.2.1         http://www.bartleby.com/107/illus832.html

3.41.10           Number

3.41.10.1               35.09

3.41.11           Reference

3.41.11.1               93

3.41.12           Illustration

3.41.12.1              

3.42 Deep Peroneal (Anterior Tibial) Nerve (Branches Arising in the Leg) (94)

3.42.1              Spinal Roots

3.42.1.1  L4, LS, S1, S2

3.42.1.1.1         Through dorsal divisions of the sacral plexus through the sciatic nerve; branches within the peroneus longus muscle (not illustrated) into deep and superficial peroneal nerve

3.42.2              Named Branches

3.42.2.1  A=Superficial peroneal nerve

3.42.2.2  B=Lateral terminal branch

3.42.2.3  C=Medial terminal branch

3.42.3              Muscular Branches

3.42.3.1  D=Tibialis Anterior / L4, L5,

3.42.3.2  E=Extensor hallucis longus / LS, S 1,

3.42.3.3  F=Extensor digitorum longus / LS, S 1,

3.42.3.4  G=Peroneus Tertius / LS, S1

3.42.4              Articular Branches

3.42.4.1  To the Talocrural joint

3.42.5              Cutaneous Branches

3.42.5.1  None

3.42.6              Lesions

3.42.6.1  Focal lesions to this nerve are usually caused by trauma. The superficial peroneal would most likely be affected. Injury would present "drop foot inability to dorsiflex and weak eversion at the subtalar and intertarsal joints. The action is saved if peroneus longus muscle and superficial peroneal nerve survive.

3.42.7              Path Description

3.42.7.1  The Deep Peroneal Nerve (n. peronæus profundus; anterior tibial nerve) (Fig. 827) begins at the bifurcation of the common peroneal nerve, between the fibula and upper part of the Peronæus longus, passes obliquely forward beneath the Extensor digitorum longus to the front of the interosseous membrane, and comes into relation with the anterior tibial artery above the middle of the leg; it then descends with the artery to the front of the ankle-joint, where it divides into a lateral and a medial terminal branch. It lies at first on the lateral side of the anterior tibial artery, then in front of it, and again on its lateral side at the ankle-joint.    42

3.42.7.2    In the leg, the deep peroneal nerve supplies muscular branches to the Tibialis anterior, Extensor digitorum longus, Peronæus tertius, and Extensor hallucis prop ius, and an articular branch to the ankle-joint.    43

3.42.7.3    The lateral terminal branch (external or tarsal branch) passes across the tarsus, beneath the Extensor digitorum brevis, and, having become enlarged like the dorsal interosseous nerve at the wrist, supplies the Extensor digitorumbrevis. From the enlargement three minute interosseous branches are given off, which supply the tarsal joints and the metatarsophalangeal joints of the second, third, and fourth toes. The first of these sends a filament to the second Interosseus dorsalis muscle.

3.42.7.4    The medial terminal branch (internal branch) accompanies the dorsalis pedis artery along the dorsum of the foot, and, at the first interosseous space, divides into two dorsal digital nerves (nn. digitales dorsales hallucis lateralis et digiti secundi medialis) which supply the adjacent sides of the great and second toes, communicating with the medial dorsal cutaneous branch of the superficial peroneal nerve. Before it divides it gives off to the first space an interosseous branch which supplies the metatarsophalangeal joint of the great toe and sends a filament to the first Interosseous dorsalis muscle.

3.42.8              Gray’s Anatomy

3.42.8.1  http://www.bartleby.com/107/213.html

3.42.8.2  Illustration

3.42.8.2.1         http://www.bartleby.com/107/illus827.html
3.42.8.2.2         http://www.bartleby.com/107/illus835.html
3.42.8.2.3         http://www.bartleby.com/107/illus836.html

3.42.9              Number

3.42.9.1  35.092

3.42.10           Reference

3.42.10.1               94

3.42.11           Illustration

3.42.11.1              

3.43 Deep Peroneal Medial and Lateral Terminal Branches (95)

3.43.1              Spinal Roots

3.43.1.1  S1, S2

3.43.1.1.1         Through dorsal divisions from the lumbar and sacral ventral rami of the sacral plexus, through the sciatic and common peroneal and branches of the deep peroneal nerves

3.43.2              Named Branches

3.43.2.1   

3.43.3              Muscular Branches

3.43.3.1  A=1st Dorsal interosseus muscle / S1, S2

3.43.3.2  B=Extensor digitorum brevis / S1, S 2

3.43.3.3  C=Extensor hallucis brevis / S1, S2

3.43.3.4  D=2nd Dorsal interosseous muscle / S1, S2

3.43.4              Articular Branches

3.43.4.1  E=Medial terminal branch: To the hallucial metatarsophalangeal joints.

3.43.4.2  F=Lateral terminal branch: By three interosseous branches to the tarsal and metatarsophalangeal joints of the middle three toes.

