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Nerves Name Long Thoracic nerve Thoracoabdominal n.s (inferior intercostals n.s) (T7T11) (ventral rami of the lower thoracic) Location Runs vertically over serratus anterior m. along (anterior) axillary line Pierce the rectus sheath after it has been supplied, near the median plane, runs between 2nd and 3rd layers of abdominal muscles (internal/transversus) Subcostal n. (T12) Branches A few along it’s path down the muscle Innervates… Serratus anterior Continuation of lower intercostals nerves Anterior abdominal muscles and overlying skin, periphery of diaphragm Ventral ramus of 12th thoracic nerve Lowest slip of external oblique and skin over ant. Sup. Iliac spine (gluteal region) Skin of scrotum or labium majus, mons pubis, adjacent medial aspect of thigh, internal oblique and transverse abdominal Skin of hypogastric region of iliac crest, internal/transverse ab. Central portion of diaphragm Ilioinguinal n. (L1) Inguinal canal Anterior ramus of L1 Iliohypogastric n. (L1) Pierces transverses abdominal, branches pierce external oblique aponeurosis Runs vertically over lateral sides of mediastinum, just anterior to lung hilum, between mediastinal pleura and pericardium Just anterior of posterior ribs, lateral to anterior longitudinal ligament Most superior (of 3) branch of sympathetic ganglion Anterior ramus of L1 Vagus nerve Wandering path inferior through chest and abdomen Cranial Nerve X Intercostals In intercostals spaces between internal and innermost layers of muscles Ventral rami of C3C5 Recurrent laryngeal Loops around subclavian a. Vagus nerve on right; runs around arch of aorta and ascends in tracheoesophageal groove on left From arch of aorta and Cervical and cardiac Impulses pass to SA node; PS posterior surface of heart, branches of vagus fibers slow rate, reduce force, & fibers extend along coronary nerve and constrict CAs; sympathetic do arteries to SA node sympathetic trunk opposite Forms on root of lung and Vagus nerve and PS fibers constrict bronchioles; extends along bronchial sympathetic trunk sympathetic fibers dilate them subdivisions Distal to trachea bifurcation, Vagus nerve, Vagal and sympathetic fibers to vagus and sympathetic nerves sympathetic ganglia, smooth muscle and glands of for plexus around esophagus greater splanchnic inferior 2/3 of esophagus Abdominal Viscera innervations… Phrenic n. Sympathetic chain ganglia Greater splanchnic nerve Cardiac plexus Pulmonary plexus Esophageal plexus Ventral rami of C3C5 Branches out along each subcostal space Pretty much everything (it’s the source of all the nerves) Transit preganglionic axons from sympathetic ganglia to preaortic ganglia in abdominal cavity All of thoracic viscera (pulmonary, esophageal, & cardiac plexi), most of GI tract (esophagusleft colic flexure of large int. Muscles and skin over intercostals space; lower nerves supply muscles and skin of anterolateral abdominal wall Intrinsic muscles of larynx (except cricothyroid); sensory inferior to level of vocal chords Notes Responsible for segmental innervation of skin (dermatome) T10 innervates umbilicus Organ Esophagus Stomach Duodenum Jejunum & Ileum Cecum & Appendix Colon Spleen Pancreas Liver Bile Duct Gallbladder Kidneys, Ureters, Suprarenal glands Diaphragm …more Nerves Subcostal Iliohypogastric & Ilioinguinal (L1) Innervation(s) Abdominal part from vagal trunks, thoracic sympathetic trunks, greater/lesser splanchnic, esophageal nerve plexus Parasympathetic: anterior/posterior vagal trunks Sympathetic: T6-T9 through celiac plexus via greater splanchnic Vagus and sympathetic nerves through celiac and superior mesenteric plexus Perivascular nerve plexus (around SMA). Sympathetic: Sup. Mesenteric plexus, T5-T9 through celiac plexus via sympathetic trunks and greater/lesser splanchnic Parasympathetic: posterior vagal trunk Superior Mesenteric plexus (S & PS). Symp from lower thoracic spinal cord, Parasymp from vagus Sympathetic: lumbar sympathetic trunk and superior hypogastric plexus. Parasympathetic: pelvic splanchnic nerves (from sacral spinal cord) From celiac plexus Vagus and thoracic splanchnic nerves passing through diaphragm. PS & S pass along celiac and superior mesentery plexuses. Hepatic nerve plexus (derivative of celiac plexus). S from celiac, PS from vagal trunk Posterior hepatic plexus via right cardiac plexus and posterior vagal trunk Celiac plexus (S), vagus nerve (PS), and right phrenic nerve (sensory) Renal plexus (S, PS, visceral afferent) supplied by splanchnic (especially “least”). Suprarenal glands get from celiac plexus and thoracic splanchnic nerves Entire motor part from phrenic nerves of C3-C5, sensory nerve in peripheral diaphragm from intercostals (lower 6 or 7) and subcostal nerves Location Anterior rami of T12, pass posterior to lateral arcuate ligaments and then on anterior surface of quadratus lamborum (runs under 12th rib) Arise from anterior ramus of L1 and enter abdomen posterior to medial arcuate ligaments, pass anterior to quadratus lumborum Genitofemoral (L1,2) Pierces anterior surface of psoas major and runs on it deep to psoas fascia Lateral femoral cutaneous nerve of thigh (L2,3) Runs on iliacus muscle and enters thigh posterior to inguinal ligament, just medial to anterior superior iliac spine Emerges from lateral border of psoas major and passes deep to the inguinal ligament Femoral nerve (L2-4) – Cindy says L4,5 Obturator nerve (L24) Lumbosacral trunk (L4,5) Sympathetic trunk Emerges from medial border of psoas major and passes through pelvis to medial thigh (obturator foramen) Passes over ala (wing) of