Cervico-brachial neuralgia Anatomy Iraj Salehi-Abari MD

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Presentation transcript:

Cervico-brachial neuralgia Anatomy Iraj Salehi-Abari MD Cervico-brachial neuralgia Anatomy Iraj Salehi-Abari MD., Internist Rheumatologist salehiabari@sina.tums.ac.ir

Introduction: Neck pain: Common Common causes: Cervical spondylosis (OA) Disc herniation Cervical disc-arthrosis  Cervical radiculopathy Today, Cervical radiculopathy is a common source of arm pain + sensory and motor dysfunction Diameter of cervical canal is a little more than cervical cord: Myelopathy is common

Anatomy of Cervical spine: Seven Vertebral bodies: C1 to C7

Anatomy of Cervical spine: C1 or Atlas: Circular ring of bone

Anatomy of Cervical spine: C2 or Axis: Odontoid process

Anatomy of Cervical spine: C1 – C2: No intervertebral disc Odontoid-Ring articulation

Anatomy of Cervical spine: C3 – C7 are joined by: Zygapophysial (Facet) joints Uncovertebral (Luschka) joints Intervertebral discs

Anatomy of Cervical spine: Upper cervical spine: Rotation of head Lower cervical spine: Flexion & Extension of head

Anatomy of Cervical spine: Disc-arthrosis: common in C3 – C7 Intervertebral foramina: Anteromedial: Lower Uncinate processes Superior: upper Pedicles Posterior: Facet joint Inferior: lower Pedicles Dorsal (sensory) and ventral (motor) roots fuse to form the spinal nerve in the intervertebral foramen

Anatomy of Cervical spine: Spinal nerve separates into ventral and dorsal rami Dorsal rami divide into lateral (motor) and medial (sensory) branches that supply the muscles and skin of the back of the neck Dorsal ramus of C1 innervates the deep muscles of the neck, it isn’t sensory Dorsal ramus of C2  greater occipital nerve

Anatomy of Cervical spine: Ventral rami of C1 – C4 n.  Cervical plexus Ventral rami of C5 – T1 n.  Brachial plexus Ventral C5 r.  Dorsal scapular n.: Rhomboids muscle Levator scapulae muscle C5, C6, C7 ventral r.  Long thoracic n.: Serratus anterior muscle

Anatomy of Cervical spine: The cervical nerve roots exit through the intervertebral foramen above the corresponding vertebral body As an example: C7 n. root: C6 – C7 intervertebral foramen C8 n. root: C7 – T1 intervertebral foramen