The A To Z of Peripheral Nerves

A to Z Peripheral Nerves™6B:A to Z Nerves 14/07/09 8:58 AM Page A
The A to Z of
Peripheral
Nerves
Dr A. L. Neill
BSc MSc MBBS PhD FACBS
medicalamanda@gmail.com
A to Z Peripheral Nerves™6B:A to Z Nerves 14/07/09 8:58 AM Page C
The A to Zs...
Soon to be released!
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The A to Z of the Brain (Coming next!)
The A to Z of Surface Anatomy
The A to Z of Hair, Nails & Skin
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The A to Z of the Heart & Circulation
The A to Z of the GIT
The A to Z of the Organs
The A to Z of Histology & Histopathology
nd
The A to Z of Emergency Medicine
The A to Z of Anatomical Exercising
The A to Z of Imaging & Radiology
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The A to Z of the Special Senses

Send your expressions of interest and pre-orders to:
Anatomy update or aspenpharmacare supportive site for
feedback and suggestions and other supportive material:
rA
http://www.aspenpharma.com.au/atlas/student.htm
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A to Z Peripheral Nerves™6B:A to Z Nerves 14/07/09 8:58 AM Page 1
The A to Z of Peripheral Nerves
Introduction
The A to Z of Skeletal Muscles was the first of the A to Zs - a series
of medical pocket reference books listing structures alphabetically so
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the book is its own index. They have proved to be invaluable tools for
the medical practitioner and student alike, and I received some very
helpful feedback and requests for more in the series. The size,
binding, practicality of knowledge retrieval as well as the colours have
all had very positive feedback and so have been maintained. This
book, and ties in with the other publications and each are extensively
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cross referenced. In particular, although a complete volume, this book
ties in with the soon to be released the A to Z of the Brain, which will
incorporate the Brain, Cranial Nerves, Neural pathways and Spinal Cord.
This book is particularly useful for those working in rehabilitation
medicine, neurology ergonomics, trauma and accident victims. It use
extends to those assessing and treating nerve damage from whatever
nd
causes, where a good understanding of both the nerve root and the
peripheral nerve damage and the resulting loss of function and/or
sensory deficit is essential. The alphabetical listing of each nerve with
its muscle and sensory functions as well as the signs and causes of
loss of the nerve facilitates quick summary and knowledge retrieval.
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Acknowledgement
Thank you ASPENpharmacare Australia: Mr Greg Lan CEO, and all
those who helped in the contribution of this edition and in the feedback
of the other books in this series. Special thanks to Ante Mihaljevic of
TM grapic design, who has assisted greatly with this new edition.
rA
Dedication
To the fates, may they forgive me.
Other A to Zs
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The A to Z of Anatomical, Medical and Histological terms

The A to Z of Bones, Joints and Ligaments and the BACK
The A to Z of the Head and Neck
The A to Z of Skeletal Muscles
1 © A. L. Neill
How to use this book

This book is an alphabetical listing of all the peripheral nerves (PN). It
excludes the cranial nerves (CN) and the autonomic nervous system
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(ANS). It contains diagrams of their pathways sensory and motor
supply and can be cross-referenced with the A to Z of Skeletal
Muscles, the A to Z of Bones, Joints and Ligaments and the A to Z
of the Head and Neck as it lists all muscular and articular branches.
It will be cross referenced with the A to Z of the Brain and the A to Z
of Topographical/Surface Anatomy (the cutaneous branches) and the
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A to Z of Radiology and Imaging (boney components involved).
The beginning of the book demonstrates the main micro-anatomical
(histological) components of the nervous system alphabetically in the
same format. Components of the basic spinal nerve (SN) structure are
outlined and summarized. The Spinal Roots, Rami, and other
components including, where applicable the nerve plexi (NP) are all
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listed for each nerve, along with lesions of loss or damage and the
commonest event or trauma causing damage to the nerve described,
generally on the opposite page of each diagram as well as listing of
the key/legend to that diagram.
PNs may be known by several names and these, as far as possible,
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have been cross-referenced so that the nerve may be found with

minimal knowledge of its spinal roots or regional origin.
It is hoped that this will prove a valuable resource for those examining
individual nerves and multiple nerve lesions as in the study of
ANATOMY and its many uses. As with all the A to Zs any suggestions
rA
on format or inclusions will be gratefully received.

Thank you
Amanda Neill
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ISBN 1 74138 166 5
© A. L. Neill 2
Table of contents
Introduction 1
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Acknowledgement 1
Dedication 1
How to use this book 2
Table of contents 3
Abbreviations 4
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Common Terms used in Neurology 6
The Nervous System - and its components 11
Nerve cells - and their components 13
Structure and Substructure of Skeletal Muscle 15
Neuromuscular junctions = Motor end plate 17
nd
Neuromuscular spindle = muscle stretch receptor 19
Neurotendinous spindle = tendinous stretch receptor 19
The Spinal Nerves 21
Nerve trunk and Peripheral Nerves 25
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Guide to Anatomical Planes and Relations 27

Anatomical Movements 29
Neurological examination 31
Peripheral nerve examination 35
Examination of other sensory deficits 47
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Examination of Reflexes 49
Key to Muscles and their SN roots 51
Map of Sensory innervation 53
The Peripheral Nerves – index and regional key 59
Root of the Neck 63
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The Brachial plexus - overview 65

The Cervical plexus - overview 69
The Peripheral Nerves 73
3 © A. L. Neill
Abbreviations
A = actions /movements of a joint
A = anterior
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adj. = adjective
aka = also known as
alt. = alternative
AM = arachnoid mater
ANS = autonomic nervous system
ant = anterior
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art = articulation (joint w/o the additional support structures)
AS = Alternative Spelling, generally referring to the diff. b/n British &
American spelling
BBB = blood brain barrier
bc = because
BP = brachial plexus
BS =blood supply
nd
b/n = between
C = cervical / carpal
c.f. = compared to
CN = cranial nerve
CNS = central nervous system
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Co = coccygeal
CoP = coccygeal plexus
collat. = collateral
CP = cervical plexus
Cr = cranial
CSF = Cerebrospinal fluid
CT = connective tissue
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DH = dorsal horn (of the spinal cord)

dist. =distal
DM =dura mater
e.g. = example
EC = extracellular (outside the cell)
ext. = extensor (as in muscle to extend across a joint)
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fl. = flexor (as in muscle to flex across a joint)

Gk. = Greek
GM = grey matter
IC = intracellular / intercostal
IC = intercarpal
IMC = intermetacarpal
jt(s) = joints = articulations
L = lateral
© A. L. Neill 4
L = left / lumbar
LL = lower limb
Lt. = Latin
lig = ligament
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M = mater
MC = metacarpal
med = medial
MN =myelinated nerve
nMN = non-myelinated nerve
N = nerve
aN
NS = nervous system/nerve supply
NT = nervous tissue
NTr = nerve tract / trunk
P = plexus
P = posterior
PaNS = parasympathetic nervous system
pl. = plural
nd
PM = pia mater
PN = peripheral nerve
post. = posterior
proc. = process
prox. = proximal
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R = Right
RC = radiocarpal
S = sacral
sing. = singular
Sc = spinal canal
SC = spinal cord
SN = spinal nerve
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SP = spinous process
SyNS = sympathetic nervous system
T = thoracic
TP = transverse process
UL = upper limb, arm
V = vertebra
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VB = vertebral body
VC = vertebral column
VH = ventral horn (of the spinal cord)
WM = white matter
w/n =within
w/o = without
& = and
5 © A. L. Neill
Common terms in Neurology

Action potential the generation of a N impulse through stimulation and depolarizing
of the N cell membrane
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Aetiology the cause of ...the study of causes of illnesses of deficits
Afferent incoming - as with sensory fibres see Sensory
Anasthesia loss of sensation
Ansa - a loop like structure
Ante before , in front - anterior = ventral as in anterior horn = ventral horn
Aperture an opening or space between bones or within a bone.
Articulation joint, which is a point of contact b/n 2 opposing bones / relating to a
aN
joint. - hence articular branches of a nerve supply the joint described.
Association fibres those N fibres (artic- = arthro-) which connect cortical areas of the
brain ipsilaterally (as opposed to commissural fibres)
Astrocytes hold neurons together, and repair their membranes (see Glia)
Axial refers to the head & trunk (vertebrae, ribs & sternum) of the body.
Axon N process carrying material away from the cell body to the target
organ, each neuron has only one axon
Axon collaterals branches of the axon
nd
Basilar relating to the base or bottom of structures
Basiocranium bones of the base of the skull
Bipolar neurons with 1 dendrite + 1 axon (see unipolar, multipolar)
Blood brain barrier = BBB the barrier protecting the brain from certain
substances found in the BS
Canal tunnel / extended foramen as in the carotid canal, at the base of

ma
the skull adj canular (canicular - small canal)

Carotid to put to sleep; compression of the common or internal carotid
artery causes coma. This refers to bony points related to the
carotid vessels
Cavity an open area or sinus w/in a bone or formed by two or more
bones (adj. cavernous), may be used interchangeably with fossa. Cavity
tends to be more enclosed fossa a shallower bowl like space
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(Orbital fossa-Orbital cavity).

