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INNERVATION J. R. Lecturer in A nato;nv, LAST, In this paper supply of muscles. of dermatomes the by the of nerve the szppl’ the form is a sounti a double a basis muscles-The author in of new of anatomical supply-Apparent matter the 1923. That will be anomalies appears it the warranted study of supply. more than Segmental in the discussion. supply of has a the of motor scheme is nerve discussion be consideration The nerve but to segmental new. shown in the the tiouble Moreover, to are headings: the is presented facts motor presented three anti students. with fact, under introduction here .S’cholar, muscles, the postgraduate since Research limb skin-No comparison practice of restatement a convenient for Sutton England is considered supply many conceptions clinical statement nerve by Bland of limbs of the provides and Surgeons the because shown supply to of limb segmental is included segmental segmentation of the supply Segmental of LIMBS ENGLAND Curator, College supply skin, misconceptions sensory by the sUPPlY THE LONDON, A natomical Royal segmental OF been used mnemonic, and Muscles certain with muscles are explained. SEGMENTAL In all vertebrates innervation the that for the SUPPLY musculature most of part For supplied by the abdomen example, the cranial however, the towards the is myotomes be in said to nerves, Each mixed spinal FIG. 1 mixed spinal the terminal butis arise from supplied the anterior primary probably and arise number location that it the dermis lateral branch * , ‘ 452 nerves of sensory supply the roots ‘ ‘ 1). limbs of arises of each anterior and posterior ‘ ‘ ventral extensor skin ; the branches Detwiler embryonic from The of “ or plexuses ‘ ‘ flexor plurisegmental adult, wall wall is is embryos branches of limb muscles origin, correspond to (1928) Murray is projected of the ; and “ THE into posterior a separation “ that the three vertebral from the body body showed bud. and compartments limb of the ventral its gives and in the In all vertebrate by the lateral the in the indicated somatopleure. plexus anterior ends is supplied lateral part ; and the limb the limb wall ; but interprimary midline ; it into anterior muscles of are innervated (1936) plexus the anterior ramus ventral divides by sequence. from and body primary rami. wall, supplied limb of the fibres. vertebrate the and is supplied emergence primary mesoderm likewise motor to and the nerve and of all corresponding Miller to length the anterior of body limbs, segmental segmental posterior the : the overlying somatopleure contributing branch both in the Anterior (Fig. unsegmented cranio-caudal The with find of and rami from after into anterior rami lateral the from the dermatomes vertebrates in regular Thus primary by branches of the the lateral strip by limb The divisions. posterior In of the thorax traced sequence of all terminal branch near the lateral branch which itself supplied the wall nerve strips the skin correspond. (Fig. with are the of the when trunk. could anterior off a longitudinal column nerves. orderly sense myotomes of the rami posterior The three #{149} strips of both’ vall. The limb buds emerue from the lateral strip (stippled in the diagram) innervated b’ the lateral l)ranches of the such space innervates sequence end motor segmental intercostal that caudal divides 2). of an anti arranged foramen segmental cutaneous segment body spinal vertebral muscles no Dermatomes-The mixed regular in orderly no and a overlying tiermatt)mes arranged there the spinal are innervation, has the same and SKIN wall with the space, and THE body corresponds supply. over OF the posterior JOURNAL the limb divisions limb to supply the respectively.* into ‘ ‘ of anterior to OF ‘ ‘ and dorsal BONE “ AND lateral Thus or JOINT posterior “ extensor.” SURGERY we INNERVATION OF FIG. The distribution of THE 453 LIMBS 2 a typical mixed spinal nerve. .- C1N TkI 1. :- 11G. The the VOL. 31 12 B, NO. 3, destination brachial AUGUS T of plexus 1949 the to anterior the ail 3 posteru)r fleXor afl(l extensor 1lI)1)Cr IiIfll). (livisions of compartments the truuks of of the 454 R. J. LAST ‘;* / -i,’i FIG. The . : dermatomes ia/ante b’ . and Rodin-” anterior Iris 4 axial lines (from Messag#{232}re des i)ieux a Figure “). .. r 5 FIG. -4 ‘- ‘: CS . ..l..