SPINAL NERVES

JIE LÜ
DEPARTMENT OF HUMAN ANATOMY

OFFICE: COLLEGE OF BASIC MEDICAL SCIENCES BUILDING A-406

EMAIL: LVJIE@CMU.EDU.CN

CELL: 189-0091-0753
SPINAL NERVE INJURY-CASE 1

• A 38-year-old man was thrown violently to the ground by an explosion

while he was working on a road. While in the hospital recovering from
burn injuries, he noticed mild back pain with a numb “pins and
needles” sensation running down his left leg into the sole and pinky toe
of his left foot. He was unable to stand on his toes with his left foot,
and his left Achilles tendon reflex was absent.
• Where is the lesion? What is the most likely diagnosis?
 SPINAL NERVES

•  8 cervical (C1-C8)
•  12 thoracic (T1-T12)
•  5 Lumbar (L1-L5)
•  5 Sacral (S1-S5)
•  1 Coccygeal (Co)

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

SPINAL NERVES

•  Rootlet
•  Root
•  Nerve
•  Ramus
•  Plexus
 SPINAL NERVES

•  Rootlet
•  Root
•  Nerve
•  Ramus
•  Plexus

Frank H. Netter, Atlas of Human Anatomy, 2014

 SPINAL NERVES

•  Rootlet
•  Root
•  Nerve
•  Ramus
•  Plexus

Vectorized in CorelDraw by Mysid on an existing image at en-wiki by Tristanb.

 SPINAL NERVES

•  Rootlet
•  Root
•  Nerve
•  Ramus
•  Plexus

Vectorized in CorelDraw by Mysid on an existing image at en-wiki by Tristanb.

 CERVICAL PLEXUS
•  Formed by ventral rami of
C1-C5 and CNXII
•  Motor: Innervates muscles
of the neck
•  Sensory: Skin of upper
chest, shoulder, neck, and
ear
•  Phrenic nerve
•  From C3-C5 (cervical
and brachial
plexuses)
•  Innervates diaphragm

Frank H. Netter, Atlas of Human Anatomy, 2014

 CERVICAL PLEXUS
•  Formed by ventral rami of
C1-C5 and CNXII
•  Motor: Innervates muscles
of the neck
•  Sensory: Skin of upper
chest, shoulder, neck, and
ear
•  Phrenic nerve
•  From C3-C5 (cervical
and brachial
plexuses)
•  Innervates diaphragm

Frank H. Netter, Atlas of Human Anatomy, 2014

 BRACHIAL PLEXUS
•  Formed by ventral
rami of spinal
nerves C5-T1
•  5 ventral Rami form
3 Trunks that
separate into 6
Divisions then form 3
Cords that give rise
to 10 Branches

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 BRACHIAL PLEXUS

•  Radial
•  Median
•  Ulnar
•  Musculocutaneous
•  Axillary

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 BRACHIAL PLEXUS-
AXILLARY NERVE
•  Motor: deltoid and
teres minor
•  deltoid - abducts
arm
•  teres - rotate arm
laterally
•  Sensory: skin of the
lateral shoulder

Frank H. Netter, Atlas of Human Anatomy, 2014

 BRACHIAL PLEXUS-
RADIAL NERVE
•  Motor: extensor muscles
of arm, forearm, and
hand
•  triceps
•  supinator
•  brachioradialis
•  extensor carpi
radialis
•  extensor carpi ulnaris
•  extensor digitorum
Frank H. Netter, Atlas of Human Anatomy, 2014
 BRACHIAL PLEXUS-
RADIAL NERVE
•  Sensory: posterior
surface of arm and
forearm, the dorsal
surface of the
lateral three and
half digits, and
their associated
palm area

Frank H. Netter, Atlas of Human Anatomy, 2014

 MUSCULOCUTA
NEOUS NERVE
•  Motor: flexors in
anterior arm:
•  coracobrachialis
•  biceps brachii
•  brachialis
•  Sensory: lateral
surface of forearm

Frank H. Netter, Atlas of Human Anatomy, 2014

 ULNAR NERVE
•  Motor: flexor muscles in
anterior forearm
•  Flexor carpi ulnaris
•  Flexor digitorum
profundus
•  hypothenar muscles
•  Sensory: medial surface
of hand, little finger,
and medial surface of
ring finger
Frank H. Netter, Atlas of Human Anatomy, 2014
 MEDIAN NERVE
•  Motor: all but one of the
flexors of the wrist and
fingers, and thenar muscles
•  Palmaris longus
•  flexor carpi radialis
•  flexor digitorum sublimis
•  flexor pollicis longus
•  pronator
•  Sensory: anterolateral 2/3
palm, thumb, index and
middle fingers; lateral surface
of ring finger
Frank H. Netter, Atlas of Human Anatomy, 2014
 THUMB NERVES
•  Radial: abducts
•  Ulnar: adducts
•  Median: opposes,
abducts

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

THUMB NERVES
•  Radial: abducts
•  Ulnar: adducts
•  Median: opposes,
abducts

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 CUTANEOUS
INNERVATION
OF WRIST AND
HAND