Caput relating to the skull
Cephalic pertaining to the head
Cerebrospinal fluid = CSF fluid - fluid surrounding the brain and SC formed by the
ependymal cells from filtered blood. It is part of the BBB, and
contains sugar, urea and protein - approx 125mls and flows
around the brain and SC at any time.
Chiasma (Gk = X) used for the crossing of the Optic fibres
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Cochlea a snail hence snail-like shape relating to the Organ of Corti in the
middle ear (adj. cochlear)
Commissural fibres those N fibres crossing the Median plane (e.g. anterior commisure)
Commisure a decussation or crossing of large groups of fibres
Condyle a rounded enlargement or process possessing an articulating surface.
Cranial Nerve (CN) N coming directly from the brain not the SC
Cranium the cranium of the skull comprises all of the bones of the skull
except for the mandible., adj. cranial pertianing to the skull cranial
nerves comnig out from the skul directly from the brain as
opposed to the SC for spinal nerves.
© A. L. Neill 6
Crest Prominent sharp thin ridge of bone formed by the attachment of

muscles particularly powerful ones eg Temporalis/Sagittal crest
Cutus skin - hence cutaneous branches refer to the nerves supplying the
skin and adnexae
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Decussation a crossing of nerve fibres inside the CNS
Dendrite nerve process bringing communication to the cell body (from
dendro = tree, bc of the tree-like shape of the dendrites).
Depolarization the loss of the potential across the cell membrane of a N due to
stimulation and formation of a N impulse (see repolarization)
Dermatome the cutaneous innervation of a SN
Dislocation a displacement of any part particularly of bone = luxation /partial
aN
dislocation = subluxation
Dermatome the cutaneous distribution of the Spinal nerve root
Distal further away from the axial skeleton (opposite of Proximal)
Dorsal to the back from dorsum -back (= posterior, as in dorsal horn =
posterior horn)
Efferent outgoing as in Motor nerves - see Motor

Endocranium refers to the interior of the “braincase” adj. endocranial divided into
the 3 major fossae anterior (for the Frontal lobes) middle (containing
nd
Temporal lobes) and posterior (for the containment of the Cerebellum).
Endoneurium innermost of the CT coverings of a PN fibre (see neurium,
perineurium and epineurium)
Epineurium outermost of the CT coverings of a PN fibre (see neurium,
perineurium and endoeurium)
Ependymal cells line the ventricles and the central canal of the SC (see Glia) form
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the CSF
Extradural space space external to the Dura mater but w/n the skull or boney canal
of the SC
Fascicle bundle, as in bundle of fibres in each PN there are a number of

fascicles of nerve fibres
Foramen a natural hole in a bone usually for the transmission of blood
vessels and/or nerves.(pl. foramina).
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Fornix an arch
Fracture = #, broken bone
Funiculus cord-like structure (generally on the surface of the brain)
Ganglion collection of N cell bodies outside the SC (also isolated islands of N

cells w/n in the white matter of the brain) (from ganglia = swelling)
Glia / Glial cells associated supporting cells of the NS connective tissue and immune
functions, types: astrocytes, oligodendrocytes, ependymal cells and
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microglia
Grey Matter (AS Gray) N tissue in the brain and SC which contains mainly N cells,
dendrites unmyleinated axons and glial cells (opposite to White
matter which contains mainly myelinated axons)
Groove long pit or furrow
Gyrus a circle, hence a coil of brain cortex.
Horn projection of grey matter in the SC (anterior and posterior horns are
for motor and sensory Ns respectively) - also called dorsal and
ventral horns respectively
7 © A. L. Neill
Impulse a depolarization of the N membrane resulting in the promulgation

of a signal along the N process.
Inter between
Interneurons act between motor and sensory neurons in a reflex - transferring
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the signal from the sensory to the motor w/o higher imput
Intra within
Introitus an orifice or point of entry to a cavity or space.
Lacerum something lacerated, mangled or torn eg foramen lacerum small

sharp hole at the base of the skull often ripping tissue in trauma.
Lacrimal related to tears and tear drops. (noun lacrima)
Lambda from the Greek letter a capital ‘L’ and written as an inverted V.(adj.
aN
lambdoid) and used to name the point of connection between the
3 skull bones Occipital and Temporals.
Lamina a plate as in the lamina of the vertebra a plate of bone connecting
the vertical and transverse spines (pl. laminae)
Leminiscus ribbonlike, flat band of N fibres (e.g. medial leminiscus)
Lesion deficit or injury - lack of function arising from this pathology
Linea a line as in the Nuchal lines of the Occitipum
Locus a place (c.f. location, locate, dislocate).
nd
Lumbar pertaining to the back particularly the lower back as in lumbago -
pain of the lower back.
Magnum large pl magna

Medulla middle
Meninges coverings of the brain and SC made up of 3 layers - Dura (hard)
mater on the outer to protect the NT; Arachnoid (spidery) mater in
ma
the middle to support the BS and Pia (soft) mater, the inner coating
to coat the NT and act as a barrier to foreign substances. CSF flows
b/n the inner 2 coverings.
Microglia phagocytic cells of the NS (see Glia)
Mixed N a nerve containing both sensory and motor components most
peripheral Ns are mixed
Motor / motor N causes muscle contraction. these Ns are efferent or moving away
from the SC
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Multipolar referring to a neuron which has many dendrites + 1 axon (see

unipolar, bipolar)
Myelin the phospholipids produced by Schwann cells to insulate the axons
of PNs and allow impulses to travel for longer and faster to the
target organ
Myotome the muscular innervation of a SN
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“Nerve” (N) N cell (neuron) capable of transmitting or firing off a signal

caused by ion transfer - excitable cell
N process - generally Axon carrying the impulse to the
skeletal muscle site general term meaning either the
neuron(s), process(es) or part of a bundle of neurons, either
cranial, spinal or peripheral
Neurilemma layers of Schwan cell membranes coating axon processes
Neurium general term for the CT covering of a PN fibre (see endoneurium,
Neurocranium refers only to the braincase of the skull.
Neuron Nerve cell
© A. L. Neill 8
Neurotransmitter substances in vacuoles at the foot of the nerve process which are
released to induce a nerve impulses or in response to a nerve
impulse.
Nucha The nape or back of the neck adj.- nuchal.
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Occiput The prominent convexity of the back of the head Occipitum =
Occipital bone adj. occipital.
Oligodendrocytes in the CNS only, become Schwann cells in the PNS and SC, act as
a barrier and insulator of axons and neurons.
Pars A part of.

Pathway General term indicating a path of defined N fibres.
aN
Perineum body cavity inferior to the the pelvis adj perineal -pertaining to the
perineum.
Perineurium middle of the 3 CT coverings of a PN fibre (see neurium,
Peripheral N (PN) coming from the SC, - often the combination of 1 or moreSNs or
part thereof and not the brain directly (cranial N) see Spinal N
Peroneal pertaining to the lower leg - particularly the Fibula.
Plexus knot - a knot or web of nerves.
pl plexi - from tangle or network as in brachial plexus or tangle of
nd
nerves involved in the innervation of the arm.
Polarization the maintenance of an unequal charge across the membrane of the
N, allowing the cell to be stimulated - all excitable cells have a
polarized membrane.
Posterior behind, at the back often used interchangebly with dorsal.
Process A general term describing any marked projection or prominence as
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in the mandibular process, in neurology the nerve process either

Dendrite or Axon depending upon the direction of the NI.
Projection fibres axons which connect the Cerebral cortex with the Brainstem or SC
Propioception sense of position of the body particularly the limbs or digits in space.
Proximal closer to the axial skeleton (opposite of distal)
Pure N a N which is either only sensory or motor not both (as in mixed N)
Ramus branch pl. Rami/branches - 2 main branches Ventral supplying all

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structures in front of the SC and Dorsal supplying al structures

behind the SC - the Rami are mixed N
Reflex referring to the Reflex arc of sensory impulse - going to the SC
and causing a motor or efferent response w/o imput from the
brain or other higher centres.
Refractory period time b/n depolarization and repolarization, where the N cannot be
restimulated in part to stop the impulse from traveling in both
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directions.
Repolarization restoration of the resting potential after transmission of a N
impulse (see depolarization, polarization).
Resting potential the charge difference across the cell membrane of the N created
by ionic imbalance.
Ridge Elevated bony growth often roughened.
Root the segment(s) of origin of the PN from the SN. N roots are pure
either motor or sensory and made up of several rootlets arising
directly from the dorsal or ventral horns of grey matter in the SC.
9 © A. L. Neill
Sagittal an arrow, the sagittal suture is notched posteriorly, making it look

like an arrow by the lambdoid sutures; the anatomical plane from
anterior to posterior
Sensory pertaining to input - which goes to the SC and then to the brain
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&/or reflex
Schwann cells cells supplying phospholipid coat - insulation to the axons to
preserve the N impulse in the PNS - role of the oligodendrocytes in
the CNS.
Spinal Cord (SC) Extension of the brain protected by the VC, PN come from here
Spinal Nerve (SN) N coming directly from the SC not the brain
Spine a thorn adj. - spinous descriptive of a sharp, slender
process/protrusion.
aN
Splanchocranium the splanchocranium refers to the facial bones of the skull.
Stimulation events which lead to the formation of a N impulse.
Subdural space space beneath the Dura mater external to the Arachmoid mater
Subluxation partial dislocation, particularly in the VC, term used to explain any
mechanical impediment to nerve function.
Sulcus long wide groove often due to a BV indentation –space b/n the gyri
of the grey matter in the brain
Sulcus long wide groove often due to a BV indentation.
nd
Sural pertaining to the lower leg.
Suture The saw-like edge of a cranial bone that serves as joint between
bones of the skull.
Synapse the gap at the joining of N and nerve process, N and N, process to
process or N and muscle for transmission or inhibition of an
impulse via neurotransmitters - presynaptic before the synapse
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(where the neurotransmitter is released) / post synaptic after the

synapse (where the neurotransmitter is received).
Telodendria axon terminal branches

Temporal refers to time and the fact that grey hair (marking the passage of
time) often appears first at the site of the temporal bone.
Thorax relating to the chest area adj thoracic.
Tract vertical columns of axons, generally myelinated in the SC &/or brain
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Trunk when SNs join together as large combined large Ns to supply

specific anatomical regions (e.g. BP) but again must re-organize to
become PNs
Ventral to the front, used interchangeably with anterior, relating to the chest
White matter N tissue which consists mainly of myelinated axons
(see Grey matter)
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© A. L. Neill 10
The Nervous system

The nervous system is made up of: the CNS = Brain + SC, the PNS = Ns exiting
from the CNS - CRANIAL directly from the brain (12 PAIRS) and from the SC (31
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PAIRS), the protective coverings of the tissue are made up of - connective tissue -
the MENINGES of which there are 3 layers, the outer or DURA MATER and the inner
often fused 2 layers THE ARACHNOID & PIA MATERS for the diffusions of CSF and
blood around the Brain and SC, and boney coverings, the Skull around the brain
and the vertebral column (VC) around the SC.
In the PNS the Ns form 2 separate divisions the voluntary and the autonomic
aN
(ANS). The ANS is made up of the Sympathetic exiting from the thoracic region
and Parasympathetic Ns, depending upon the region of the SC, and these nerves
may travel with the PNs.
PROTECTIVE CENTRAL NERVOUS PERIPHERAL NERVOUS

COVERINGS SYSTEM = CNS SYSTEM = PNS
nd
BRAIN ANS
BONEY = SKULL
CONNECTIVE
TISSUE
= MENINGES CRANIAL
NERVES (1-12)
ma
BONEY = VC
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SPINAL
CORD = SC SPINAL
CONNECTIVE
NERVES = SNs
TISSUE
= MENINGES
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11 © A. L. Neill
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aN
nd
ma
rA
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© A. L. Neill 12
The Nerve Cells