- 6 FIG. The connected early innervation with formation of the early forelimb the trunk (Fig. 5). of the axial line-C. bud. Fig. 7 the At an early 6 represents dermatome stage a is C.7 dermatome and later stage no longer is shows connected still the with trunk. THE JOURNAL OF BONE AND JOINT SURGERY INNERVATION . divisions. In the ; in divide form the the the which spots spots continued : nearest fourth in the axis in the post-axial for that the flexor Axial proximal in to meet. the the growing the axial line contact with roots become attached and 5). gap (Fig. 6). In angle limb and At turn Th.2 become have line extends from the the C.8, in of He parts Th.1, lying fifth anti Th.2) in the Herringham’s the that and sixth, way, they limb encounters the order flexor movement on or both the still. line second the the this way “ from just cartilage the of an axial skin supplied skin to beginning Th. trunk has the of 1 coming by into the cranially wrist just the below extensor C.4 five (C.4) limb. sternal and posterior deltoid of the branch The the surfaces to (supraclavicular no cutaneous into a point and above dermatomes nerve outwards to the and moving is attached the and first, distally sides (C.7) at bud. at beginning C.5 some central limb 4. intercostal flexor The of the caudal contact trunk, stolen extends distracted prominens on “ into discontinuous is projected plexus the which is supplied, and the of the come In costal first of skin represents from indeed, skin cranial segment C.8 tip in along way. growing The down which following the area breaks is a line across the the meet and law there limb. on in Figure ; the vertebra this central has, been dermatomes grows, distracted axial of the in contact supply on nerve; nerve. made across to Herringham, Th.1 to lower C.6 as shown are the the anterior dermatomes of where limb proximally missing nerve higher across is a gap, in the bud line Th.3) level lower another border in dermatomes which five arrangement 5.1 limb limb, the the or Proximally more and upper of Louis. nerves) limb. the (Th.2 the the upper other on L.5 adjacent in their each caudally and The in the of the line As in that Herringham’s extensor surfaces to trunk, is entirely out and first limb Put 6, 7, 8 and is the the ; they C.5, produced (Fig. tip crosses the the and spots limb. (1893) pointed On both flexor from example, vein higher while (i.e., the movement example, according represents alone For to post-axial that upper fill pre-axial to body, tenth trunk.” possibly in the to the is is C.7 line. and line This root ninth the by tend of the flexor two by by Herringham both 1) Of supplied to divisions 3). on headings: supplied unite posterior (Fig. supplied themselves divisions and supplied be always axis axial plexus this will missing-a limb is distracted C.7 be be approach of the to to to are of the in basilic is two tends tends whether 4). For skin vhich the anterior under This root by eighth, order surfaces dermatomes dermatomes the trunks and compartments “ the into first the the tends arm from unite case law lower the from the extensor “ farthest and that lines-Sherrington area of a limb. certain in and area, his 455 divide extensor which lower numerical sequence of the limb (Fig. cephalic and example, limb each border the the first roots by pre-axial area, progression the segments in extensor surfaces from the LIMBS roots and stated area pre-axial will flexor He THE the In the pre-axial of the area, stated law limb. post-axial Thus, “ the for is nearer in the the plexus arrangement of the that plexus extremity. orderly surfaces 2) of two two lower innervation showed skin, brachial lumbo-sacral of the separate (1886) extensor of the of the nerves provide the case case OF insertion the limb the axial ; the is roughly symmetrical. In of the skin the limb there limb from the foetal and L.1 supplied by limb is mostly axial line presented post-axial is also the 31 B, on limb 3, asymmetry. position on to posterior visible the lower surface accepted down to by extremity thigh. their its pre-axial rotation these been seems well easiest segmental and lower posterior have It side of the of the facts regular of trunk line part investigators. noting along axial 4 where All and encroachment anterior Figure most to extension to the The in of the by partly partly extremity. dermatomes its is due and is shown are of the is traced the flexor and This of flexion, surface-it (1943) (Fig. upper NO. is great arrangement line lower the Harris side In the in the Th.12 on by summarise if the axial VOL. lower adult to sequence back along its 4). limb the Li, 2, 3, 4, AUGUST 1949 segments 5, 