Transcript Brachial Plexus

Brachial Plexus
• Formed by ventral rami of C5–C8 and T1
• It gives rise to the nerves that innervate the upper limb
– Skin, Shoulder Joint, Muscles
Roots (ventral rami):
C4
C5
Dorsal scapular
Nerve to
subclavius
Suprascapular
Cords
C6
Posterior
divisions
C7
Lateral
C8
Posterior
T1
Upper
Middle
Trunks
Lower
Long thoracic
Medial pectoral
Lateral pectoral
Medial
Axillary
Musculocutaneous
Radial
Upper subscapular
Median
Ulnar
Medial cutaneous
nerves of the arm
and forearm
Lower subscapular
Thoracodorsal
(a) Roots (rami C5 – T1), trunks, divisions, and cords
Anterior
divisions
Posterior
divisions
Trunks
Roots
Figure 13.9 (a)
Axillary
nerve
Anterior
divisions
Posterior
divisions
Trunks
Roots
Humerus
Radial nerve
Musculocutaneous nerve
Ulna
Radius
Ulnar nerve
Median nerve
Radial nerve (superficial branch)
Dorsal branch of ulnar nerve
Superficial branch of ulnar nerve
Digital branch of ulnar nerve
Muscular branch
Median nerve
Digital branch
(c) The major nerves of the upper limb
Figure 13.9 (c)
Lumbar Plexus
• Arises from L1–L4
• Innervates the thigh, abdominal wall, and psoas
muscle
• Femoral Nerve- Quadriceps
• Obturator Nerve- adductor muscles
Ventral rami
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral
cutaneous
Obturator
Femoral
Lumbosacral
trunk
Ventral
rami:
Iliohypogastric
L1
Ilioinguinal
Femoral
Lateral femoral
L2
cutaneous
Obturator
L3
Anterior femoral
cutaneous
Saphenous
L4
L5
(a) Ventral rami and major branches
of the lumbar plexus
(b) Distribution of the major nerves from
the lumbar plexus to the lower limb
Figure 13.10
Sacral Plexus
• Arises from L4–S4
• Serves the buttock, lower limb, pelvic structures, and
perineum
• Sciatic nerve
– Longest and thickest nerve of the body
– Innervates the hamstring muscles, adductor magnus, and
most muscles in the leg and foot
– Composed of two nerves: tibial and common fibular
Ventral rami
Ventral rami:
L4
Superior
gluteal
Lumbosacral
trunk
Inferior
gluteal
Common
fibular
Tibial
Posterior
femoral
cutaneous
Pudendal
Sciatic
L5
S1
S2
S3
S4
S5
Co1
Ventral rami and major branches
of the sacral plexus
Figure 13.11 (a)
Superior gluteal
Inferior gluteal
Pudendal
Sciatic
Posterior femoral
cutaneous
Common fibular
Tibial
Sural (cut)
Deep fibular
Superficial fibular
Plantar branches
(b) Distribution of the major nerves from
the sacral plexus to the lower limb
Figure 13.11 (b)
Reflexes
• Inborn (intrinsic) reflex: a rapid, involuntary,
predictable motor response to a stimulus
• Learned (acquired) reflexes result from
practice or repetition,
– Example: driving skills
Stimulus
Skin
1 Receptor
Interneuron
2 Sensory neuron
3 Integration center
4 Motor neuron
5 Effector
Spinal cord
(in cross section)
Figure 13.14
Secondary sensory
endings (type II fiber)
Primary sensory
endings (type Ia
fiber)
Muscle spindle
Connective
tissue capsule
Efferent (motor)
fiber to muscle spindle
 Efferent (motor)
fiber to extrafusal
muscle fibers
Extrafusal muscle
fiber
Intrafusal muscle
fibers
Sensory fiber
Golgi tendon
organ
Tendon
Figure 13.15
Muscle
spindle
Intrafusal
muscle fiber
Primary
sensory (la)
nerve fiber
Extrafusal
muscle fiber
Time
Time
(a) Unstretched
muscle. Action
potentials (APs)
are generated at
a constant rate in
the associated
sensory (la) fiber.
(b) Stretched
muscle. Stretching
activates the muscle
spindle, increasing
the rate of APs.
Figure 13.16a, b
The patellar (knee-jerk) reflex—a specific example of a stretch reflex
2
Quadriceps
(extensors)
1
3a
3b
3b
Patella
Muscle
spindle
Spinal cord
(L2–L4)
Hamstrings
(flexors)
Patellar
ligament
1 Tapping the patellar ligament excites
muscle spindles in the quadriceps.
2 Afferent impulses (blue) travel to the
spinal cord, where synapses occur with
motor neurons and interneurons.
3a The motor neurons (red) send
+
–
Excitatory synapse
Inhibitory synapse
activating impulses to the quadriceps
causing it to contract, extending the
knee.
3b The interneurons (green) make
inhibitory synapses with ventral horn
neurons (purple) that prevent the
antagonist muscles (hamstrings) from
resisting the contraction of the
quadriceps.
Figure 13.17 (2 of 2)
Superficial Reflexes
• Plantar reflex
– Stimulus: stroking lateral aspect of the sole of the
foot
– Response: downward flexion of the toes
– Tests for function of corticospinal tracts
Superficial Reflexes
• Babinski’s sign
– Stimulus: as above
– Response: dorsiflexion of hallux and fanning of
toes
– Present in infants due to incomplete myelination
– In adults, indicates corticospinal or motor cortex
damage