3.43.5              Cutaneous Branches

3.43.5.1  From the medial terminal branch there are two dorsal digital nerves supplying the adjacent sides of the big and second toe (1st interdigital cleft)

3.43.6              Lesions

3.43.6.1  The terminal branches may be injured where they cross the ankle and on the dorsum of the foot by trauma, ankle fractures, dislocations and sprains. Spontaneous entrapment beneath the inferior extensor retinaculum has been termed anterior tarsal tunnel syndrome. This focal lesion can go undetected, the cutaneous distribution being so small and the extensor action of the toe musculature minimal.

3.43.7              Gray’s Anatomy

3.43.7.1  http://www.bartleby.com/107/213.html

3.43.8              Number

3.43.8.1  35.0921

3.43.9              Reference

3.43.9.1  95

3.43.10           Illustration

3.43.10.1              

3.44 Superficial Peroneal Nerve (96)

3.44.1              Spinal Roots

3.44.1.1  L5, S1, S2

3.44.1.1.1         Through dorsal divisions from lumbar and sacral ventral rami of the sacral plexus, through the sciatic nerve and branching superficial from the deep peroneal nerve

3.44.2              Named Branches

3.44.2.1  A=Medial branch

3.44.2.2  B=Lateral branch

3.44.3              Muscular Branches

3.44.3.1  C=Peroneus Longus L5, S1, S2

3.44.3.2  D=Peroneus brevis L5, S1, S2.

3.44.4              Articular Branches

3.44.4.1  None

3.44.5              Cutaneous Branches

3.44.5.1  None

3.44.5.2  Note

3.44.5.2.1         See medial and lateral branches of superficial peroneal nerve

3.44.6              Lesions

3.44.6.1  Focal lesions to this nerve are common because of its superficial location. However, the common peroneal is more vulnerable and likely .to be damaged, affecting both deep and superficial peroneal nerves. Focal lesions will present an inverted foot by the unopposed action of the deep crural muscle group (tibia innervation). Weakness in eversion of the subtalar and intertarsal joints. This action is saved by the extensor digitorum longus, and is present if peroneus Tertius survives.

3.44.7              Path Description

3.44.7.1  The Superficial Peroneal Nerve (n. peronæus superficialis; musculocutaneous nerve) (Figs. 827, 835) supplies the Peronei longus and brevis and the skin over the greater part of the dorsum of the foot. It passes forward between the Peronæi and the Extensor digitorum longus, pierces the deep fascia at the lower third of the leg, and divides into a medial and an intermediate dorsal cutaneous nerve. In its course between the muscles, the nerve gives off muscular branches to the Peronæi longus and brevis, and cutaneous filaments to the integument of the lower part of the leg.

3.44.8              Gray’s Anatomy

3.44.8.1  http://www.bartleby.com/107/213.html

3.44.8.2  Illustrations

3.44.8.2.1         http://www.bartleby.com/107/illus827.html
3.44.8.2.2         http://www.bartleby.com/107/illus835.html
3.44.8.2.3         http://www.bartleby.com/107/illus836.html

3.44.9              Number

3.44.9.1  35.093

3.44.10           Reference

3.44.10.1               96

3.44.11           Illustration

3.44.11.1              

3.45 Superficial Peroneal Nerve Medial and Lateral Terminal Branches (97)

3.45.1              Spinal Roots

3.45.1.1  L4, L5, S1

3.45.1.1.1         Through dorsal divisions from lumbar and sacral ventral rami of the sacral plexus, through the sciatic, the common peroneal and bifurcating from the superficial peroneal nerve

3.45.2              Named Branches

3.45.2.1  A=Medial branch

3.45.2.2  B=Lateral branch

3.45.2.3  C=Dorsal digital branches

3.45.3              Muscular Branches

3.45.3.1  None

3.45.4              Articular Branches

3.45.4.1  None

3.45.5              Cutaneous Branches

3.45.5.1  Medial branch

3.45.5.1.1         To the skin of the anterior central lower leg, ankle and foot then dividing into dorsal digital nerves to supply the medial side of the big toe and the adjacent sides of the second and third toes

3.45.5.2  Lateral branch

3.45.5.2.1         To the skin of the anterolateral lower leg, ankle and foot. It then divides into dorsal digital nerves to supply the medial side of the big toe and the adjacent sides of the third and forth, and forth and fifth toes.

3.45.6              Lesions

3.45.6.1  Focal lesions distal to the muscular branches of the superficial peroneal nerve would result in paresthesias to the skin areas described above. Either or both medial and lateral branches may be subject to trauma.