5.1, encountered 2, 3. are Adjacent C.4, 5, 6, 7, 8, Th.1, dermatomes overlap 2 in that order considerably, and but 456 there is in overlap fl() the across investigation localisation to cutaneous the overlap in the itself. Another end of which lies are line. The’ less fl() than are Research all on the maps to of the Sherrington’s and Foerster’s the posterior the pre-axial evidence spiral around of the limb. If (lermatome maps will are more extensive are open to algesia, accept made 4) certain must in face of the Their claim that medical atijacent nerve an 1) The error. the site of the Office and overlap the level of L.1; anterior axial axial lines a ‘ ‘ the Metlical reproduced in of dermatomes axial lines, root the and see is Foerster meet at of affected in may the accepted and findings by hypo- is tlifficult 3) Nt) mention known cases of been article Garrett their dermatomes have axial the Keegan are their to plexus anterior of observers. well consult the a dermatome of adjacent plexuses of with of each Nevertheless, of mapping of the series according roots alteration of countless should particular, dermatomes method ; there interested to a large fundamentally caudal Foerster. of overlap is convincing anti behind Head from In cranial whole, post-fixation nerve is not findings disagreed dermatomes. opinions and their from lack unanimous Those scrotum one-third the Injuries, a fundamental subjective 2) The isolated roots. to Nerve the they : the confirmed On pre-fixation students maps ignoring limb exist of Sherrington, almost vet of the of the vill ‘ ‘ proximal anterior end the Stationery borders are required. to wide and respects of the post-axial criticisms. of variability, injected and those the 4). Peripheral reported several do not lines findings be (Fig. these spinal line, higher is matter, low the proximal skin for that two-thirds segments dermatome, (1948) In delineation their be open In Garrett axial than H.M. ‘ ‘ there (1943). and experimental. their by A is, anti and, axial posterior the of (1943). of each Atlas Keegan and across published abruptly To anaesthetise to go seven it with changes limb great accurate to be able dermatomes-that anterior of dermatomes of Anatomy in Grant’s recently, The For it is helpful analgesia. is 5.3. is very cord. missing of the as the Investigation map rest spinal forwards covering the skin lines the protrusions) the (clitoris). axial of of in the in far distribution to a separate modified clinical line as exists of the regions to dermatomes pamphlet For More such penis limb, Aids ‘ ‘ Text-book disregardeti. cases, missing out Council Cunningham’s (1933) supply arises of the six in disc nerve as value lesions in are included, for the dermatome (labium majus) it is necessary accurate is referred For reader the perineum root clinical segmental for example, application the at of paraesthesia of dermatomes of the LAST The or (as, or here skin (labium majus) of the scrotum lines. lesions lesion well-known the there root lines-for no confusing anaesthetise axial root anaesthesia axial trunk the of of a single test across to J. N. is to be common. tiisc protrusions some or involvement of Keegan and of Garrett (1948). SEGMENTAL but The position of the axial the existence of an orderly widely appreciateti. is not so limb every are to muscle it has meaningless. be myotomes The has often whom the chaos of myotomes. and can Rules of segmental upper limb segments. than The be a source mastered four lower) segments concerned long of any spinal at least manner in which subject which, perplexity, joint of to to cover movements muscle nerve to in themselves, of a limb root seems musculature motor dermatomes dermatomes complex remembered; limb of the tables overlying or of the plexus has and underlying the student to a bewildering are segmentally segmentation becomes of minutes. general any origin to memorise easily of the segmental between of the in a matter that the of confusion, and known innervation distribution fundamental whole MUSCLES motor learn arrangement if the the LIMB is well the necessary innervation-In the to muscular orderly But in of correspondence proved is appreciated OF dermatomes order been the comparatively innervated rational hitherto lack and sequence In Similarly memorised. SUPPLY lines movement in it may of be said a joint a movement (though and THE this is innervated JOURNAL its opposite OF is less by BONE are AND true of the two adjoining in numerical JOINT SURGERY INNERVATION