sacrum and descends into pelvis, along medial side of psoas muscle Very close to lateral surface of lumbar vertebrae and anterior Branches These are two branches of the same origin, IlioHypogastric is superior to IlioInguinal (alphabetically in order) Divides lateral to the common and external iliac arteries into femoral and genital branches Innervates Supply external oblique and skin of anterolateral abdominal wall Supply skin of the suprapubic and inguinal regions Notes In our body this was a single nerve (thicker, in Sam’s opinion, than you would expect each one to be) Sensory for areas of skin in genital and femoral regions as well as motor to cremaster muscle Supplies skin on its anterolateral surface of the thigh Terminal branches before distribution within femoral triangle Innervates iliacus, flexors of hip, extensors of knee (anterior femoral compartment) Adductor muscles (medial compartment) Forms sacral plexus Same old stuff… This was a fat nerve, running between psoas major and iliacus Find it deep to iliac vessels, on medial side (under psoas) Sciatic nerve (L4-S3) Posterior femoral cutaneous nerve (S1S3) (same as posterior cutaneous nerve of thigh) Superior gluteal n. (L4-S1) Inferior gluteal n. (L5-S2) Pudendal nerves (S24) surface of sacrum Largest branch of sacral plexus, leaves through greater sciatic foramen inferior to piriformis muscle and enters gluteal region Leaves pelvis through greater sciatic foramen inferior to piriformis muscle, runs deep to gluteus maximus and emerges from inferior border Leaves pelvis through greater sciatic foramen superior to piriformis, runs between gluteus medius and minimus Leaves pelvis through greater sciatic foramen inferior to piriformis and divides into several branches Enters gluteal regions through greater sciatic foramen inferior to piriformis; descends posterior to (outer side of) sacrospinous ligament, enters perineum through lesser sciatic foramen Brachial Plexus (moving down the chart is away from the neck) Supplies no muscle in gluteal region, all of lower limb (leg) below the knee (posterior compartment?) Supplies skin of buttock through inferior clunial branches and skin over posterior aspect of thigh and calf; lateral perineum, upper medial thigh via perineal branch Innervates gluteus medius, gluteus minimus, and tensor of fascia lata Gluteus maximus muscle Supplies most innervation to the perineum; supplies no structures in gluteal region Nerve Musculocutaneous N. (C5-C7) Median N. (C6-8, T1) Medial Cutaneous N. of arm (C8, T1) Medial Cutaneous N. of forearm (C8, T1) Ulnar N. (C7,8,T1) Axillary N. (C5,6) Radial N. (C5-8) Saphenous N. Tibial Common fibular Superficial fibular Deep fibular Location Middle branch of “M,” pierces through coracobrachialis and descends between biceps brachii and brachialis Lateral root joins medial root to form it lateral to axillary artery Medial cord, along medial side of axillary vein Medial cord, between axillary artery and vein Medial cord, passes down medial aspect of arm and runs posterior to medial epicondoyle to enter forearm Terminal branch of posterior cord, posterior aspect of arm with posterior circumflex humeral artery, gives rise to lateral cutaneous n. of arm Descends posterior to axillary artery, enters radial groove w/ deep brachial artery to pass between long and medial heads of triceps Originates with Femoral n, descends with femoral vessels through femoral triangle and adductor canal then descends with great saphenous vein Forms as sciatic bifurcates at apex of popliteal fossa; runs on popliteus, terminates beneath flexor retinaculum by dividing… Forms as sciatic bifurcates at apex of popliteal fossa; follows medial border of biceps femoris & tendon, over posterior head of fibular, winds around neck of fibula where it divides… Descends in lateral compartment of the leg, pierces deep fascia at distal third of leg to become subcutaneous Passes through extensor digitorum longus and descends on interosseous membrane, enters dorsum of foot Branches Continues as lateral cutaneous nerve of arm Lateral cutaneous n of arm Posterior cutaneous n of arm and forearm From femoral From sciatic… …divides into medial and lateral plantar nerves From sciatic… …divides into deep and superficial fibular nerves From common fibular divides to lateral and intermediate dorsal cutaneous n. From common fibular Innervates Supplies all nerves in anterior compartment of arm (coracobrachialis, bicps, brachialis), forearm Flexor muscles of forearm (except flexor carpi ulnaris, ulnar half of flexor digitorum profundus, and 5 hand muscles) Supplies skin on medial side of arm Supplies skin on medial side of forearm Innervates 1.5 flexor muscles in forearm, most small hand muscles, and skin of hand medial to line bisecting 4th digit Innervates teres minor and deltoid, glenohumoral joint, and skin over inferior part of deltoid Innervates triceps, anconeus, brachioradialis, & extensor muscles of forearm; supplies skin on posterior aspect of arm and forearm via posterior cut. N. of arm and forearm Supplies skin on medial side of leg and foot Supplies posterior muscles of leg and knee joint Supplies skin on lateral part of posterior aspect of leg via its branch, the lateral sural cutaneous nerve; also supplies knee joint via its articular branch Supplies fibularis longus and brevis and skin on distal third of anterior surface of leg and dorsum of foot and all digits, except lateral side of 5th and adjoining sides of 1st and 2nd Supplies anterior muscles of leg, dorsum of foot, and skin of first interdigital cleft; sends articular branches to joints it crosses Notes