3.45.7              Path Description

3.45.7.1  The medial dorsal cutaneous nerve (n. cutaneus dorsalis medialis; internal dorsal cutaneous branch) passes in front of the ankle-joint, and divides into two dorsal digital branches, one of which supplies the medial side of the great toe, the other, the adjacent side of the second and third toes. It also supplies the integument of the medial side of the foot and ankle, and communicates with the saphenous nerve, and with the deep peroneal nerve (Fig. 825).    47

3.45.7.2    The intermediate dorsal cutaneous nerve (n. cutaneus dorsalis intermedius; external dorsal cutaneous branch), the smaller, passes along the lateral part of the dorsum of the foot, and divides into dorsal digital branches, which supply the contiguous sides of the third and fourth, and of the fourth and fifth toes. It also supplies the skin of the lateral side of the foot and ankle, and communicates with the sural nerve (Fig. 825). The branches of the superficial peroneal nerve supply the skin of the dorsal surfaces of all the toes excepting the lateral side of the little toe, and the adjoining sides of the great and second toes, the former being supplied by the lateral dorsal cutaneous nerve from the sural nerve, and the latter by the medial branch of the deep peroneal nerve. Frequently some of the lateral branches of the superficial peroneal are absent, and their places are then taken by branches of the sural nerve.