sequence for control ; they the hip rotation lateral joint and rotation limb the lower in the lumbar segments cord. that the for the centre ankle, into are namely flexor and centres extensor innervated joint the knee the the in the example, 2 and the 3 control upper the 3, 4-5, by Hip are, knee ankle in the and centre and en These and saying JOINTS and lower, consist each dissociate anterior Extend 3 Flex 4 5 Dorsiflex 5 I Plantarfiex learning the muscle joint movements movements is all that is now in this of an exercise required Psoas \‘astus The above are (flexes simple innervation way OF first. (Table THE 4 5 1 describetl the whole give 7). its LOWER ankle) muscles 1 This gives by L.4, an muscles. not also be that control It by noted indication 5.1 that flexion of the is important and all 5.2 the and like the . knee) . . . . . . . . . other at (Table INNERVATION OF foot 31 B, NO. 3, are joints of the TARSAL limb. The II. MOVEMENTS . . . 4 . . . . 5 of the this, anterior tibialis among foot flexing muscles the hip innervated are and because posterior tibial posterior the it lies. same four III). III AND ROTATIONAL MOVEMENT AT medial rotation (ci. flexion) . . 2 Abduction and lateral rotation (cf. extension) . . 4 anti the is innervated which by and 1949 in of any examples: lower in Table Adduction AUGUST as action 2, 3 3, 4 I , 2 is shown . LATERAL mentally) readily, primary 5 VOL. only II OF TABLE SEGMENTAL of the of the (if memorised following . remember movements extension The . innervation to be of the supply. TABLE peroneal performed can A knowledge eversion foot foot be . INNERVATION Invert Evert can movements and SEGMENTAL 2 . . antero-posterior of inversion These I). J,1i113 Intrinsic system nerve (flex hip) (extends four centres Foot be (Fig. to an(l iliacus intermedius Soleus segmental to and of the muscles joint Ankle 2 3 4 numbers segment I OF Knee other the one will be one segment 2 while centre medial respectively) To of each bloc, sacral , 2. the case spinal flexion, namely, extension, one joint into the ankle 4, 5-1 contracting segments INNERVATION the hip, 1 ; and start two centre limb, TABLE Extend For innervation controlling 5 ; knee SEGMENTAL Flex joint. is 3, 4, 5, 1 (lumbar lower components, from in 457 LIMBS 2, 3, 4, 5, of which the for one joint 2, 3-4, : hip THE 4 and 5 control the opposite movements, The second rule is that in passing distally comprising Thus namely, 4, 5, 1,2. Lower limb-The spinal segments, possible segments adduction, while and abduction. four it follows all movements includes OF THE HIP It should segments 458 J. R. From this movement by analysis the tWo will value distribution limb-In through two lower farther segments Table IV. with two numerical exception of inversion segments, and sequence. it muscle the spinal but If becomes also these a simple mentally to foot, opposite not out with only the each movement movements matter work of the the to their state essential the muscular segment. case of the contiguous the upper spinal In down The that, memorised a given the limb. in are of of any Upper seen from next numbers segmental be is controlled segments corresponding the it a joint of LAST three cases limb are limb segments the the of spinal the centres upper INNERVATION Shoulder each quite joint one. lower limb movement so universally is a single TABLE SEGMENTAL that hold segment by joints rule not essential controlled controlling the does are But down the in shown in is controlled as the their in the case rule that cord still of joints holds. simplest form in IV OF JOINTS OF THE Elbow UPPER LIMB \Vrist Hand Al)(ltlct, externally rotate 5 Flex 5 6 Adduct, internally It 6 7 8 rotate is to be latissimus the above major Extend Pronate Supinate that flexion and extension and deltoid are used and latissimus segments dorsi). The of the in these are following examples Pectoralis major (adducts Latissimus dorsi (adducts l)eltoid (abducts shoulder) Subscapularis (internally It may be complete, as be pointed muscles of the C.3, fibres 4 and 5, outlined in here purposes. remembering any spinal and student is intended the the roots and the roots 6, not nerve, but for the essential of any limb C.5 as that it is not poor C.4. and the for of is no without innervation to include The scheme for a simple muscular are There accuracy provides may Although teaching to it roots is C.4, sufficient scheme muscle these point. segmental equal is not ; or here. all the the emphasis the given segment with