Chapter 18 peripheral nerveous system Nervous system Chapter 18 peripheral nerveous system spinal nerve overview cervical plexus brachial plexus anterior branches of thoracic nerve lumbar plexus sacral plexus the correlate anatomical basement of the spinal nerve injury’s location the innervation of main joints all over the body cranial nerve visceral nervous system

overview cranial nerve spinal nerve visceral nerve peripheral nerve visceral nerve（automatic nervous system) sympathetic nerve parasympathetic nerve

spinal ganglia（dorsal root ganglion） visceral motor ganglion cranial ganglia spinal ganglia（dorsal root ganglion） visceral motor ganglion nerve In peripheral nervous system, the fibers assemble as nerve. endoneural membrane Endoneurium lamellar sheath epineurium medullary sheath：is composed of Sch’s processes by convoluted neurons of layers.

the regeneration of peripheral nerve the degeneration of nerve fiber anterograde degeneration retrogression degeneration nerve growth factor nerve growth factor (NGF) brain-derived neurotrophic factor (BDNF) ciliary neurotrophic factor (CNTF) fibroblast growth factor (FGF)

(一)the construction, subdivision and fiber ingredients Spinal cord overview (一)the construction, subdivision and fiber ingredients anterior root—motor posterior root—nerve spinal ganglia 31对 C 8 T 12 L 5 S 5 Co 1

the typical branches of spinal nerve Fiber ingredients 1.Meningeal branch 2. communicating branch white communicating branch, gray communicating branch 3. posterior branch medial branch, lateral branch, muscular branch , cutaneous branches 4. anterior branches cervical plexus ,brachial plexus, lumbar plexus ,sacral plexus somatic sensory fiber visceral sensory fiber somatic motor fiber visceral motor fiber

the composition and position of cervical plexus anterior branches of C1-4 branches of cervical plexus superficial cutaneous branches —the middle point of sternomastoid’s posterior border 1. lesser occipital nerve(C2) 2. great auricular nerve(C2－C3) 3. transverse nerve of neck(C2－C3) （superficial cervical nerve） 4. supraclavicular nerves(C3－C4)

5. diaphragmatic nerve(C3－C5) muscular branch dominate the muscle of deep layer, levator scapulae and infrahyoid muscles group 5. diaphragmatic nerve(C3－C5) ansa cervicalis(loop of hypoglossal nerve)

the construction and position of brachial plexus C5-8, anterior branches of T1 scalene fissure the branches of brachial plexus 1. long thoracic nerve(C5－C7) serratus anterior 2. thoracodorsal nerve(C6－C8) latissimus dorsi muscle 3. axillary nerve(C5－C6) 4. musculocutaneous nerve(C5－C7)

5. median nerve(C6－T1) 6. ulnar nerve(C8,T１) 7. radial nerve(C5－T１)

the innervation of skin of hand M median nerve U ulnar nerve R radial nerve

dorsal nerve of scapula(C4-C5) suprascapular nerve(C5-C6) subscapular nerve(C5-C7) medial pectoral nerve(C8,T1) lateral pectoral nerve(C5-C7) medial brachial cutaneous nerve(C8,T１) medial antebrachial cutaneous nerve(C8,T１)

the anterior branch of thoracic nerve 12 pairs the 1st to 11th intercostal nerve the 12th subcostal nerve cutaneous branches lateral cutaneous branch anterior cutaneous branch T2 sternal angle T4 mammary papilla T6 xiphoid process T8 costal arch T10 umbilicus T12 the middle point of the line of umbilicus and pubic symphysis

The segmental distribution of anterior branch of thoracic nerve T2 areal is at the level of sternal angle T4 areal is at the level of mammary papilla T6 areal is at the level of xiphisternal synchondrosis T8 areal is at the level of costal arch（between umbilicus and xiphoid process） T10 areal is at the level of umbilicus T12 areal is at the level of middle point of line of umbilicus and pubic symphysis

the constitution and position of lumbar plexus T12 L1-3.4 the branches of lumbar plexus 1. iliohypogastric nerve(T12,L1) 2. ilioinguinal nerve(L1) 3. lateral femoral cutaneous nerve(L２-３) 4. femoral nerve(L２-L4) 5. obturator nerve(L２-L4) 6. genitofemoral nerve(L1,L２)

the constitution and position of sacral plexus L4.5 S1-5 Co1 the branches of sacral plexus 1. superior gluteal nerve(L4,L5,S1） 2. inferior gluteal nerve(L5,S1,S2) 3. posterior femoral cutaneous nerve(S1-S3) 4. pudendal nerve(S2-S4) superior gluteal nerve inferior gluteal nerve pudendal nerve posterior femoral cutaneous nerve

(1) tibial nerve(L4,L5,S1-S3) medial plantar nerve 5. sciatic nerve(L4 L5 S1-S3) (1) tibial nerve(L4,L5,S1-S3) medial plantar nerve lateral plantar nerve lateral plantar nerve medial plantar nerve

(2) common peroneal nerve(L4, L5, S1, S2) superficial peroneal nerve deep peroneal nerve deep peroneal nerve superficial peroneal nerve

the related anatomical basement of the injury location of spinal cord the segmental regularity of the distribution of spinal cord

the motor related muscles for level diagnosis of upper limb nerve the muscles detected for clinical affection and its innervation the motor related muscles for level diagnosis of upper limb nerve and its innervation motor the name of muscles nerve nerve segment abduction of shoulder deltoid axillary C5 bending of elbow biceps brachii musculocutaneous nerve C5,C6 extending wrist of radialis extensor carpi radialis muscle radial nerve C6 extending wrist of radialis extending elbow flexion of finger abduction of thumb triceps brachii flexor pollicis longus，flexor digitorum profundus abductor pollicis brevis first dorsal interossei median nerve ulnar nerve C7 C8 T1 C8,T1

The related muscles detected for level diagnosis of lower limb nerve and its innervation motor name of muscle nerve nerve segment flexion of hip bone iliopsoas muscle femoral nerve L1,L2 adduction of hip bone ator of thigh obturator nerve L2,L3 extention of knee quadriceps femoris femoral nerve L3,L 4 dorsiflexion anterior tibial deep peroneal L4 of ankle muscle nerve cross-foot tibialis posterior tibial nerve L4,L 5 strephexopodia peroneus longus superficial peroneus brevis peroneal nerve L5,S1 genuflex biceps femoris sciatic nerve S1 plantar flexion of ankle triceps surae tibial nerve S1,S 2