3.45.8              Gray’s Anatomy

3.45.8.1  http://www.bartleby.com/107/213.html

3.45.8.2  Illustration

3.45.8.2.1         http://www.bartleby.com/107/illus825.html

3.45.9              Number

3.45.9.1  35.0931 & 35.0932

3.45.10           Reference

3.45.10.1               97

3.45.11           Illustration

3.45.11.1              

3.46 Perforating Cutaneous Nerve (98) (Blank)

Back Table of Contents References

3.46.1              Spinal Roots

3.46.1.1   

3.46.2              Named Branches

3.46.2.1   

3.46.3              Muscular Branches

3.46.3.1   

3.46.4              Articular Branches

3.46.4.1   

3.46.5              Cutaneous Branches

3.46.5.1   

3.46.6              Lesions

3.46.6.1   

3.46.7              Gray’s Anatomy

3.46.7.1  http://www.bartleby.com/107/213.html

3.46.8              Number

3.46.8.1  35

3.46.9              Reference

3.46.9.1   

3.46.10           Illustration

3.46.10.1                

3.47 Sacral Muscular Branches (4th Sacral) (99) (Blank)

Back Table of Contents References

3.47.1              Spinal Roots

3.47.1.1   

3.47.2              Named Branches

3.47.2.1   

3.47.3              Muscular Branches

3.47.3.1   

3.47.4              Articular Branches

3.47.4.1   

3.47.5              Cutaneous Branches

3.47.5.1   

3.47.6              Lesions

3.47.6.1   

3.47.7              Gray’s Anatomy

3.47.7.1  http://www.bartleby.com/107/213.html

3.47.8              Number

3.47.8.1  35

3.47.9              Reference

3.47.9.1   

3.47.10           Illustration

3.47.10.1                

3.48 Pudendal Nerve: Inferior Rectal Branch (Inferior Hemeorrhoidal Nerve) (100) (Blank)

Back Table of Contents References

3.48.1              Spinal Roots

3.48.1.1   

3.48.2              Named Branches

3.48.2.1   

3.48.3              Muscular Branches

3.48.3.1   

3.48.4              Articular Branches

3.48.4.1   

3.48.5              Cutaneous Branches

3.48.5.1   

3.48.6              Lesions

3.48.6.1   

3.48.7              Gray’s Anatomy

3.48.7.1  http://www.bartleby.com/107/213.html

3.48.8              Number

3.48.8.1  35

3.48.9              Reference

3.48.9.1   

3.48.10           Illustration

3.48.10.1                

3.49 Pudendal Nerve (Perineal Branch) (101) (Blank)

Back Table of Contents References

3.49.1              Spinal Roots

3.49.1.1   

3.49.2              Named Branches

3.49.2.1   

3.49.3              Muscular Branches

3.49.3.1   

3.49.4              Articular Branches

3.49.4.1   

3.49.5              Cutaneous Branches

3.49.5.1   

3.49.6              Lesions

3.49.6.1   

3.49.7              Gray’s Anatomy

3.49.7.1  http://www.bartleby.com/107/213.html

3.49.8              Number

3.49.8.1   

3.49.9              Reference

3.49.9.1   

3.49.10           Illustration

3.49.10.1                

3.50 Pudendal Nerve (Dorsal Nerve of Penis or Clitoris) (102) (Blank)

Back Table of Contents References

3.50.1              Spinal Roots

3.50.1.1   

3.50.2              Named Branches

3.50.2.1   

3.50.3              Muscular Branches

3.50.3.1   

3.50.4              Articular Branches

3.50.4.1   

3.50.5              Cutaneous Branches

3.50.5.1   

3.50.6              Lesions

3.50.6.1   

3.50.7              Gray’s Anatomy

3.50.7.1  http://www.bartleby.com/107/213.html

3.50.8              Number

3.50.8.1   

3.50.9              Reference

3.50.9.1   

3.50.10           Illustration

3.50.10.1                

3.51 Blank

3.51.1              Spinal Roots

3.51.1.1   

3.51.2              Named Branches

3.51.2.1   

3.51.3              Muscular Branches

3.51.3.1   

3.51.4              Articular Branches

3.51.4.1   

3.51.5              Cutaneous Branches

3.51.5.1   

3.51.6              Lesions

3.51.6.1   

3.51.7              Number

3.51.7.1   

3.51.8              Reference

3.51.8.1   

3.51.9              Illustration

3.51.9.1   

4    TORSO

4.1  LATERAL PECTORAL

Back Table of Contents References

4.1.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.1.1.1     .

4.1.2  NUMBER

4.1.2.1     35

4.1.3  REFERENCE

4.1.3.1      

4.1.4  ROOTS

4.1.4.1      

4.1.4.2     Lumbar Plexus

4.1.4.3     VENTRAL

4.1.5  DIVISION

4.1.5.1     Dorsal Ventral

4.1.5.2      

4.1.6  CUTANEOUS BRANCHES

4.1.6.1      

4.1.6.1.1   

4.1.6.2      

4.1.6.2.1  .

4.1.7  ARTICULAR BRANCHES

4.1.7.1      

4.1.7.1.1   

4.1.8  MUSCULAR BRANCHES

4.1.8.1      

4.1.8.2      

4.1.8.3      

4.1.8.4      

4.1.8.5      

4.1.8.6      

4.2  MEDIAL PECTORAL

Back Table of Contents References

4.2.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.2.1.1     .

4.2.2  NUMBER

4.2.2.1     35

4.2.3  REFERENCE

4.2.3.1      

4.2.4  ROOTS

4.2.4.1      

4.2.4.2     Lumbar Plexus

4.2.4.3     VENTRAL

4.2.5  DIVISION

4.2.5.1     Dorsal Ventral

4.2.5.2      

4.2.6  CUTANEOUS BRANCHES

4.2.6.1      

4.2.6.1.1   

4.2.6.2      

4.2.6.2.1  .

4.2.7  ARTICULAR BRANCHES

4.2.7.1      

4.2.7.1.1   

4.2.8  MUSCULAR BRANCHES

4.2.8.1      

4.2.8.2      

4.2.8.3      

4.2.8.4      

4.2.8.5      

4.2.8.6      

4.3  1ST THOR INTERCSTL N

Back Table of Contents References

4.3.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.3.1.1     .

4.3.2  NUMBER

4.3.2.1     35

4.3.3  REFERENCE

4.3.3.1      

4.3.4  ROOTS

4.3.4.1      

4.3.4.2     Lumbar Plexus

4.3.4.3     VENTRAL

4.3.5  DIVISION

4.3.5.1     Dorsal Ventral

4.3.5.2      

4.3.6  CUTANEOUS BRANCHES

4.3.6.1      

4.3.6.1.1   

4.3.6.2      

4.3.6.2.1  .

4.3.7  ARTICULAR BRANCHES

4.3.7.1      

4.3.7.1.1   

4.3.8  MUSCULAR BRANCHES

4.3.8.1      

4.3.8.2      

4.3.8.3      

4.3.8.4      

4.3.8.5      

4.3.8.6      

4.4  2ND THOR INTRCSTL N

Back Table of Contents References

4.4.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.4.1.1     .

4.4.2  NUMBER

4.4.2.1     35

4.4.3  REFERENCE

4.4.3.1      

4.4.4  ROOTS

4.4.4.1      

4.4.4.2     Lumbar Plexus

4.4.4.3     VENTRAL

4.4.5  DIVISION

4.4.5.1     Dorsal Ventral

4.4.5.2      

4.4.6  CUTANEOUS BRANCHES

4.4.6.1      

4.4.6.1.1   

4.4.6.2      

4.4.6.2.1  .

4.4.7  ARTICULAR BRANCHES

4.4.7.1      

4.4.7.1.1   

4.4.8  MUSCULAR BRANCHES

4.4.8.1      

4.4.8.2      

4.4.8.3      

4.4.8.4      

4.4.8.5      

4.4.8.6      

4.5  UPPER INTERCSTL=T3-6

Back Table of Contents References

4.5.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.5.1.1     .