formula: quoted plexus not purposes segments student segments brachial essential whether an of illustrates practical them medical list true of the 6, 7 5, 6 of the nerve in 6, 7, 8 for pectoralis 6, 7, 8 5 . merely covered 6, 7, 8 . . major, already and . the five debatable supply . . phrenic give the . it is usually of the of segmentation a more have and forearm accurate may of the gluteal and lateral rotation is to and Therefore, segmental muscles it C.5 to indicate The contribute. receives should . . examples all it is indeed clinician . two phrenic . Th.l pectoralis are application . shoulder) elbov) from function. the analysis region the rotates the . . muscles included; they deltoid indicate . fibres several not and 5, 6, 7, 8 (5 for shoulder) shoulder) first are Intrinsic clinical method distribution of segment. Detailed to not is C.4, case For of from the constitution 5 form will diaphragm and deltoid The diaphragm in receive the receive that it the wish that (flexes that muscles significance. doubt C.3 out may equal objected the shoulder movements, involved Brachioradialis 6 7 8 Extend dorsi The Flex 7 8 noted analysis. 6 6 considered region-In of the Fortunately remember be hip there the in the conception superior gluteal of and forearm-For those innervation of muscles innervation of extension, the who gluteal further. the simple scheme is given as L.4, 5. is an easy scheme gluteal region segmental nerve These the are the of memorising as 4, 5, 1 and THE essential the the more inferior JOURNAL detailed gluteal OF abduction segments, BONE but as one AND others arrangement: JOINT segment SURGERY INNER\’ATION OF THE 459 LIMBS KNEE INVERSION FIG. The segmental HAND innervation (unii,sK of the VOL. 31 B, NO. 3, AUGUST segmental 1949 movements innervation EVEP.SICN of the lower limb. FINOE)S MUSCLES) FIG. The I 7 of the 8 movements of the upper limb. H. 460 lower, namely, femoris and segments 5, 1 , 2. The same nerve to obturator the apparently the supplies three J. LAST segments are internus lower muscles). Nerve to to the muscles to limb remaining muscles of the the forearm is given in enlarge the this as formula 7 ; and than is the limbs are under control downwards, innervation case with case of more is shown in Table Fingers and flexor carpi cord, ulnaris from over 90 described per a communication (1904) was in present evitlence found of lateral centre fibres flexor Harris text-book the and that and a constituent current at are C.6, from the of the and . . . . . . . . . Extend lower, one that (inferior internus); flexor the rule distal to The detailed in important second more is best . muscles more joints consider them segmental the to take this seventh cervical the the efferent and so to the writer’s from carpi of nerve, that wrist centre ulnaris the the must reach is, in fact, nerve clinical of the of its reason is under Harris ulnar nerve for control flexor in found that A frequency in spite he \Vilfred of ulnar \\‘alsh axilla remainder nerve. the medial But in the observation fibres. of the this the is that The only. head C.7 radialis appear nerve. nerve ulnar head suggestion not ulnar lateral other carpi it does fibres in half the with flexion the Flexor ulnar significant lateral as any the Th.1 and ; the adds delicate flexor to plexus, cord fibres The but and cord brachial is that flexors. formula; C.8 is supplietl is the Th.1 as it is from lateral plexus 7,8 7,8 . wrist above observations the nerve . contains he 6, 7 6, 7 lower) innervated brachial route. . of and FOREARM lower) . segment medial It ulnar segment . in the ulnaris descriptions. 7, . . similar makes THE . of the the OF . from carpi of the head forced to MUSCLES . dissections, \\‘alsh 8) (Fig. . is derived, matle suggests by constant C.7 twenty-six It ,8 . scheme, nerve dissections iii centres. . innervation dissections from thirty this ulnar of 290 maximus The that . is indicated a contribution cent. migrated innervation to obturator buttock. . muscles (one the this into the piriformis, has segmental is probably . joint intrinsic note fits which has (1877) to 7, and except VI THE thumb-Flex (one Hand C.6, I maximus) of all the It of the 6-7 , I medius, femoris) that gluteus namely, placed OF Extend by of 4, 5, 1. C.8. 