The basic functioning cell of the NS is the NEURON(E) = NERVE CELL. Most are
multipolar meaning that they have multiple dendritic (2) processes, which feed
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impulses into the nerve cell body (7). All neurons only have one axon (6), taking an
impulse away from the cell body. They may be insulated on their axons so that the
nerve impulse can travel faster and longer by a myelin sheath (3) a white
phospholipid material, produced by the Schwann cell - a connective tissue cell
which supports the N and protects it from outside influences. The impulse
terminates on to the target organ - generally skeletal muscle in the PNS via a
neuromuscular junction located in the muscle-end-plate (18), or on another N via
aN
a synapse.
1 nucleus and nucleolus

2 dendrites
3 neurilemma - protective myelin sheath from Schwann cells
4 axon terminal branches / telodendria
5 nodes of Ranvier
6 axon and base of axon - axon hillock
7 N cell body plasma with neurofibrils, Nissl bodies, mitochondria,
nd
Golgi & ribosomes
8 presynaptic membrane
9 synaptic vesicles
10 neurotransmitter
11 synaptic cleft
12 postsynaptic membrane on dendrite or N cell body
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13 myofibril of skeletal muscle

14 sarcolemma - cell membrane of the skeletal muscle cell
15 sarcoplasm - plasma of the skeletal muscle cell
16 subneural clefts
17 mitochondria
18 muscle end plate
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13 © A. L. Neill
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2
2
1 7
aN
6
3
5
nd
4
18
3
ma
4 4
13
rA
14
15 17
16
13, 14 4
8
9
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10
11
7
12
© A. L. Neill 14
Structure and Substructure of

Skeletal muscles
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1 muscle eg. Biceps
2 epimysium surrounding a whole muscle
3 perimysium surrounding a muscle fascicle
4 endomysium surrounding each muscle fibre
aN
5 muscle fibre
6 nucleus (note the muscle cell is multinucleated)
7 sarcolemma around each myofibril
8 myofibril
nd
9 sarcomere basic contractile unit of the muscle
10 myosin filament
11 actin filament
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A band - myosin to myosin filaments

H band – myosin only segments minimum in contraction
I band - actin only segment maximum in relaxation
Z line - line of attachment of the actin filaments
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15 © A. L. Neill
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1
2
3
aN
4
5
6
7
nd
8
2 I
A
ma
9
rA
H
Z
H
©D
A
11
10
© A. L. Neill 16
Neuromuscular Junction –
Nerve end attaching to Skeletal muscle
longitudinal
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1 axon - sheathed
2 mylein sheath – multiple lipid layers
3 Schwann cell
aN
4 axonlemma – axon membrane
5 pre-synaptic vesicles
6 axon – unsheathed / naked
7 presynaptic membrane
8 junctional folds (in sarcolemma)
nd
9 synaptic cleft (~20nm)
10 mitochondria
11 sarcolemma
12 myofilaments in muscle fibre
ma
rA
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17 © A. L. Neill
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I 2
aN
3 4
5 6
11
nd
10
7
ma
9
8
rA
12
©D
© A. L. Neill 18
Neuro-Muscular Spindle –
feedback loop to stop overextension in Skeletal
muscle
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Neuro-Tendinous Spindle –
feedback loop to tendon
aN
1 capsule of spindle
2 myelinated motor fibres
3 myelinated sensory fibres
4 unmyelinated motor fibres
nd
5 annualospiral fibre endings
6 bag of nuclei in intrafusal muscle
7 motor end plates
8 muscle fibres i = intrafusal e = extrafusal
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9 skeletal muscle nuclei

10 tendon fibres i = intrafusal e = extrafusal
11 naked axons
12 nuclei in tendon
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19 © A. L. Neill
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8e
3
2
aN
4
6 5
8i
nd
7
9 7
ma
9
rA
10
12
©D
I
2
7
11
10e
10i
© A. L. Neill 20
The Spinal nerves (SN) = NERVES which

come from the spine cord (SC)
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There are 31 pairs of Spinal nerves that branch off the SC.
Cervical 8 (Nerve - C2 exits b/n vertebrae C1 & C2 and - nerve C8 b/n

vertebrae C7 &T1)
Thoracic 12 (Nerve T4 exits b/n vertebrae T4 & T5)
Lumbar 5 (Nerve L3 exits b/n vertebrae L3 & L4)
Sacral 5
aN
Coccygeal 1
1 cervical enlargement of SC
2 Cervical plexus (CP)
3 Brachial plexus (BP) containing : Auxillary, Radial, Musculocutaneous,
Median, and Ulnar Ns
4 Intercostal Ns - thoracic Ns
5 Lumbar enlargement of the SC
6 Cauda equina
nd
7 Lumbar plexus (LP)
8 Sacral plexus (SP)
9 Cervical Ns C1-8
10 Thoracic Ns T1-12
11 Lumbar Ns L1-5
12 Sacral Ns S1-5
ma
13 Coccygeal Ns C1
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21 © A. L. Neill
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1
2 9
aN
3
4
nd
10
ma
6
rA
11 5
7
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12
8
13
© A. L. Neill 22

Each SN has a dorsal (pure sensory) and ventral (pure motor) root coming from the SC.
The dorsal roots convey messages to the SC via the dorsal root ganglion and ventral
roots take impulses away from the SC to the target organ, w/o synapse.
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After leaving the SC the “pure” nerves JOIN together to form a PERIPHERAL NERVE
(generally a mixed nerve), which then re-splits to form VENTRAL and DORSAL RAMI
(branches).
The roots of the PNs are named from exit points of each SN which joins together to
make up the PN. These Ns interact with the ANS, via peripheral ganglion.
The basic structure of all SN is similar and they are classified as cervical, thoracic,
lumbar, sacral and coccygeal depending upon from which region of the SC they exit.
aN
Reflex arcs only involve the loop of sensory imput from the dorsal root to the outflow
of the ventral roots, bypassing the higher centres, so may remain intact with
complete severance of the SC or brain damage.
Diagrams represent the SC in the VC to show proportion and surrounding structures,
as well as regions within the SC; a typical SN of the thoracic region with its
segmental branches; and a general SN arrangement and pathways, including
convergence with visceral afferents and efferents. The effects of this are seen in the
sites of referred pain (p57).
nd
1 white matter
2 sympathetic afferent and efferent communicating rami
3 sympathetic ganglion
4 vertebral body of the VC
5 PN mixed N
6 ventral root - pure motor
ma
7 dorsal root - pure sensory

8 SC - meningeal coverings continue from the brain
9 Nerve cell bodies / Grey matter
10 posterior root ganglion - on the dorsal root
11 SN which branches to form ventral and dorsal branches
12 white matter - lateral column
13 anterior horn of Grey matter in SC
rA
14 white matter - anterior column

15 anterior median fissure
16 central canal
17 lateral horn - of grey matter
18 white matter posterior column
19 ventral ramus
20 transverse process
©D
21 reflex arc
22 mediastinal structures and BVs
23 dorsal ramus
24 cutaneous branches
25 lateral cutaneous branch of the PN with their anterior and posterior
terminal branches to supply skin in the region
26 muscular branches to supply the regional muscle
27 anterior cutaneous branch to supply skin in medial area
28 viscera or organs and BS
29 cutaneous afferent meet with visceral afferent travelling together as in
referred pain sites.
23 © A. L. Neill
8 8
eill
10
aN
20
9
11
4
nd
23 7
5
1
19 16
ma
6
2
3
25
22
rA
27
26
18
17 9 21
10 12
©D
24
29
26 3
13 14
28 28
© A. L. Neill 24
Nerve trunk and Peripheral Nerves

A N trunk consists of several PNs travelling together and forming a Nerve structure
eill
which forms and reforms as a plexus eg the BP
These Ns may be mixed containing sensory and motor Ns. They are surrounded by a
protective CT covering, the epineurium, which carries the BVs and lymphatics. The
perineurium surrounds individual PN fascicles and endoneurium surrounds the N
processes. The vessels perforate the coverings to supply the N tissue and supporting
tissues. Axons are further protected by Schwann cell insulating layers. Loose CT
cushions and insulates the PNs w/in the trunk. As observed in referred pain patterns
there may be overlap b/n PNs particularly in the same N tract.
aN
Cross section
Longitudinal section
1 epineurium - surrounding the trunk or large PN
2 perineurium - surrounding the PN and individual fascicles
3 endoneurium covering each process/in the fascicle
nd
4 connective tissue
5 BVs
6 PN
7 feeding BV
8 extrinsic BV
9 oblique perforating BV
10 feeding BV
ma
rA
©D
25 © A. L. Neill
A
6
eill
aN 1
nd
2
5 3
4
ma
4 1
5 9
2
rA
3
10
©D
7 5
© A. L. Neill 26
Guide to Anatomical Planes and Relations

This is the anatomical position.
eill
A = Anterior Aspect from the front Posterior Aspect from the back
used interchangeably with ventral and dorsal respectively
B= Lateral Aspect from either side
C = Transverse / Horizontal plane
D= Midsagittal plane = Median plane; trunk moving away from this
plane = lateral flexion or lateral movement moving into this plane
aN
medial movement; limbs moving away from this direction =
abduction; limbs moving closer to this plane = adduction
E = Coronal plane
F = Median
nd
ma
rA
©D
27 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 28
Anatomical Movements
eill
aN
Hip flexion Hip extension
nd
Hip abduction Hip adduction
ma
rA
Hip lateral and medial

rotation Hip circumduction
©D
Knee flexion Knee extension
29 © A. L. Neill
eill
Foot dorsiflexion Foot plantar flexion
aN
Foot inversion Foot eversion
Foot normal position

nd
ma
Fingers extension Fingers flexion

rA
Forearm pronation Forearm supination Hand deviation

radial/laterally
ulna/medially
©D
Fingers abduction Fingers adduction Thumb opposition
© A. L. Neill 30
Neurological examination
General Considerations
eill
When examining the neurological patient - look for:
ASYMMETRY muscle wasting, hypertrophy, fasciculation
DEFORMITY limbs held in a strained position / uneven
posture
TONE CHANGES IN THE LIMBS
aN
hyer-reflexia / spasticity / resistance to
passive movement hypo- tonia / flaccidity
hyper-reflexive limbs will react to any sudden passive movement -

lifting the thigh suddenly will cause the leg to extend spontaneously
dorsiflexing the ankle will cause jerky resistance - CLONUS
nd
ma
rA
©D
31 © A. L. Neill
Check for Brain or upper motor neurone

problems before examining the PNs
eill
TEST FOR PYRAMIDAL WEAKNESS -
damage to the motor cortex in the brain or the descending tracts
when the patient closes their eyes they cannot maintain the position
of the outstretched arm - it will - ABDUCT, PRONATE & DROP (DOWN,
OUT AND ROUND ABOUT !!)
aN
nd
ma
rA
©D
© A. L. Neill 32
TEST FOR CEREBELLAR WEAKNESS (also as in DRUNK !!)