4.5.2  NUMBER

4.5.2.1     35

4.5.3  REFERENCE

4.5.3.1      

4.5.4  ROOTS

4.5.4.1      

4.5.4.2     Lumbar Plexus

4.5.4.3     VENTRAL

4.5.5  DIVISION

4.5.5.1     Dorsal Ventral

4.5.5.2      

4.5.6  CUTANEOUS BRANCHES

4.5.6.1      

4.5.6.1.1   

4.5.6.2      

4.5.6.2.1  .

4.5.7  ARTICULAR BRANCHES

4.5.7.1      

4.5.7.1.1   

4.5.8  MUSCULAR BRANCHES

4.5.8.1      

4.5.8.2      

4.5.8.3      

4.5.8.4      

4.5.8.5      

4.5.8.6      

4.6  LWR INTCSTL N.=T7-11

Back Table of Contents References

4.6.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.6.1.1     .

4.6.2  NUMBER

4.6.2.1     35

4.6.3  REFERENCE

4.6.3.1      

4.6.4  ROOTS

4.6.4.1      

4.6.4.2     Lumbar Plexus

4.6.4.3     VENTRAL

4.6.5  DIVISION

4.6.5.1     Dorsal Ventral

4.6.5.2      

4.6.6  CUTANEOUS BRANCHES

4.6.6.1      

4.6.6.1.1   

4.6.6.2      

4.6.6.2.1  .

4.6.7  ARTICULAR BRANCHES

4.6.7.1      

4.6.7.1.1   

4.6.8  MUSCULAR BRANCHES

4.6.8.1      

4.6.8.2      

4.6.8.3      

4.6.8.4      

4.6.8.5      

4.6.8.6      

4.7  1ST DORSAL RAMUS(SUBOCCIPITAL N)

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4.7.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.7.1.1     .

4.7.2  NUMBER

4.7.2.1     35

4.7.3  REFERENCE

4.7.3.1      

4.7.4  ROOTS

4.7.4.1      

4.7.4.2     Lumbar Plexus

4.7.4.3     VENTRAL

4.7.5  DIVISION

4.7.5.1     Dorsal Ventral

4.7.5.2      

4.7.6  CUTANEOUS BRANCHES

4.7.6.1      

4.7.6.1.1   

4.7.6.2      

4.7.6.2.1  .

4.7.7  ARTICULAR BRANCHES

4.7.7.1      

4.7.7.1.1   

4.7.8  MUSCULAR BRANCHES

4.7.8.1      

4.7.8.2      

4.7.8.3      

4.7.8.4      

4.7.8.5      

4.7.8.6      

4.8  2ND DOR RAMUS(GREATER OCCIPITAL N)

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4.8.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.8.1.1     .

4.8.2  NUMBER

4.8.2.1     35

4.8.3  REFERENCE

4.8.3.1      

4.8.4  ROOTS

4.8.4.1      

4.8.4.2     Lumbar Plexus

4.8.4.3     VENTRAL

4.8.5  DIVISION

4.8.5.1     Dorsal Ventral

4.8.5.2      

4.8.6  CUTANEOUS BRANCHES

4.8.6.1      

4.8.6.1.1   

4.8.6.2      

4.8.6.2.1  .

4.8.7  ARTICULAR BRANCHES

4.8.7.1      

4.8.7.1.1   

4.8.8  MUSCULAR BRANCHES

4.8.8.1      

4.8.8.2      

4.8.8.3      

4.8.8.4      

4.8.8.5      

4.8.8.6      

4.9  3RD DORSAL RAMUS

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4.9.1  DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.9.1.1     .

4.9.2  NUMBER

4.9.2.1     35

4.9.3  REFERENCE

4.9.3.1      

4.9.4  ROOTS

4.9.4.1      

4.9.4.2     Lumbar Plexus

4.9.4.3     VENTRAL

4.9.5  DIVISION

4.9.5.1     Dorsal Ventral

4.9.5.2      

4.9.6  CUTANEOUS BRANCHES

4.9.6.1      

4.9.6.1.1   

4.9.6.2      

4.9.6.2.1  .

4.9.7  ARTICULAR BRANCHES

4.9.7.1      

4.9.7.1.1   

4.9.8  MUSCULAR BRANCHES

4.9.8.1      

4.9.8.2      

4.9.8.3      

4.9.8.4      

4.9.8.5      

4.9.8.6      

4.10 LOWR CER DOR RAM (C4-8)

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4.10.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.10.1.1  .