5 its (nerve muscles as (gluteus groups innervation forearm, elbow INNERVATION W’rist-Flex interesting by the TABLE is group VI. SEGMENTAL innervated supplies gemellus extensors, of the the 5, 1 ,2, the caudally remembering retains supplied the quadratus (gluteus fasciae rectus still superior of all nerve of these and scheme nerve tensor prevertebral group, its gluteal other limb are in the or of the lower simple C.6, holds one lower buttock to higher MUSCLES gluteal minimus, Inferior part with the innervation above It GLUTEAL Superior into The internus of the forearm-In from 1 , but (S.l,2). obturator muscles of segmental fall to the nerves and The to THE 5, 1 , 2 muscle attachment spinal nerve) the and buttock lower gain separate all of the a true downwards from internus gemellus is not gluteal , nerve the V.) gluteus obturator superior All OF gemellus Nerve which and the that V INNERVATION femoris (itiaclratlis inferior in (note (Table TABLE SEGMENTAL contained respectively order almost absence the existence of the carpi innervateti as from wrist ulnaris, by these segment. THE JOURNAL OF BONE AND JOINT SURGERY INNERVATION Discussion-Among were those the of Ferrier stimulation of single stated co-ordinated dermatomes and apparent border has the peronei). plan : little no that in are pre-axial medial conception His conclusions on conclusions were a procedure which, normal that ‘ ‘ at to the writer’s in limitations this only case. The of the to confine that segmental extent of the spinal Much more accurate or Sherrington, innervation of the segmental popliteal nerve (1947) based still clinical the foot ; such a distribution a limb are controlled by Sherrington’s work (1892) wrote almost to of the foot An by : . . . the 4 in the exercised B, NO. 3, AUGUST own experiments interest. of my In in man the though are whole cortex centres generally 1949 it limit always, outlined system of controls composed in groups not muscles of segments of lour are which is, in be arrived in as may the be cat by expected. observation ; once was final tione, of the In of how but joint movements. arranged for each sole of joints connection spacious own intrinsic is the sequence innervation medial in also age he thinking muscles root.” orderly their are the sacral and that of the in my to third in regular segments this a more outflow the the Guttmann’s peripheral amounts motor shows in in most either segmental of distribution 5.3 muscles the centres. into the details intrinsic that by about is significance the limbs possessed word Many probability of the myotomes (1904) It can It is by clinical circumlocution in the cat, results example truth determined there spinal above distributed the destination concept extend the produce Harris its movements written. that the and never investigation. than supplies stately mvotomes. Sherrington’s is an results, the the the when centre. that placed the lower not principles spinal downwards, caudally of the prerolandic that in with that in than the evidence. been feels of could \\‘ilfred precisely particular, author showed, Herringham’s man. It is the 1 segment out in Rhesus that available means most segments The through above the this he Th. false with joint joint be There contrary, court. correct equivocal be stated no evidence, fit experimental single now In would often, muscle Area 31 that does appreciation which movements. VOL. is of In view certainty joint from “ by ; the of can is has plexus.” very from unknown. uncertain on to one it should muscles are human reproduce with inferred agrees who or Th.l; hand. the pointed innervation in anti underlying CS in centres, of approach to but information is very view, be though limb fibres attempted distribution can author the of nerves spinal brachio- monkey he out spinal method stimulus Rhesus approximately method columns, motor centres Herringham of has the possible in the analytical synthetic grey It is not man of the writer The than of by the the of tibials the of the dissection of the pre-axial (1886) variation direct on the from of dermatomes, separate 9). distribution anterior by point Herringham on the minor in that, centres can example, never muscles In are sense posterior place C.7, showed true arrangement is more motor or deep only. made (Fig. methods the opinion, stimulation movements these deceive hypothesis of single of the no intra-segmental brilliantly were nature Th.1 (for of the hand. Furthermore head has a higher segmental was stimulation the joint of applied illustrates by by to and Herringham’s supply has C.6 the this is no side lateral distribution made regular neither directly the root by there putting pre-axial as are denied supplied hand post-axial the head-thus of higher