Frank H. Netter, Atlas of Human Anatomy, 2014

 CUTANEOUS
INNERVATION
OF WRIST AND
HAND

Frank H. Netter, Atlas of Human Anatomy, 2014

QUIZ

• The brachial plexus gives rise to all of the following

nerves except:
(A) Axillary nerve
(B) Radial nerve
(C) Obturator nerve
(D) Median nerve
(E) Ulnar nerve
QUIZ

•  The brachial plexus:

(A) does not enter the axilla
(B) extends medially on either side of the last few cervical and first
thoracic vertebrae
(C) includes the phrenic nerve
(D) passes above the first rib posterior to the clavicle
(E) Provides almost the entire nerve supply of the neck, shoulder and
chest
 LUMBOSACRAL
PLEXUS
•  Formed by ventral
rami of spinal nerves
L1-S4 with 5 main
branches:
•  Femoral
•  Obturator
•  Sciatic
•  Tibial
•  Peroneal
Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010
 LUMBOSACRAL
PLEXUS

•  Femoral
•  Obturator
•  Sciatic
•  Tibial
•  Peroneal

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 FEMORAL NERVE
•  Motor:
•  Knee extensors
•  quadriceps
femoris
•  Hip flexors
•  Pectineus
•  Iliacus
•  satorius
•  Sensory: anteriomedial
thigh, medial surface of
Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010
leg and foot
 OBTURATOR
NERVE

•  Motor: adductor
group and
gracilis cause
adduction of the
thigh and knee
•  Sensory: medial
thigh

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 SCIATIC NERVE
•  Motor: posterior
thigh muscles,
adductor magnus,
muscles of leg and
foot
•  Sensory: the skin of
the lateral leg, heel,
and both the dorsal
and plantar surfaces
Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010
of the foot.
 TIBIAL NERVE

•  Motor: posterior
compartment of leg
•  Sensory: skin of the
posterolateral side
of the leg, lateral
side of the foot, and
the sole of the foot.

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 TIBIAL NERVE

•  Motor: posterior
compartment of leg
•  Sensory: skin of the
posterolateral side
of the leg, lateral
side of the foot, and
the sole of the foot.

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 PERONEAL NERVE

•  Motor: lateral and

anterior compartment
of leg, short head of
the biceps femoris
•  Sensory: upper lateral
and lower
posterolateral leg,
anterolateral leg, and
Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010
the dorsum of the foot
QUIZ

• Which of the following is CORRECT regarding the sciatic nerve?

(A) Arises from the lumbar plexus.
(B) Is the second largest nerve in the body.
(C) Splits at about the level of the knee into tibial and common
fibular nerves.
(D) Splits into tibial and femoral nerves.
QUIZ

• In what anatomical landmark can you find the femoral nerve?
(A) Popliteal Fossa
(B) Adductor Canal
(C) Femoral Triangle
(D) Pes Anserine Group
SPINAL NERVE INJURY-CASE 1

•  Following an accident, a 38-year-old man developed difficulty walking and

low back pain radiating to the lateral sole of his left foot. The key
symptoms and signs in this case are:
•  Weakness of the left gastrocnemius and hamstrings, with absent left
Achilles tendon reflex
•  Paresthesias and decreased sensation in the left lateral calf, lateral foot
including the small toe, and sole
•  Where is the lesion? What is the most likely diagnosis?
SPINAL NERVE INJURY-CASE 1

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 NERVE ROOTS
AND DISC
HERNIATION

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 NERVE ROOTS
AND DISC
HERNIATION

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 NERVE ROOTS
AND DISC
HERNIATION

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

 DERMATOMES
AND MYOTOMES

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

RADICULOPAT
HY

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

RADICULOPAT
HY

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

CAUDA
EQUINA
SYNDROME

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

UPPER-
EXTREMITY
NERVE
INJURIES

Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010

CARPAL
TUNNEL
SYNDROME
QUIZ

• A dermatome is:

(A) A bundle of spinal nerves below the level of the spinal cord.
(B) Area innervated by a single set of spinal nerves.
(C) Area of skin innervated by a single sensory (dorsal root
ganglion) neuron
(D) Area of the spinal cord associated with a single set of spinal
nerves
(E) Number of muscle fibers innervated by a single motor neuron
VISUAL LAB- NERVE DAMAGE AND REGENERATION

https://www.youtube.com/watch?v=OKr-9WJTHME
SUMMARY

What are the What are the How does spinal nerve
components of spinal components of injury affect its
nerve? different plexus? function ?

What are the main What are the main

What are dermatome
nerves innervating nerves innervating
and myotome?
upper limbs? lower limbs?
REFERENCE

•  Quiz questions https://quizlet.com/168222910/spinal-nerves-flash-cards/

•  Videos for fun http://www.brainfacts.org/brain-anatomy-and-function/anatomy
•  Book Hal Blumenfeld, Neuroanatomy through Clinical Cases, 2010
•  Book Grey’s Anatomy: The Anatomic Basis of Clinical Practice, 2016
•  Book Michael McKinley, Valerie O'Loughlin, Human Anatomy, 2011
•  Book Stanley Finger, Minds Behind the Brain, 2000
•  Study tips http://www.learnmedicalneuroscience.nl/study-tips-neuroanatomy/
•  Study tips http://teachmeanatomy.info/