4.10.2              NUMBER

4.10.2.1  35

4.10.3              REFERENCE

4.10.3.1   

4.10.4              ROOTS

4.10.4.1   

4.10.4.2  Lumbar Plexus

4.10.4.3  VENTRAL

4.10.5              DIVISION

4.10.5.1  Dorsal Ventral

4.10.5.2   

4.10.6              CUTANEOUS BRANCHES

4.10.6.1   

4.10.6.1.1          

4.10.6.2   

4.10.6.2.1         .

4.10.7              ARTICULAR BRANCHES

4.10.7.1   

4.10.7.1.1          

4.10.8              MUSCULAR BRANCHES

4.10.8.1   

4.10.8.2   

4.10.8.3   

4.10.8.4   

4.10.8.5   

4.10.8.6   

4.11 UPP THOR DOR RAM (T1-6)

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4.11.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.11.1.1  .

4.11.2              NUMBER

4.11.2.1  35

4.11.3              REFERENCE

4.11.3.1   

4.11.4              ROOTS

4.11.4.1   

4.11.4.2  Lumbar Plexus

4.11.4.3  VENTRAL

4.11.5              DIVISION

4.11.5.1  Dorsal Ventral

4.11.5.2   

4.11.6              CUTANEOUS BRANCHES

4.11.6.1   

4.11.6.1.1          

4.11.6.2   

4.11.6.2.1         .

4.11.7              ARTICULAR BRANCHES

4.11.7.1   

4.11.7.1.1          

4.11.8              MUSCULAR BRANCHES

4.11.8.1   

4.11.8.2   

4.11.8.3   

4.11.8.4   

4.11.8.5   

4.11.8.6   

4.12 LOWR THOR DOR RAM (T7-12)

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4.12.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.12.1.1  .

4.12.2              NUMBER

4.12.2.1  35

4.12.3              REFERENCE

4.12.3.1   

4.12.4              ROOTS

4.12.4.1   

4.12.4.2  Lumbar Plexus

4.12.4.3  VENTRAL

4.12.5              DIVISION

4.12.5.1  Dorsal Ventral

4.12.5.2   

4.12.6              CUTANEOUS BRANCHES

4.12.6.1   

4.12.6.1.1          

4.12.6.2   

4.12.6.2.1         .

4.12.7              ARTICULAR BRANCHES

4.12.7.1   

4.12.7.1.1          

4.12.8              MUSCULAR BRANCHES

4.12.8.1   

4.12.8.2   

4.12.8.3   

4.12.8.4   

4.12.8.5   

4.12.8.6   

4.13 LUMBAR DOR RAM (L1-5)

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4.13.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.13.1.1  .

4.13.2              NUMBER

4.13.2.1  35

4.13.3              REFERENCE

4.13.3.1   

4.13.4              ROOTS

4.13.4.1   

4.13.4.2  Lumbar Plexus

4.13.4.3  VENTRAL

4.13.5              DIVISION

4.13.5.1  Dorsal Ventral

4.13.5.2   

4.13.6              CUTANEOUS BRANCHES

4.13.6.1   

4.13.6.1.1          

4.13.6.2   

4.13.6.2.1         .

4.13.7              ARTICULAR BRANCHES

4.13.7.1   

4.13.7.1.1          

4.13.8              MUSCULAR BRANCHES

4.13.8.1   

4.13.8.2   

4.13.8.3   

4.13.8.4   

4.13.8.5   

4.13.8.6   

4.14 UPPER SACRAL DOR RAM (S1-3)

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4.14.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.14.1.1  .

4.14.2              NUMBER

4.14.2.1  35

4.14.3              REFERENCE

4.14.3.1   

4.14.4              ROOTS

4.14.4.1   

4.14.4.2  Lumbar Plexus

4.14.4.3  VENTRAL

4.14.5              DIVISION

4.14.5.1  Dorsal Ventral

4.14.5.2   

4.14.6              CUTANEOUS BRANCHES

4.14.6.1   

4.14.6.1.1          

4.14.6.2   

4.14.6.2.1         .

4.14.7              ARTICULAR BRANCHES

4.14.7.1   

4.14.7.1.1          

4.14.8              MUSCULAR BRANCHES

4.14.8.1   

4.14.8.2   

4.14.8.3   

4.14.8.4   

4.14.8.5   

4.14.8.6   

4.15 LWR SAC&COC DR R(ANOCOCCYGEAL N) (S4,5,C01)

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4.15.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.15.1.1  .

4.15.2              NUMBER

4.15.2.1  35

4.15.3              REFERENCE

4.15.3.1   

4.15.4              ROOTS

4.15.4.1   

4.15.4.2  Lumbar Plexus

4.15.4.3  VENTRAL

4.15.5              DIVISION

4.15.5.1  Dorsal Ventral

4.15.5.2   

4.15.6              CUTANEOUS BRANCHES

4.15.6.1   

4.15.6.1.1          

4.15.6.2   

4.15.6.2.1         .