the are of the from the pre-axial to the the case of the gastrocnemius C.8 and by no is one and They cord in border by contract. a muscle anterior muscles obtained spinal that situations enough of limb that There ; the supplied (1892) said post-axial wrist it was by been fortuitous are supplied hand muscles on the of the muscles Sherrington of the the one Nevertheless, muscles of the has : in a fev is entirely thumb hand.” muscles too, arrangement muscles in the intrinsic an than extensor of the to correspond. misleading supply and said supply movements enlargements It be segmental multi-jointed most lumbar limbs be very flexor superficial finger Th.I can segmentation. The ‘ ‘ the the the combinations.” segmental ulnar and 461 LIMBS into reported determined cervical of that Such of limb stated the mvotomes the who and muscular a higher and the THE investigations (1881), nerves that resemblance radialis Yeo spinal It is evident ‘ ‘ of highly earliest and OF arrangement for consecutive becomes This in orderly joint. clear. control sequence It is probable is 462 J. R. that the and tlmt it (1892) and cord, control subcortical in such spinal Bruce (1901) described afl(l the htrn cells in each. an antcro-lattral innervates latter’s movements centres as the gives Physiological body wall, ‘ocietv of he cell cells of aggregates showed in anti the the the the of anterior -the forefoot side from had been ‘hen than the animal a month the the lateral horns exist entities in foetal rat, anatomical l)laced . in l)art the upper limi) in Tables It demarcated, l)Ut central core of extentling that shade areas a further plexus The the in the IV anti off cervical VI. The that as (10 the is intiicated segment would of the boundaries in the above or the precisely (Ic- scribeti by Romanes can anything but for the joiit spinal movements exist tO ; and by the a hypothetical of the joint can be made with Such a the lower of Inan. enlargement boundaries seems so limb centres the of horn. centres in indicated are psterirl’ some confidence. reconstruction . limb more centres lateral centres lover rabbit the m )re the spinal man, that reconstructli)n than (1941 as and author the since that centres inferred of the has shovn centres fur lie of the Romanes has be ceiltres motor confirmat 1( )n, and experi- inconceivable . less His regions ample clinical anterior as was old. muscles in for which the alflpUtate(l limb situated s1)iIlal side that of the caudally -1 he ‘as one on conclusion etc.) 9 cells cells and At group horn reduced a cat. postero-lateral mental. JIG. At adult much received 1)0th S group limbs. of an C.8 a metlial, metiial of the cord spinal of anterior horn; anterior 3 adult the muscles in L2. the number that 5J)iflal spinal, Sherrington anterior correctly, groups measure in man. in the opinion, lateral 1892 is in large above situation groups was the in such of three He animals described of their describeti the been existence a postero-lateral. of in lower have a description Sherrington muscles the of atlas and the meeting common of exists LAST joint of the formulae below that Fig. in man 9. be similar, following not are centres centre itself the precise stateti-though 4. sometimes not formulae and in Area can is shown A reconstruction centres cortical ; the centres sharply The main be taken beyond the limit itself. clinical ()f the importance cortical of centres, the precise because location a lesion in the confined THE cord of the exclusively JOURNAL spinal to OF BONE centres a single AND JOINT is less joint area SURGERY INNERVATION is unlikely and to occur their virtually the in the I)reCise scheme Perhaps class, smile whose proceedeti. At age knee reference its and and anatomy the Tables cases subtracted or addeti. But vary his lesion inability for the segments always to other, Herringham a Each fact the relative which A an of anti of the a diyision takes brachi in the simpler Place before the The place formation while more richer segments anti post-fixation is high precisely root as far of acting than derived to these facts with its we figures be are not a as its the coarser find that , - - of ( fh.1 plexus the motor flexor I Cross-section The’ arrow . ; S..3) fibres are intermuScular 10 IG of the indicates above arm the septum site of hetvecn compartments. the the elbow. foetal flexor and compartment in mind branch for from to of tne the brachialis compartment and anterior from compartment, where it fuseswith Also included in the flexor radial nerve which nerve, a nerve lateral and between of the medial flexor 31 B, runs NO. 3, flexor intermuscular anti extensor AUGUST part and compartment, septa corilpartments. 