incoordination - ATAXIA
eill
patient demonstrates dysmetria (intention tremor) and
dysdiadochokinesia (inability to repeat simple movements rapidly) as
in:
finger nose touching rapid supination and pronation
in the upper limb
aN
nd
ma
or tapping feet on the floor / running the heel of one leg down the
shin to the big toe of the other
patients cannot stand still without help even with their eyes open (if
rA
©D
33 © A. L. Neill
this is not possible only with the eyes closed then the problem is only
SENSORY ATAXIA not motor and sensory ataxia) and have a wide
based gait
eill
aN
nd
ma
TEST FOR UPPER MOTOR NEURONE DISEASE

BABINSKY reflex
stroke the sole of the foot

normal - foot will flex
rA
abnormal - foot will extend, knee will flex and leg will lift
©D
© A. L. Neill 34
Peripheral nerve examination

green arrows represent limb direction (patient)
red arrows represent resistance (examiner)
eill
RADIAL NERVE
TRICEPS (C6-8)
cannot extend arm against resistance
BRACHIORADIALIS (C5-6)
aN
nd
from mid position - arm cannot flex against resistance
ma
EXTENSOR DIGITORUM (C7-8)

fingers cannot extend against resistance
rA
(also POSTERIOR INTEROSSEUS NERVE)

©D
EXTENSOR POLLICUS LONGUS AND BREVIS (C7-8)

thumb cannot extend against resistance
(also POSTERIOR INTEROSSEUS NERVE)
35 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 36
MEDIAN & ULNAR NERVES
eill
FLEXOR DIDGITORUM PROFUNDUS (C7-8)
fingers cannot resist extension when flexed (both Ns)
aN
nd
OPPONENS POLLICIS (C8-T1)
thumb cannot touch hypothenar eminence - cannot oppose
ma
(Median N)
rA
FIRST DORSAL INTEROSSEUS +

©D
ABDUCTOR DIGITI MINIMI (C8-T1)

fingers cannot abduct against resistance (ulnar N)
37 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 38
eill
LONG THORACIC NERVE
SERRATUS ANTERIOR (C5-7)
scapula wings when patient pushes arms into their body
aN
nd
AXILLARY NERVE
DELTOID (C5-6)
arm cannot abduct against resistance >15 degrees
ma
rA
MUSCULOCUTANEOUS NERVE
©D
BICEPS (C5-6)
arm cannot flex against resistance
39 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 40
eill
INFERIOR GLUTEAL NERVE
GLUTEUS MAXIMUS (L5, S1-2)
(supine) cannot extend hip - ie keep foot on table against
resistance
aN
nd
SUPERIOR GLUTEAL NERVE
GLUTEUS MEDIUS, MINIMUS, TENSOR FACSIA LATA (L4-5)
(supine) cannot abduct hip against resistance
ma
rA
OBTURATOR NERVE
ADDUCTORS (L2-4)
©D
(supine) cannot adduct hip against resistance (keep legs

closed)
41 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 42
eill
SCIATIC NERVE
HAMSTRINGS (L5, S1-2)
knee cannot flex against resistance
aN
nd
FEMORAL NERVE
ILIOPSOAS (L1-3)
cannot flex hip against resistance
ma
rA
©D
UADRICEPS (L2-4)
knee cannot extend against resistance
43 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 44
DEEP & SUPERFICIAL PERONEAL + TIBIAL

NERVES
eill
TIBIALIS ANTERIOR (L4-5)
foot cannot dorsiflex against resistance (cannot walk on high
heels) (Deep Peroneal)
aN
GASTROCNEMIUS, SOLEUS (S1-2)
foot cannot plantar flex against resistance (cannot walk on
toes) (Tibial)
nd
EXTENSOR HALLICIS LONGUS
EXTENSOR HALLICIS BREVIS (L5-S1)
ma
toes cannot dorsiflex against resistance (Deep Peroneal)
TIBIALIS POSTERIOR (L4-5)

rA
foot cannot invert against resistance (Tibial)

©D
PERONEUS LONGUS
PERONEUS BREVIS (L5-S1)
foot cannot evert against resistance (supf Peroneal)
45 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 46
EXAMINATION of other sensory deficits
POSITION SENSE
eill
determination of deficit by lack of detection of change of
position
move the joints of the fingers or toes up and down closing the
patients eyes
aN
VIBRATION
determination of deficit by lack of perception of vibration
tuning fork vibrated over the joints of the fingers and toes
2 POINT DISCIMINATION
nd
determination of deficit by lack of detection of 2 pinpricks at
once over increasing distances (normal - detection at 5mm)
SENSORY INATTENTION
ma
determination of deficit by lack of detection of 2 pinpricks at

once in different regions or on different limbs
Pathology - these test are primarily used to detect

peripheral neuropathy ± demyelinating diseases.
rA
If the pattern of deficit is distal with improvement on

proximal movement ie as the examiner moves closer to
body core it is most likely the former.
An erratic pattern of deficit is more, likely to be a

©D
demyelinating disease.
47 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 48
EXAMINATION OF REFLEXES
This is to determine if the neural pathway at the spinal level is intact
even with higher level loss as in Upper motor neurone loss, brain
eill
damage or spinal transection, or if there is progressive loss at a
spinal level without detection of higher level loss, as in peripheral
neuropathy ± deymeliniating diseases .
may be enhanced by asking the patient to clench their teeth.
aN
MUSCULOCUTANEOUS NERVE
BICEPS JERK - (C5,6)
strike Biceps tendon - positive Biceps contraction
RADIAL NERVE
SUPINATOR JERK (C6,7)
nd
strike lower end of radis - positive Elbow and finger flexion
TRICEPS JERK (C7,8)
strike above the Olecranon - positive Elbow extension
HOFFMAN REFLEX -determination of general hyper-reflexia
ma
flick thumb on the terminal phalanx while extended - positive

thumb flexion
SCIATIC NERVE
KNEE JERK - (L2,3,4) / QUADRICEPS
strike Patella with flexed relaxed leg - positive knee flexion
rA
ANKLE JERK - (S1,2) TIBIALIS ANTERIOR

externally rotate leg - dorsiflex foot
strike Archilles tendon - positive plantar flexion of the foot.
other reflexes
©D
ABDOMINAL REFLEXES - stroking of the abdomen on the supine

patient towards the umbilicus causes a contraction of the
abdominal muscles - often absent particularly in obesity,
pregnancy, post surgery and with age.
CREMASTERIC REFLEX - stroke the inner thigh - positive

testicular elevation.
49 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 50
Key to Muscles and their SN root supply (ventral

branch) - from cephalic to caudal
please note variations in the supply occur due to individual anomalies of N pathways
eill
and origins
Muscles of the Axis of the Muscles of the Girdles of the Muscles of the Limbs
body body (Pectoral and Pelvic) UL & LL
1 Longus Capitus 5 Sternocleidomastoid 16 Coracobrachialis

2 Longus Colli 6 Trapezius 17 Biceps brachii
aN
3 Infrahyoid muscles 7 Levator Scapulae 18 Brachioradialis
4 Diaphragm 8 Rhomboids 19 Supinator
9 Pectoral muscles 20 Triceps
29 Intercostal muscles, 10 Subscapularis 21 Ext Carpi Ulnaris
Subcostales, Levator 11 Serratus muscles 22 Pronator muscles
Costales (Ant = a /Post = b) 23 Flexor Carpi Radialis
30 Tranversus Thoracis 12 Deltoid 24 Ext Digitorum
31 Oblique muscles 13 Teres muscles 25 Flexor Digitorum
nd
32 Rectus Abdominus 14 Latissimus Dorsi 26 Flexor Carpi Ulnaris
33 Transversus Abdominus 15 Supra & Infraspinatus 27 Interossei & Lumbricals
34 Quadratus Lumborum muscles 28 Short muscles of the
thumb & little finger
46 Sphincters of the pelvis 35 Psoas muscles 38 Sartorius

ma
(urtherae & ani) 36 Pelvic and Gluteal 39 Gracilis & the Adductors
47 Muscles of the ant. muscles 40 Hamstrings
perineum 37 Obturator muscles (Semimembranous
48 Levator ani & Semitendinous & Biceps
Ischiococcygeus femoris) + Quadriceps
41 Pectineus
42 Peroneal muscles
43 Ant. muscles of the leg
rA
44 Post. muscles of the leg

45 Muscles of the foot
©D
51 © A. L. Neill
C1 C2 C3 C4 C5 C6 C7 C8
1 1 1
±2 2 2 2
3 3 ±3
4 4 4
eill
±5 5 5 5 ±5
6 6 ±6
7 7
8 8
9 9 9 9 9
10 10 10
11a 11a 11a
12 12 ±12
13 13 13 13
aN
14 14
15 15
16 16
17 17
18 18 ±18
19 22 22 22
20 20 20 20
21 21
23 23 24
25 25
nd
26
28 28
±29
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12
9
22
24
27
ma
28
11a 11a 11a 11b 11b 11b
29 29 29 29 29 29 29 29 29 29 29 29
30 30 30 30 30
31 31 31 31 31 31 31
32 32 32 32 32 32
33 33 33 33
35
L1 L2 L3 L4 L5
31 31
rA
32 32
33
34 34
35 35 35 35 35
36 36
37 37 37
38 38 38
39 39 39
40 40 40 40
©D
41 41
±42 42 42
±43 43 43
45
S1 S2 S3 S4 S5 Co1
36 36 ±36
37 37
42
44 44
45 45
±46 46 46 46 46
47 47
±48 48 48 48 48
© A. L. Neill 52
MAP OF SENSORY INNERVATION -

determination of deficit by paraesthesia or anaesthesia
corresponding to N root or PN cutaneous distribution
eill
ANTERIOR
DERMATOMES
(SEGMENTAL) - cutaneous distribution of the N roots
Quick Guide for dermatome level -
aN
T5 = NIPPLE
T10 = Umbilicus
T12 = Inguinal Ligament
PERIPHERAL NERVES
1 Greater Auricular N
nd
2 Supraclavicular Ns + Anterior cutaneous N of the neck
3 Intercostal Ns anterior + lateral branches
4 Axillary N
5 Medial cutaneous N of the arm + forearm (brachial +
antebrachial)
ma
6 Inferior lateral cutaneous branches of the Radial N