4.15.7              ARTICULAR BRANCHES

4.15.7.1   

4.15.7.1.1          

4.15.8              MUSCULAR BRANCHES

4.15.8.1   

4.15.8.2   

4.15.8.3   

4.15.8.4   

4.15.8.5   

4.15.8.6   

4.16 The Celiac Plexus (Plexus Cœliacus; Solar Plexus)

4.16.1              Path Description

4.16.1.1  The celiac plexus, the largest of the three sympathetic plexuses, is situated at the level of the upper part of the first lumbar vertebra and is composed of two large ganglia, the celiac ganglia, and a dense net-work of nerve fibers uniting them together. It surrounds the celiac artery and the root of the superior mesenteric artery. It lies behind the stomach and the omental bursa, in front of the crura of the diaphragm and the commencement of the abdominal aorta, and between the suprarenal glands. The plexus and the ganglia receive the greater and lesser splanchnic nerves of both sides and some filaments from the right vagus, and give off numerous secondary plexuses along the neighboring arteries.

4.16.1.2 The celiac plexus is located near where the celiac trunk, superior mesenteric artery, and renal arteries branch from the abdominal aorta. It is behind the stomach and the omental bursa and in front of the crura of the diaphragm, on the level of the first lumbar vertebra, L1.

4.16.1.3 The plexus is formed (in part) by the greater and lesser splanchnic nerves of both sides, and also parts of the right vagus nerve.

4.16.1.4 The celiac plexus proper consists of the celiac ganglia with a network of interconnecting fibers. The aorticorenal ganglia are often considered to be part of the celiac ganglia, and thus, part of the plexus.

4.16.1.5   

4.16.2              Associated Plexus

4.16.2.1  Phrenic.

4.16.2.2  Renal.

4.16.2.3  Hepatic.

4.16.2.4  Spermatic.

4.16.2.5  Lienal.

4.16.2.6  Superior mesenteric.

4.16.2.7  Superior gastric.

4.16.2.8  Abdominal aortic.

4.16.2.9  Suprarenal.

4.16.2.10               Inferior mesenteric

4.17 Celiac Ganglia (ganglia cæliaca; semilunar ganglia)

4.17.1              Path Description

4.17.1.1  The Celiac Ganglia (ganglia cæliaca; semilunar ganglia) are two large irregularlyshaped masses having the appearance of lymph glands and placed one on either side of the middle line in front of the crura of the diaphragm close to the suprarenal glands, that on the right side being placed behind the inferior vena cava. The upper part of each ganglion is joined by the greater splanchnic nerve, while the lower part, which is segmented off and named the aorticorenal ganglion, receives the lesser splanchnic nerve and gives off the greater part of the renal plexus

4.18 Phrenic Plexus (plexus phrenicus)

4.18.1              The phrenic plexus (plexus phrenicus) accompanies the inferior phrenic artery to the diaphragm, some filaments passing to the suprarenal gland. It arises from the upper part of the celiac ganglion, and is larger on the right than on the left side. It receives one or two branches from the phrenic nerve. At the point of junction of the right phrenic plexus with the phrenic nerve is a small ganglion (ganglion phrenicum). This plexus distributes branches to the inferior vena cava, and to the suprarenal and hepatic plexuses.

4.19 The Thoracic Portion of the Sympathetic System

4.19.1              The thoracic portion of the sympathetic trunk (Fig. 846). consists of a series of ganglia, which usually correspond in number to that of the vertebræ; but, on account of the occasional coalescence of two ganglia, their number is uncertain. The thoracic ganglia rest against the heads of the ribs, and are covered by the costal pleura; the last two, however, are more anterior than the rest, and are placed on the sides of the bodies of the eleventh and twelfth thoracic vertebræ. The ganglia are small in size, and of a grayish color. The first, larger than the others, is of an elongated form, and frequently blended with the inferior cervical ganglion. They are connected together by the intervening portions of the trunk.    1

4.19.2                Two rami communicantes, a white and a gray, connect each ganglion with its corresponding spinal nerve.    2

4.19.3                The branches from the upper five ganglia are very small; they supply filaments to the thoracic aorta and its branches. Twigs from the second, third, and fourth ganglia enter the posterior pulmonary plexus.    3

4.19.4                The branches from the lower seven ganglia are large, and white in color; they distribute filaments to the aorta, and unite to form the greater, the lesser, and the lowest splanchnic nerves.

4.20 Thoracic splanchnic nerves

4.20.1              Thoracic splanchnic nerves arise from the sympathetic trunk in the thorax and travel inferiorly to provide sympathetic innervation to the abdomen. The nerves contain preganglionic sympathetic and visceral afferent fibers.

