ANATOMY

OF
PERIPHERAL NERVES
By KARAN VERMA
 ANATOMY

Structure of a peripheral nerve: A peripheral nerve consists of Formation of a peripheral nerve: These are
masses of axis cylinders
formed from nerves arising from the spinal cord
(axons), each with a neurilemmal tube
(spinal nerves). There are 31 pairs of spinal nerves
An individual nerve fibre is enclosed in a
in the body, each representing a segment of the
collagen connective tissue known as endoneurium
spinal cord. These, either through direct branching
A bundle of such nerve fibres are further bound
or through a network of nerves (plexus), give rise
together by fibrous tissue to form a fasciculus. The
to peripheral nerves. Peripheral nerves are mixed
binding fibrous tissue is known as perineurium. A
nerves carrying motor, sensory and autonomous
number of fasciculi are bound together by a fibrous

tissue sheath known as epineurium. An individual

nerve, therefore, is a bundle of a number of fasciculi

 RADIAL NERVE
This nerve is a continuation of the third of the arm. In the distal-third of the arm it

posterior cord of the brachial plexus. In the axilla, comes to lie in the anterior compartment, between

it gives off a branch to the long head of triceps, and the brachialis muscle on the medial side and

enters the arm. brachioradialis and extensor carpi radialis longus

Course in the arm: As it comes into the arm, the on the lateral side.

radial nerve gives off the posterior cutaneous Before it crosses the elbow in front of the lateral

nerve of the arm and a branch to the medial head condyle, it divides into two branches – superficial

of the triceps. It now travels infero-laterally into and deep. The superficial branch is primarily

the groove for the radial nerve on the posterior sensory and travels along side the radial artery into

surface of the humerus, winding spirally around the forearm. The deep branch is primarily motor. It

the bone. In the groove, it gives branches to the gives branches to the extensor carpi radialis brevis

lateral head of triceps and anconeus muscles and the supinator. It then pierces the supinator

and cutaneous branches to the arm and forearm. and emerges in the posterior compartment of

After winding around the humerus, the nerve the forearm to become the posterior interosseous
 MEDIAN NERVE

This nerve is formed by the joining above the wrist, where it lies between the tendons

of branches from the lateral and medial cords of the flexor digitorum superficialis and flexor carpi

of brachial plexus. In the arm, the median nerve radialis.

descends adjacent to the brachial artery. Course in the hand: The nerve passes deep to the

Course in the forearm: The nerve enters the forearm flexor retinaculum and enters the palm. Here a

between the two heads of the pronator teres. It then short and stout muscular branch from it supplies

passes deep to the tendinous bridge of the origin of the muscles of the thenar eminence (abductor

the flexor digitorum superficialis, in the proximal- pollicis brevis, opponens pollicis and flexor pollicis

third of the forearm. In the mid-forearm it descends brevis). The median nerve finally divides into 4 to

between the flexor digitorum superficialis and 5 palmar digital branches supplying the area of

flexor digitorum profundus. About 5 cm above the Also, motor branches are

wrist, it comes to lie on the lateral side of the flexor skin

given to the first and second lumbrical muscles
 ULNAR NERVE
This nerve arises from the medial cord ulnaris, and descends along the medial side of the

of the brachial plexus. In the arm, it lies on the forearm. Here it lies anterior to the flexor digitorum

medial side of the axillary artery. At the junction profundus, along with the ulnar vessels

of the middle and lower-third of the arm, it pierces Course at the wrist: It passes in front of the flexor

the medial intermuscular septum and comes to lie retinaculum just lateral to the pisiform bone. On

in the posterior compartment. It becomes more and into entering the superficial palm, and the ulnar deep nerve

more superficial as it approaches the elbow, where finally divides

it lies behind the medial epicondyle. terminal branches

Course in the forearm: The ulnar nerve enters the

forearm between the two heads of the flexor carpi

 ACCESSORY NERVE
SUPPLIES THE TRAPEZIUS MUSCLE
 LONG THORACIC NERVE
 The nerve arises from the ventral rami
 of C5, C6 and C7. It descends behind the brachial
 plexus on the lateral surface of the serratus anterior,
which it supplies.
 AXILLARY NERVE

The axillary nerve arises from the anterior branch continues horizontally between the

posterior cord of the brachial plexus and curves deltoid and the surgical neck of the humerus, and

backwards on the lower border of the subscapularis. supplies the rest of the deltoid.

It crosses the quadrangular space and comes to

lie on the medial side of the surgical neck of the

humerus, medial and inferior to the capsule of the

shoulder joint. Here it divides into anterior and

posterior branches. The posterior branch supplies the teres

minor and posterior part of the deltoid and

terminates as the cutaneous nerve which supplies

the skin over the lower-half of the deltoid. The

 SCIATIC NERVE

The sciatic nerve consists of two

anatomically distinct components – the tibial and
common peroneal nerves. The common peroneal
component is more frequently affected than the
tibial. Complete lesion of the sciatic nerve is rare.
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