7 Musculocutaneous N
8 Median N
9 Ulnar N
10 Iliohypogastric + Genitofemoral N
11 Ilioinguinal + Genitofemoral N
rA
12 Lateral Femoral cutaneous N

13 Obturator N
14 Femoral N (ant. cut. branch)
15 Saphenous branch of Femoral N
16 Superficial Peroneal N
©D
17 Deep Peroneal N
18 Tibial N
19 Greater Occipital N
20 Cutaneous branches of the Dorsal rami
21 Trigeminal N / ganglion
21i Ophthalmic N
21ii Maxillary N
21iii Mandibular N
53 © A. L. Neill
21i
eill
V1
21ii
21iii
1 V2
V3
2
C2
aN
C3
4 C4
T2
T3
T4 C5
3 T5
T6 T2
5 T7
nd
6 T8
T9
T10 T1 C6
7
T11
T12
6 10 L1 C
ma
6
C C
S3 8 7
8 11 L2
9
12
15
rA
L3
14
L4
15
©D
16
S1
18 L5
12
14
© A. L. Neill 54
MAP OF SENSORY INNERVATION -

determination of deficit by paraesthesia or anaesthesia
corresponding to N root or PN cutaneous distribution
eill
POSTERIOR
DERMATOMES
(SEGMENTAL - cutaneous distribution of the N roots)
aN
PERIPHERAL NERVES
1 Greater Auricular N
2 Supraclavicular Ns + Anterior cutaneous N of the
neck
3 Intercostal Ns anterior + lateral branches
4 Axillary N
nd
5 Medial Cutaneous N of the arm +forearm (brachial
+ antebrachial)
6 Inferior lateral cutaneous branches of the Radial N
ma
8 Median N
9 Ulnar N
10 Iliohypogastric + Genitofemoral N
11 Ilioinguinal + Genitofemoral N
12 Lateral Femoral cutaneous N
13 Obturator N
rA
14 Femoral N (ant. cut. branch)

15 Saphenous branch of Femoral N
16 Superficial Peroneal N
17 Deep Peroneal N
18 Tibial N
©D
19 Greater Occipital N
20 Cutaneous branches of the Dorsal rami
55 © A. L. Neill
19
eill
C2 1
C3
4
C4 T2
aN
C5 T3
T4
T5
T6
T7 20
T8
T2
T9 3
T10
T11 5
nd
T1 T12
C6 L1
7
L2
L3 10
5
ma
C8 S5 S3
C
7
S4
12 9
rA
S2
©D
L4
L5
S1
© A. L. Neill 56
MAP OF SENSORY INNERVATION
VISCERAL
eill
mapping of the viscera -organs with sensory innervation,
basis of referred pain sites.
REFERRED PAIN
Visceral afferents converge on the same neurones in the
aN
posterior horn.
Patient perceives pain in the cutaneous distribution
(see p16 for Nerve pathways).
Common sites of convergance and Pain referral

nd
Nerve root Referred site
1 T1-3 Heart
2 T2-3 Ascending aorta
ma
3 T7-8 Gall Bladder + Pancreas

4 T10-11 Testis / Ovary
5 T10-L1 Kidney + Ureter
6 T11-12 Appendix
7 T11-L1 Colon
8 S2-4 Prostate / Vagina + Cervix
rA
©D
57 © A. L. Neill
eill
C1
C2
C3
C4
aN
C5
C6
C7
C8
T1
T2
2
T3
nd
T4
1
T5
T6
3
ma
T7
T8
T9 7
T10 4
rA
T11 6
T12
5
L1
L2
L3
8
©D
L4
L5
S1
S2
S3
S4
S5
© A. L. Neill 58
eill
aN
nd
ma
Key
part of the Dorsal rami
rA
part of the Cervical Plexus
part of Thoracic ventral rami
part of the Brachial Plexus

©D
part of the Lumbar Plexus
part of Sacral Plexus
59 © A. L. Neill
The Peripheral Nerves

Accesory Obturator nerve
Accessory Phrenic nerve see also Phrenic nerve
eill
Anococcygeal nerves (see Dorsal rami sacral and coccygeal region)
Ansa Cervicalis (= Ansa Hypoglossi, loop of the Hypoglossal N, nerve loop of the neck)
Anterior Cutaneous nerve of the neck (= transverse cutaneous nerve of the neck)
Anterior Tibial nerve (see Deep Peroneal nerve)
Axillary nerve
Common Peroneal nerve (= Fibular nerve) (see Posterior Interosseous nerve)
Clunial nerves (see Femoral nerve)
Cubital nerve (see Ulnar nerve)
aN
Deep Peroneal nerve (= Anterior Tibial nerve)
Dorsal rami of the Spinal nerves - overview
Dorsal nerve of the penis (see Pudendal nerve)
Dorsal rami - Cervical region
see also Greater occipital and Suboccipital nerves
Dorsal rami - Lumbar region
Dorsal rami - Thoracic region
Dorsal rami - Sacral (and Coccygeal) region
nd
Dorsal Scapular nerve (see also Nerves to Levator Scapulae)
Femoral nerve
Fibular nerve (see Common Peroneal nerve)
First Dorsal ramus (see Suboccipital nerve)
First Thoracic IC nerve (= one of the intercostobrachial nerves)
Genitofemoral nerve
ma
Greater Auricular nerve

Greater Occipital nerve (Second dorsal ramus)
Iliohypogastric nerve
Ilioinguinal nerve
Inferior Gluteal nerve
Inferior Rectal nerve
Intercostobrachial nerve (= Lateral cutaneous branch of second thoracic IC nerve)
see also Second Thoracic Intercostal nerve
rA
Intercostobrachial nerves
(see First thoracic IC nerve & Second thoracic intercostobrachial nerve)
Intercostal nerves - lower
Intercostal nerves - upper
Labial nerve (see Pudendal nerve)
Lateral cutaneous femoral nerve
Lateral pectoral nerve
Lateral plantar nerve
©D
Lesser occipital nerve (= small occipital nerve)

Levator scapulae nerve (= nerve to Levator scapulae see also Dorsal scapular nerve)
Long thoracic Nerve
Longus capitus nerve (= nerve to Longus capitus)
Longus colli nerve (= nerve to Longus colli)
Lower cervical dorsal rami (see Dorsal rami cervical region)
Lower subscapular nerve (see also Upper subscapular nerve)
Lumbar Plexus - summary
Lumbar Plexus - overview of the branches
Medial cutaneous nerve of the arm (Medial brachial cutaneous nerve)
© A. L. Neill 60
Medial cutaneous Nerve of the forearm (= Medial antebracheal cutaneous nerve)

Medial pectoral nerve
Medial calcaneal cutaneous nerve (see Tibial nerve)
Medial sural cutaneous nerve (see Tibial nerve)
eill
Medial plantar nerve
Median nerve
Median nerve -palmar digital branches
Middle Subscapular nerve (see Thoracodorsal nerve)
Musculocutaneous nerve (see also Radial nerve)
Obturator nerve (see also Accessory Obturator)
Obturator internus nerve (= nerve to Obturator internus)
Perforating cutaneous nerve
aN
Perineal nerve (see Pudendal nerve)
Phrenic nerve (see also Accessory phrenic nerve)
Piriformis nerve (= nerve to Piriformis)
Posterior femoral cutaneous nerve
Posterior Interosseous nerve (= Deep radial nerve) (see also Radial Nerve)
Pudendal nerve
Quaratus femoris nerve (=nerve to Quadratus femoris)
Radial nerve (see also Musculocutaneous nerve)
nd
Radial nerve - terminal branches
Rectus capitus anterior nerve (= nerve to Rectus captious anterior)
Rectus capitus lateralis nerve (= nerve to Rectus capitus Lateralis)
Sacral nerves - muscular
Sacral plexus - overview
Saphenous nerve (see Femoral Nerve)
ma
Scaleni and Longus colli nerve (=nerve to Scaleni and Longus colli)
Scalenus medius nerve (=nerve to Scalenus medius)
Sciatic nerve
Scrotal nerve (see Pudendal nerve)
Second Thoracic Intercostal nerve (= one of the intercostobrachial nerves)
Spinal Nerves - cervical
lumbar
sacral & coccygeal
thoracic
rA
Sternocleidomastoid nerve (=nerve to Sternocleidomastoid)

Subclavius nerve (= nerve to Subclavius)
Subcostal nerve (= Twelfth thoracic nerve)
Suboccipital nerve (= First Dorsal ramus)
Superficial peroneal nerve
Superior gluteal nerve
Supraclavicular nerve
©D
Suprascapular nerve
Sural nerve (see Sciatic nerve)
Third dorsal ramus
Thoracic nerves - summary
Thoracodorsal nerve (= Middle Subscapular nerve)
Tibial nerve
Trapezius nerve (= nerve to Trapezius)
Twelfth thoracic nerve (see Subcostal nerve)
Ulnar nerve
Ulnar nerve - Deep terminal branch
Upper subscapular nerve (see also Lower subscapular nerve)
61 © A. L. Neill
eill
aN
nd
ma
rA
©D
© A. L. Neill 62
Root of the Neck

Anterior
eill
1 vertebral artery (L)
2 TP of CI (Atlas) (L)
3 superior cervical ganglion (L)
4 Levator Scapulae
aN
5 Scalenus Medius
6 phrenic N (N roots C3,4,5)
7 Scalenus Anterior
8 upper trunk of the BP (L)
nd
9 thyrocervical trunk and deep cervical branch
10 inferior cervical ganglion (L)
11 Thoracic duct
12 subclavian vessels (L)
ma
13 Sternothyroid (L)
14 Trachea
15 hyoid muscles (R) = Sterno- hyoid thyroid
16 common carotid artery
rA
R 17 CN X = Vagus N
18 Omohyoid
19 BP = brachial plexus
20 Oesophagus
©D
21 TP of C6 (anterior tubercle)
22 middle cervical ganglion (R)
23 sympathetic trunk
24 Longus Colli
63 © A. L. Neill
eill
aN
24 1
2
3
23
nd
4
5
22
6
ma
21 7
8
9
1
20 10
rA
11
12
19
17
©D
18 16 13
15 14
© A. L. Neill 64
Brachial Plexus Overview