1949 the radial in the to by the elbow is contained of the adult joint. do ratlial The tleveloped of of the not septum in extensor represent between the that extent is extensor nerve flexor (Fig. part foetal 10). of of the compartment. the is the the the A similar limb, nerve in and ulnar explanation brachialis muscle in arm the the upper to understanti musculocutaneous brachio-radialis the difficult for position part (hgitorum from of the muscle. nerve this innervated as flexor supply, is more nerve, is a flexor included are anterior It alteration has compartment above by a muscle nerve compartment trunks. brachialis Subsequent that flexor (musculospiral) while compartments such a tiouble of the of the ratlial limb. have is a nerve innervated foetal extensor that can divisions the brachialis the of flexor of these compartment of understand to lumbricals each the extensor portion it is easy accompanying nerves, originally nerve VOL. limb must limb. metlian the ; exact extensor entirely profundus that placed segments of flexors the consequently cauclal \Vith the normally al . and in number lumbo-sacral formation innervation muscles; of the as show. extensor the it takes distributed, never plexus after trunks, concerned, had paralysis, to the of the is He L.4 division anti plexus most drop. vith the i the the at weakness may limb flexor plexus a a lecture SUPPLY posterior respectively. demand will of the plimyelitis a pure appropriate know’n NERVE root innervation extensor foot was clinical positions was DOUBLE anterior compartments branches. as Anterior without the to wider quadriceps the column, their component into a limb own. II) own member 1886. WITH divides to but I and refer of pre- his veakness, moment-it (Tables figures vertebral maintain in MUSCLES the foot post-fixation a segment to was taught satisfaction. their a Jarnaical1 and serve to has great from wider interest, made author given of became that limb incidence it has case be The doctors the academic can muscle. these gluteal the until lower and The regard each pre- with any to vliom was presenteti invert above of he scheme by satisfaction him to of although with for left post-fixation-The In case had is of great the of recalled example and the months plexuses. known. striking conclusion the to been centres that students, have most of such suppl’ postgratluate 463 LIMBS remembered segmental of comprehension jerk, understood the THE existence easily application the of eighteen absent the so hundreti of its experience. But be to Place to several examples Pre- can as a mnemonic Many the cord. levels OF the ulnar The (livision 464 J. R. In the sciatic case nerve although nerve a flexor which of the is the flexor compartment. always developed of the the lumbar side of psoas cephalic of that side bone. cases that In part (obturator) some cases of the brachialis, by the nerve fusion supply out true is the lies and of all muscles the the will have its it emerges the caudal nerve developed of flexor posterior on the it emerges femoral side ; in such in the the is supply of the obturator border it nerve, from on the thigh, femoral arises the head into it derives emerges pre-axial extensor the that true short the is a nerve Like the the migrated by fact nerve obturator at nerve, of ; it femoral. from sciatic individuals misnamed obturator This, of the is that itself of the biceps. adductor nerve moiety of the later usually of three fibres from muscle of flexor only is supplied accessory receives innervated The the ; the pectineus muscle is formed In short, bone reason and notwithstanding be called pubic The An obturator head component leg. nerve 3) and (2, compartment. in one The popliteal short example. and ; but rightly of the of the obturator nerves should medial the compartment nerve. accessory the popliteal another compartment But lateral compartment obturator by except extensor affords extensor extensor supplied compartment in the Pectineus accessory are by the extensor developed compartment. medial Ofl the flexor is supplied in the an divisions all compartment) of the was of the from hamstrings, of the muscle, nerve biceps the nerve also of the (the LAST limb flexor and, like flesh. is a certain guide to their embryological development. 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