4.20.2              A striking analogy exists between the splanchnic and the cardiac nerves. The cardiac nerves are three in number; they arise from all three cervical ganglia, and are distributed to a large and important organ in the thoracic cavity. The splanchnic nerves, also three in number, are connected probably with all the thoracic ganglia, and are distributed to important organs in the abdominal cavity.

4.20.3              Illustrations

4.20.3.1  http://en.wikipedia.org/wiki/Thoracic_splanchnic_nerves

4.20.4              There are three main thoracic splanchnic nerves:

4.20.4.1  Greater Splanchnic Nerve (n. splanchnicus major; great splanchnic nerve)

4.20.4.1.1         The greater splanchnic nerve (n. splanchnicus major; great splanchnic nerve) is white in color, firm in texture, and of a considerable size; it is formed by branches from the fifth to the ninth or tenth thoracic ganglia, but the fibers in the higher roots may be traced upward in the sympathetic trunk as far as the first or second thoracic ganglion. It descends obliquely on the bodies of the vertebræ, perforates the crus of the diaphragm, and ends in the celiac ganglion. A ganglion (ganglion splanchnicum) exists on this nerve opposite the eleventh or twelfth thoracic vertebra.
4.20.4.1.2         The nerve travels through the diaphragm and enters the abdominal cavity, where its fibers synapse at the celiac ganglia. The nerve contributes to the celiac plexus, a network of nerves located in the vicinity of where the celiac trunk branches from the abdominal aorta. The fibers in this nerve modulate the activity of the enteric nervous system of the foregut. They also provide the sympathetic innervation to the adrenal medulla, stimulating catecholamine release.

4.20.4.2  Lesser splanchnic nerve (n. splanchnicus minor)

4.20.4.2.1         The lesser splanchnic nerve (n. splanchnicus minor) is formed by filaments from the ninth and tenth, and sometimes the eleventh thoracic ganglia, and from the cord between them. It pierces the diaphragm with the preceding nerve, and joins the aorticorenal ganglion.
4.20.4.2.2         The nerve travels inferiorly, lateral to the greater splanchnic nerve. Its fibers synapse with their postganglionic counterparts in the celiac ganglia, or in the aorticorenal ganglion. The nerve modulates the activity of the enteric nervous system of the midgut.

4.20.4.3  Lowest splanchnic nerve (n. splanchnicus imus; least splanchnic nerve)

4.20.4.3.1         The lowest splanchnic nerve (n. splanchnicus imus; least splanchnic nerve) arises from the last thoracic ganglion, and, piercing the diaphragm, ends in the renal plexus.
4.20.4.3.2         The nerve travels into the abdomen, where its fibers synapse in the renal ganglia.

4.20.4.4 The nerve's origins can be remembered by the "4-3-2 rule", accounting for the number of ganglia giving rise to each nerve. However, different sources define the nerves in different ways, so this rule may not always be reliable.

4.20.5               DIVISION

4.20.5.1  Dorsal Ventral

4.20.5.2   

4.20.6              CUTANEOUS BRANCHES

4.20.6.1   

4.20.6.1.1          

4.20.6.2   

4.20.6.2.1         .

4.20.7              ARTICULAR BRANCHES

4.20.7.1   

4.20.7.1.1          

4.20.8              MUSCULAR BRANCHES

4.20.8.1   

4.20.8.2   

4.20.8.3   

4.20.8.4   

4.20.8.5   

4.20.8.6   

4.21  

4.21.1              DESCRIPTION:  PATH, FUNCTION, LESIONS, CUTANEOUS AREA, AND ADDITIONAL COMMENTS

4.21.1.1  .

4.21.2              NUMBER

4.21.2.1  35

4.21.3              REFERENCE

4.21.3.1   

4.21.4              ROOTS

4.21.4.1   

4.21.4.2  Lumbar Plexus

4.21.4.3  VENTRAL

4.21.5              DIVISION

4.21.5.1  Dorsal Ventral

4.21.5.2   

4.21.6              CUTANEOUS BRANCHES

4.21.6.1   

4.21.6.1.1          

4.21.6.2   

4.21.6.2.1         .

4.21.7              ARTICULAR BRANCHES

4.21.7.1   

4.21.7.1.1          

4.21.8              MUSCULAR BRANCHES

4.21.8.1   

4.21.8.2   

4.21.8.3   

4.21.8.4   

4.21.8.5   

4.21.8.6   



[1] Alexander Dg. Gempad Document. [Online] Available http://www.massagetoday.com/mpacms/mt/article.php?id=13428, Jun 2006.