The Plexus of nerves associated with innervation
of the upper limb
eill
It is divided into
ROOTS 5 C5-T1 (all the resulting SNs come from these
roots)
TRUNKS 3 the 4 major Ns emerging from the neck
aN
above the CLAVICLE
UPPER, MIDDLE & LOWER
DIVISIONS 6 the ANTERIOR & POSTERIOR branches of
each TRUNK
CORDS 3 described for their relation around the
AXILLARY artery
LATERAL, POSTERIOR & MEDIAL
nd
Branches above the clavicle
1 Nerves to Scalani & Longus colli
2 branch to the Phrenic N
3 Dorsal scapular N
ma
4 Long thoracic N
rA
©D
65 © A. L. Neill
eill
Trunks Roots
Divisions
Cords
aN
nd
ma
1
2
3
4
5
rA
6
©D
© A. L. Neill 66
Brachial Plexus and the Branches of these cords -

the PNs below the Clavicle-infraclavicular branches
eill
LATERAL cord branches
1 Lateral pectoral N
3 Lateral root to the Median N
Lesions Erb Duchenne paralysis loss of shoulder abduction,
external rotation + weak elbow flexion and supination.
aN
MEDIAL cord branches
4 Medial Pectoral N
5 Medial Cutaneous N of the`arm
6 Medial Cutaneous N of the forearm
7 Medial root to the Median N
nd
8 Ulnar N
Lesions Klumpke’s paralysis: paralysis of the wrist and finger
flexors ± Horner’s syndrome because of sympathetic
outflow effects = eye constriction and pupil
contraction loss of sweating on the face and neck.
ma
POSTERIOR cord branches

9 Upper Subscapular N
10 Thoracodorsal N
11 Lower Subscapular N
12 Axillary N
rA
13 Radial N
Lesions (Saturday night Palsy- crutches pushing into the
Post. cord and causing damage) wrist drop due to
damage to the Radial nerve. Erb Duchenne
paralysis loss of shoulder abduction, external
rotation + weak elbow flexion and supination.
©D
14 Subclavian artery
15 Axillary artery
67 © A. L. Neill
eill
aN
nd
14
ma
1
3
12
9
4
2 10
rA
5
13 6
7 11
8
15
©D
© A. L. Neill 68
Cervical Plexus Overview

The Plexus of nerves associated with innervation
of the neck - see the root of the neck
eill
It is divided into
SUPERFICAL & DEEP BRANCHES
SUPERFICAL branches
Ascending and descending superficial branches
aN
1 Lesser Occipital N
2 Greater auricular N
3 Anterior Cutaneous N of the Neck
4 Supraclavicular N
Lesions mainly loss of innervation of the front & side of the neck
DEEP branches - MEDIAL
nd
5 Rectus Capitus Lateralis N
6 Rectus Capitus Anterior N
7 Longus Capitus N
8 Longus Colli N
9 Ansa Cervicalis
ma
Lesions mainly loss of flexion and extension of the neck

DEEP branches - LATERAL
10 Sternocleidomastoid N
11 Trapezius N
12 Levator Scapulae N
rA
13 Scalenus N
Lesions mainly loss of lateral flexion and rotation of the neck
other Nerves in this region include
14 Hypoglossal N (CNXII)
15 branch to the Vagus N (CNX)
©D
16 Tranverse Cutaneous N to the Neck

17 branch to the Phrenic N
18 Lesser Occipital N
19 C1 ventral ramus
20 Accessory (CNXI)
See the root of the neck
69 © A. L. Neill
eill
2 1
2
3
aN
4 3
nd
4
ma
14
20
19 5
7 9
15
rA
18 6
7 8
2
13 16
12
©D
13
12 8
9
17
4
© A. L. Neill 70
A Accessory Obturator nerve

LP (emerges from the anteromedial border of Psoas major
present in 30% of patients)
eill
Spinal Roots L3-4
Nerve type motor
Muscular branches to Pectineus
to Abductor Longus
Articular Branches NONE
aN
Cutaneous branches NONE
LESIONS weakens the hip
associated lesions/losses iatrogenic - cut in pelvic surgery
causes associated with ovarian cancer /
cancerous groin nodes
nd
1 to Pectineus
2 to Adductor longus
3 sympathetic chain
4 12th rib
ma
rA
©D
71 © A. L. Neill
eill
4 3
aN
nd
ma
2
rA
2
©D
© A. L. Neill 72
A Accessory Phrenic Nerve

CP (deep branches) see also Phrenic Nerve
present in 30%
eill
from Ansa cervicalis
from Nerve to Subclavius
Spinal Roots C3, C4, C5

Nerve type mixed = motor + sensory
Muscular branches to the diaphragm including the
aN
crura (1-3)
Sensory branches supplies branches to the pleura
over the diaphragm and the
diaphragm, including the central
tendon for proprioception
nd
LESIONS minimal loss of function with an
intact Phrenic N
typical aetiologies damage to neck-Hyoid and thyroid
muscles and Clavicle
associated lesions/losses associated with deep neck injuries
ma
1 to diaphragm - sternal branches

2 to diaphragm (lateral branches)
3 to diaphragm (posterior branches to the crura
surrounding the oesophagus)
4 1st rib
rA
5 costal cartilages
6 12th rib
7 central tendon with aorta and IVC passing through
8 Clavicle
9 Scapula
10 oesophagus
©D
73 © A. L. Neill
eill
3
aN
1
5
nd 2
10 7
6
ma
4 8
rA
©D
© A. L. Neill 74
A Ansa Cervicalis
(= Ansa Hypoglossi = loop of Hypoglossal nerve = nerve loop
of the neck)
eill
see also Hypoglossal Nerve*
CP overviews
Spinal Roots + Cranial Ns CNXII (Hypoglossal) C1, C2, C3

Nerve Type mixed = motor + sensory
Muscular branches branches to the Hyoid and Thyroid
aN
muscles
LESIONS loss/weakness of infrahyoid
muscles and depression of the
Hyoid bone and Thyroid cartilages
nd
hence speech and/or swallowing
difficulties
typical aetiologies congenital malformation (at C2
bony points) deep wounds /
trauma, #s, dislocations iatrogenic
ma
surgical injuries
associated lesions/losses part of a C2 root radiculopathy
severe trauma to the neck as in
strangulation / hanging
1 superior spinal root

rA
2 inferior spinal root

3 N to Sternothyroid
4 N to Sternohyoid
5 N to Omohyoid superior belly
6 N to Geniohyoid
7 N to Omohyoid inferior belly
©D
8 N to N to Thyrohyoid
9 Mandible
10 tongue
11 Hyoid bone
12 Clavicle
*In the A to Z of the Brain.
75 © A. L. Neill
eill
10
aN
1
11
8
2
nd
6
5
9
4
ma
3
rA
12
7
©D
© A. L. Neill 76
A Anterior (Transverse) Cutaneous Nerves of the Neck

CP (superficial branches)
eill
Spinal Roots C2, C3
Nerve type sensory
Muscular branches NONE
Cutaneous branches skin over the anterior and lateral
neck to the Manubrium -
aN
ascending (1) & descending (2)
branches
LESIONS loss of sensation/parasthesia on
the area described
nd
ma
rA
©D
77 © A. L. Neill
eill
aN
nd
ma
2
rA
©D
© A. L. Neill 78
A Axillary Nerve
BP (Infraclavicular branches)
eill
Spinal Roots C5, C6
Muscular branches to Teres Minor & Deltoid (1-2)
Articular Branches to the Glenohumeral joint (3)
Cutaneous branches to the skin over the Deltoid and
aN
Triceps (also from the
Suprascapular nerve)
LESIONS weak external rotation of the
Humerus weak abduction of the
Humerus parasthesia over the
Shoulder and back of the Arm
typical aetiologies inferior dislocation of the shoulder
nd
associated lesions/losses sports injuries
1 N to Teres Minor
2 N to Deltoid
ma
3 N to Genohumeral joint
4 Axillary artery
5 Scapula
6 Clavicle
7 2nd rib
rA
©D
79 © A. L. Neill
eill
aN
2
1
nd
5
2
ma
6
rA
3
4
©D
© A. L. Neill 80
Common Peroneal Nerve

SP (dorsal division)
C
eill
Spinal Roots L4, L5, S1, S2
Nerve type sensory
MAJOR BRANCHES deep peroneal (anterior tibial)
superficial tibial
(musculocutaneous)
aN
Articular Branches 3 to the knee (3,4,5,)
Cutaneous branches branches to the proximal leg an
lateral foot
LESIONS pain in leg and on the lateral side
of the foot
typical aetiologies common with injuries with crossed
nd
legs impact in car accidents
associated lesions/losses sciatic N damage also commonly
involves this nerve sacral / plexus
injuries also commonly -trauma to
leg, particularly if crossed or
ma
kneeling at the time of trauma.
1 deep peroneal N (anterior tibial N)

2 superficial peroneal N
3 superior lateral genicular N (travels with artery)
4 lateral genicular N (travels with artery)
rA
5 anterior tibial recurrent N (travels with artery)

6 lateral sural N (lateral cutaneous N of the calf)
7 popliteal artery
8 cruciate ligaments
9 menisci
©D
81 © A. L. Neill
eill
9
aN
3
7
nd
4
ma
5
1 8
2
rA
6
©D
© A. L. Neill 82
Deep Peroneal Nerve

SP (dorsal division
via the Sciatic nerve)
eill
D Spinal Roots L4, L5, S1, S2
Nerve type mixed = motor +sensory
MAJOR BRANCHES Superficial peroneal
Lateral terminal branch (S1,2)
Medial terminal branch (S1,2)
aN
Muscular branches to the dorsum of the foot and toes
Articular Branches to the ankle, medial of the foot and
medial 3 toes
Cutaneous branches branches to the 2 medial toes -
hallcus and the 2nd toe
LESIONS partial foot drop - weak
nd
dorsiflexion spared if superficial
peroneal nerve intact
typical aetiologies common ankle sprains,
dislocations and injuries
particularly from hyper-
ma
plantarflexion, entrapment may

occur under the extensor
retinaculum -anterior tarsal tunnel
syndrome
associated lesions/losses lower leg and foot injuries
rA
1 Superficial peroneal N
2 Lateral terminal branch
3 Medial terminal branch
4 N to Tibialis anterior
5 N to Extensor hallicus longus
6 N to Extensor Digitorum longus
©D
7 N to Peroneus tertius
8 1st interosseous muscle
9 Extensor digitorum brevis
10 Extensor hallicus brevis
11 2nd dorsal interosseous muscle
83 © A. L. Neill
eill
D
1
4
aN
6
5
nd
7
ma
3
2
2
rA
9 3 10
11
8
©D
© A. L. Neill 84
Dorsal Rami of the Spinal nerves summary
Spinal Roots throughout the vertebral column
eill
D
supply the muscle & the skin of the back muscles & their
joints - mixed Ns, most of the supply is segmental, regions
discussed in Spinal Nerves.
aN
Cutaneous innervation often overlaps with the lateral
branches of the ventral rami.
1 cervical dorsal rami

2 first dorsal ramus = Subocciptial nerve
3 second dorsal ramus = Greater Occipital nerve
4 third dorsal ramus
nd
5 lower cervical dorsal rami
6 upper thoracic dorsal rami
7 lower thoracic dorsal rami
8 lumbar dorsal rami
9 sacral dorsal rami
ma
10 coccygeal dorsal rami

rA
©D
85 © A. L. Neill
eill
3 D
1
2
aN
4 5
nd
6
ma
7
rA
9
©D
10
© A. L. Neill 86
Dorsal Rami - Cervical

see also Greater Occipital and Suboccipital nerves and Third
Dorsal Ramus
eill
D Spinal Roots C1-8 cervical dorsal rami
MAJOR BRANCHES each dorsal ramus has at least
Medial and Lateral branches
Muscular branches Lateral - to the lateral neck muscles
aN
Medial - to posterior medial neck muscles
some overlap and dual innervation
Articular Branches Lateral - NONE
Medial - cervical zygapophysial joints
Cutaneous branches Lateral - NONE
Medial - to the dorsum neck - over Trapezius
nd
LESIONS generally little parasthesia because of
multiple innervation in this region and
synergistic muscle actions prevent muscle
weakness from being shown but intrinsic
muscles of the neck are vulnerable if there
ma
is a lesion in these nerves and may

present as subluxations
typical aetiologies whiplash injuries to the neck in car
accidents / sudden jolts to the upper
shoulders /lower neck and scapula
region / sports tackles
rA
associated lesions/ neck pain / torsion and reduced neck

losses movement may present weeks to
months after trauma
Medial branches send branches to …
1 Semispinalis capitus
©D
2 Semispinalis Cervicus
3 Multifidus
4 Interspinalis
Lateral branches send branches to …
5 Iliocostalis cervicus
6 Longissimus capitus
7 Longissimus cervicus
87 © A. L. Neill
eill
D
3 2
aN 4
nd
ma
rA
7
©D
© A. L. Neill 88
Dorsal Rami - Lumbar
Spinal Roots L1-5 lumbar dorsal rami
eill
D MAJOR BRANCHES each dorsal ramus has at least Medial
and Lateral branches
Muscular branches Lateral - to the lateral deep lumbar
back muscles
Medial - to posterior medial deep
aN
lumbar back muscles
Medial - lumbar zygapophysial joints
Cutaneous branches Lateral - supply gluteal skin and
region of greater trochanter
nd
Medial - NONE
synergistic muscle actions prevent
muscle weakness from being shown
ma
typical aetiologies sports tackles and jolts to the spine /

often in car accidents
associated lesions/ lower spinal trauma and degenration
losses may present weeks to months after
trauma/disease
rA

1 Multifidus

2 Sacropinalis
3 Longissimus thoracis
©D
4 Iliocostalis lumborum
89 © A. L. Neill
eill
D
3 4
aN 2
nd
1
ma
rA
©D
© A. L. Neill 90
Dorsal Rami - Sacral (& Coccygeal)

(Anococcygeal Nerves)
eill
Spinal Roots S1-5 (Co1) sacral dorsal rami
D Nerve type mixed = motor + sensory
MAJOR BRANCHES each dorsal ramus has at least
Medial and Lateral branches
Muscular branches Lateral - NONE
aN
Medial - to Multifidus
Articular Branches Lateral - sacroliliac joint
Medial - NONE
Cutaneous branches Lateral - medial buttock region
and skin over coccyx
Medial - NONE
LESIONS parasthesia in this region damage
nd
typical aetiologies to the lower back and coccyx /
sports injuries, particlarly falling
associated lesions/losses sitting on the floor after a chair is
pulled away
ma

1 Multifidus

2 skin
3 Gluteus maximus
rA
©D
91 © A. L. Neill
eill
D
aN
1
3
nd
ma
rA
3
©D
© A. L. Neill 92
Dorsal Rami - Thoracic
Spinal Roots T1-12 thoracic dorsal rami
eill
D MAJOR BRANCHES each dorsal ramus has at least Medial
and Lateral branches
Muscular branches Lateral - to the lateral deep thoracic
muscles
Medial - to posterior medial deep
aN
thoracic back muscles
Medial - thoracic zygapophysial joints
Cutaneous branches Lateral - supply skin lateral to costal
angles, iliac crest and buttocks
nd
Medial - to the mid-back as far as the
mid scapula line
synergistic muscle actions prevent muscle
ma
weakness from being shown but intrinsic

muscles of the thoracic spine are vulnerable
if there is a lesion in these nerves and may
present as subluxations
typical aetiologies sports tackles and jolts to the spine /
often in car accidents
rA
associated lesions/ rib trauma and spinal vertebral collapse as

losses in osteoporosis and leukaemic deposits in
the veterbral bodies - may present weeks
to months after trauma/disease
1 Semispinalis thoracis
©D
2 Multifidus
3 Longissimus thoracis
4 Spinalis thoracis
5 Iliocostalis cervicus
6 Longissimus thoracis (cut to show deeper structures)
7 Levator costrum breves
8 Levator costrum breves + longus
93 © A. L. Neill
eill
D
1 2 5
aN
7
2
nd
1
ma
4
rA
©D
3
3 6
© A. L. Neill 94
Dorsal Scapular Nerve

BP see also Levator Scapulae nerve (CP)
eill
Spinal Roots ±C3, ±C4, C5
Nerve type motor
D Muscular branches to Levator Scapulae (1), Rhomboids
Major and Minor (1-2)
aN
LESIONS ± Rhomboids and Levator
Scapulae weakened - paralyzed
resulting in winged scapula
typical aetiologies neck and BP injuries
associated lesions/losses unable to fully assess injuries to
BP with injury to this N
nd
ma
rA
©D
95 © A. L. Neill
eill
D
aN
1 1
2
nd
ma
2
rA
©D
© A. L. Neill 96
Femoral nerve
LP (emerges from the lateral border of Psoas major)
eill
Spinal Roots L2, L3, L4 (same as Obturator N)
MAJOR BRANCHES ANTERIOR division, POSTERIOR division
Muscular branches ABDOMINAL to Iliacus
F to Pectineus
to Sartorius
aN
ANTERIOR
POSTERIOR to Rectus Femoris
to the Vasti muscles
to Articular genus
Articular Branches ABDOMINAL, ANTERIOR NONE
POSTERIOR to the hip and knee
Cutaneous branches ABDOMINAL NONE
nd
ANTERIOR anterior thigh, knee & leg
POSTERIOR medial of the ankle & the foot
LESIONS weak hip and knee flexion of the anterior
only - weakens the hip, knee flexion and
instability of the posterior only - weak knee
ma
flexion
associated lesions/ iatrogenic - cut in pelvic surgery cut in
losses causes varicose vein surgery & knee surgery
(posterior-Saphenous N) trauma to the
femoral triangle (abdominal)
rA
1 ANTERIOR division
2 POSTERIOR division
3 to Iliacus
4 to Pectineus
5 Intermediate Femoral Cutaneous
6 Medial Femoral Cutaneous anterior branch
7 Medial Femoral Cutaneous posterior branch
©D
8 to Rectus Femoris
9 to Vastus lateralis
10 to Vastus medialis
11 to Vastus intermedius
12 to Articular genus
13 to the hip
14 to the knee
15 Saphenous nerve
16 Infrapatellar branch
17 adductor canal for deep BVs and Ns
97 © A. L. Neill
eill
F
aN
1
4
nd
ma
2 13
5 8
1
rA
6
11
5
6 17
©D
7
10
5 12
9 15
14 16
© A. L. Neill 98
First Thoracic Intercostal Nerve

part of BP
eill
Spinal Roots T1
Muscular branches to intercostal muscles (1-2)
Articular Branches costovertebral joints and
F sternocostal joints
Cutaneous branches to skin overlying the 1st IC space
aN
anteriorly and axilla (3-4)
LESIONS radicular pain over 1st IC space
typical aetiologies neck and BP injuries of the
Median and Ulna nerves
BP with injury to this N - unless
nd
associated with other IC nerve
injuries
1 N to internal intercostal
2 N to external intercostal
ma
3 to skin overlying the 1st IC space anteriorly and

Manubrium.
4 to skin overlying the axilla
5 branch to BP
rA
©D
99 © A. L. Neill
eill
5
F
aN
2
1
nd
3
ma
4
rA
©D
© A. L. Neill 100
Genitofemoral nerve
LP (emerges from the anterolateral border of Psoas major)
eill
Spinal Roots L1, L2
Muscular branches to Genital area (cremaster
muscle in males)
Cutaneous branches to femoral triangle
aN
G to genital area
LESIONS loss of cremaster reflex /
parasthesia over area described
associated lesions/losses iatrogenic - cut in appendectomy
causes
nd
1 Genital branch
2 Femoral branch
3 Genital branch (cutaneous)
ma
rA
©D
101 © A. L. Neill
eill
aN
G
nd
ma
1
rA
3
2
©D
© A. L. Neill 102
Greater Auricular Nerve

eill
Spinal Roots C2, C3
Nerve type sensory
Cutaneous branches skin over the Parotid Gland (1)
skin over the mastoid process
aN
G and the back of the ear (2)
LESIONS loss of sensation on the area
nd described
ma
rA
©D
103 © A. L. Neill
eill
aN
2 G
1
nd
ma
rA
©D
© A. L. Neill 104
Greater Occipital Nerve (second dorsal ramus)
Spinal Roots C2 cervical dorsal ramus
eill
MAJOR BRANCHES Medial and Lateral branches
Muscular branches to the capitus muscles in the neck
/ head (3-6)
Articular Branches to the atlanto-occipital and
atlanto-axial joints
aN
G Cutaneous branches to the dorsum neck and head to
the level of the ear
LESIONS parasthesia to the back of the
head in occipital region
typical aetiologies whiplash injuries to the neck in
car accidents
nd
associated lesions/losses injury to sternocleidomastoid /
occiptal nerves often
overcompensate and cause muscle
spasm and headaches (seen
several weeks after the accident)
ma
1 Medial branch
2 Lateral branch
3 to Obliquus capitus inferior
4 to Semispinalis capitus
5 Longissimus capitus
rA
6 to Splenius capitus
©D
105 © A. L. Neill
eill
aN
G
1
4
3
nd
6
2
ma
5
rA
©D
© A. L. Neill 106
Iliohypogastric nerve
eill
Spinal Roots T12, L1
Muscular branches to Transversus Abdominus
to Internal abdominal oblique
(also see intercostals - lower T7-12, and ilioinguinal n)
aN
Cutaneous branches lateral cutaneous branch
anterior cutaneous branch
LESIONS weakening of abdominal wall
I associated lesions/ iatrogenic - cut in appendectomy
losses may develop a direct inguinal or
abdominal hernia
nd
Ilio-inguinal nerve
Spinal Roots L1
ma

Muscular branches to Transversus Abdominus
to Internal abdominal oblique
(also see intercostals - lower T7-12, & iliohypogastric n)
Cutaneous branches to groin / scrotum / mons pubis /
rA
labia majora
LESIONS weakening of abdominal wall
associated lesions/ iatrogenic - cut in appendectomy,
losses causes nephrectomies / pfannenstiels
excision may develop in large
pregnancies a direct inguinal or
©D
abdominal hernia referred pain from

Ureter and renal pelvis
1 to Transversus Abdominus
2 to Internal abdominal oblique
3 lateral cutaneous branch
4 anterior cutaneous branch
107 © A. L. Neill
2 1
eill
aN I
nd
ma
2
1
rA
©D
3 4
© A. L. Neill 108
Inferior Gluteal nerve

eill
Spinal Roots L5, S1, S2
Nerve type motor
Muscular branches to GM (2)
LESIONS difficulty running jumping and
aN
climbing stairs, rising from a
seated position, skating
typical aetiologies commoner than superior gluteal
I N injuries, but rare to be
injured alone
associated lesions/losses pelvic and back injuries
nd
1 Pyriformis
2 to Gluteus Maximus
ma
rA
©D
109 © A. L. Neill
eill
aN I
nd
1
ma
rA
2
©D
© A. L. Neill 110
Inferior Rectal nerve

see also Pudenal nerve
SP (anterior division directly from SP)
eill
Spinal Roots S2, S3, S4
MAJOR BRANCHES from the PUDENAL nerve
Perineal
aN
Posterior scrotal or Labial nerves
Dorsal nerve to the Penis (Clitoris)
Muscular branches to the levator ani, external anal
sphincter & coccygeas
I Articular Branches NONE
Cutaneous branches skin between the anus and the
coccyx and lining the anal canal
nd
below the circumanal line
LESIONS sagging of the pelvic floor /
compromised rectal and bladder
control (particularly in the female)
cystocoele or rectocoele / prolapse
ma
of uterus in older females

typical aetiologies pressure on the sacrum
associated lesions/losses uterine prolapse / obesity / large
abdominal mass
1 Perineal branch
rA
2 Posterior scrotal / labial nerves

3 Dorsal nerve to penis / clitoris
4 to the external anal sphincter
5 Perineal diapragm
6 Urethra
7 Levator ani
©D
111 © A. L. Neill
eill
aN I
nd
4
ma
1
rA
7
3
5
2 6
©D
© A. L. Neill 112
Intercostal Nerves - Lower

Spinal Roots T7-11 thoracic ventral ramus
eill
Muscular branches to muscles of thorax and abdomen
Articular Branches costovertebral joints and sternocostal
joints (ac)
Cutaneous branches supplies skin over the abdomen
and latissimus dorsi and the costal
aN
surface of the diaphragm
T10 supplies skin over the umbilicus
LESIONS loss of sensation and movements of the
rectus muscles with entrapment in the
I muscle of nerve and fat - abdominal
muscles cannot move so contraction
occurs unilaterally
nd
Clicking rib syndrome - subluxation of
interchondral joints refers pain to the
abdomen in areas described - “clicks”
when moving thorax/abdomen in sitting up
typical aetiologies osteoporosis / leukaemia thoracic
vertebral fractures
ma
associated lesions/ peritonitis and other diseases of the

losses viscera / trauma to the abdomen cause
abdominal spasm and guarding
1 Collateral branches to Subcostalis

2 Lateral Cutaneous branch
rA
3 Anterior Cutaneous branch

4 to Internal intercostals
5 N to external intercostals and the muscle attachment
6 to Intercostals intimi
7 External Oblique
8 Rectus Abdominus
©D
9 N to Serratus posterior inferior

10 N to External Oblique
11 Transversus Abdominus
12 layers of the abdominal wall reflected - pieced and
innervated by the lower intercostal nerves segmentally
13 transverse process of thoracic VB
14 dorsal ramus of thoracic N (supplies muscles, skin
and joints of the VC and back)
113 © A. L. Neill
eill
5
13
1
2
14
aN
4
I
nd
6
9
ma
8
11
3
7
rA
3
10
8
12
5
©D
© A. L. Neill 114
Intercostal Nerves - Upper
Spinal Roots T3-6 thoracic ventral ramus
eill
NAMED BRANCHES Collateral branches (cb) 1
-terminal Lateral Cutaneous branches (lc) 2
Anterior Cutaneous branches (ac) 3
Muscular branches to muscles of the chest and back (4-10)
aN
joints (ac)
Cutaneous branches supplies skin over the intercostal space
anteriorly laterally and posteriorly (lc, ac)
I LESIONS loss of sensation in areas described -
needs 2 or more intercostals nerves
involved to be detected because of
nd
innervation overlap T4 corresponds to
the nipple line T5,T6 pain in the same
area as heart mistaken for angina
pectoris / oesophageal spasm
typical aetiologies osteoporosis / leukaemia thoracic
ma
vertebral fractures
associated lesions/ thoracic vertebral damage / from trauma
losses or disease
1 Collateral branches
2 Lateral Cutaneous branch with their anterior and
rA
posterior terminal branches

4 to Internal intercostals
5 to External intercostals
6 to Intercostals intimi
7 to Subcostalis
©D
8 to Tranverse thoracis
9 to Serratus posterior inferior
10 to External oblique
115 © A. L. Neill
eill
9
2
1
aN 7
I
nd
6
ma
2
rA
4
8
10
5
©D
© A. L. Neill 116
Order NOW to complete

Contact Anatomy Update for further information and
eill
additional educational resources: GPO 637 Sydney 2001
aN
nd
Origins, insertions, actions, blood supply and All anatomical terms are listed along with a
nerve supply listed for all muscles, separate pronunciation guide and etymology (word
ma
listing of all major muscle groups; separate origin), Tables of abbrev. medical prefixes,
index of all muscles; regional index of the suffixes & word roots; degrees & professional
muscle along the side and cross referencing associations are included, along with guides
with common muscle names. to basic anatomical principles.
rA
©D
All bones are separately listed, as well as an All bones, their joints, movements, ligaments,
examination of all cavities, joints and relations, Blood and Nerve supply are listed.
anthropological markers. Radiology of the Each major joint is discussed in detail -
skull and its cavities are shown and shown with and without their additional
explained from several aspects. supportive structures.
117 © A. L. Neill
your ‘A to Z’ set so far!

Mobile: 041001861 Fax: 612 93651000
eill
aN
nd
All peripheral nerves, their pathways, All the bones and muscles of the Head &
branches, alternative names and nerve root Neck region are described indiv.
ma
origins are listed, including functional NS & BS listed + pathological lesions.

deficits, likely aetiology of the trauma and radiological views and overviews of the
examination techniques to illicit region inc. lymphatic drainage arterial aas,
pathology deficits. cutan Ns and teeth
The
A to Z
rA
of the
Brain
COMING
©D
SOON!
As well as all the Bones Joints and ligaments The Brain, CNs, SC, & neural pathways are
of the body drawn individually - a separate described, in colour coded sections and listed
section on postures, vertebral development alphabetically as well as clinical examination
and regional differences along with of the CNs, neural damage assessment, the
movements is included. cerebral BS and is significance - cross ref.
with all the other A to Zs.
© A. L. Neill 118
Lateral Cutaneous Femoral nerve

eill
Spinal Roots L2-3
Nerve type sensory
Cutaneous branches supplies skin of thigh and gluteal
region (1-2)
aN
LESIONS parasthesia to area described
associated lesions/losses iatrogenic - cut in surgery
causes nd
L
ma
rA
©D
119 © A. L. Neill
eill
aN
nd
L
ma
2
rA
1
1
2
©D
© A. L. Neill 120
Lateral Pectoral Nerve

eill
Spinal Roots C5-7 (lateral cord - ant divisions)
Nerve type motor
Muscular branches to muscles of the chest (1-2)
Articular Branches to Glenohumeral joint
LESIONS weakness in scapula, adduction
aN
and medical rotation of arm i.e.
difficulty in reaching to touch
opposite shoulder
1 Pectoralis Major
2 Pectoralis Minor
nd
L
ma
rA
©D
121 © A. L. Neill
eill
aN
nd
2
L
1 1
ma
2
rA
©D
© A. L. Neill 122
Lateral Plantar nerve

SP (ventral divisions)
eill
Spinal Roots L4, L5, S1, S2, S3
Muscular branches to the lateral toes 4th and 5th / and
adductors of the big toe
Articular Branches to the joints of the 4th and 5th toes
aN
Cutaneous branches to the skin on 4th and 5th toes and
the lateral side of the foot
LESIONS parasthesia on the 5th toe and
inability to abduct toes
particularly the lateral digits
typical aetiologies foot wear damage / trauma to the
side of the foot and little toe
nd
trauma and associated ankle dislocations
losses and trauma
L
1 superficial branch
2 deep branch
ma
3 common plantar digital nerves

4 proper plantar digital nerves
5 to Quadratus Plantae
6 to Abductor digiti minimi
7 to Flexor digiti minimi brevis
8 to 3rd plantar interosseous muscle
rA
9 to the 4th dorsal interosseous muscle

10 Adductor hallicus (oblique head)
11 Adductor hallicus (transverse head)
12 1st and 2nd plantar interossei
13 1st to 3rd lumbricals
14 1st to 3rd dorsal interossei
©D
123 © A. L. Neill
eill
5
6
1
aN
nd
7
13
L
1
8 10 12
ma
3 13
14
10
9
11
14
rA
14 14
4
©D
© A. L. Neill 124
Lesser Occipital Nerve (Small Occipital Nerve)

eill
Spinal Roots C2, ±C3
Nerve type sensory
Cutaneous branches skin on the neck along the
posterior border of
aN
Sternocleidomastoid to the
Mastoid process, behind and
around the Pinna of the ear
LESIONS loss of sensation on the area
described
nd
L
ma
rA
©D
125 © A. L. Neill
eill
aN
nd
L
ma
rA
©D
© A. L. Neill 126
Levator Scapulae (Nerve to)

see also Dorsal Scapular nerve
CP (deep lateral branches)
eill
BP (supraclavicular branches)
Spinal Roots C3, C4

(proprioceptive)
aN
Muscular branches to Levator Scapulae
LESIONS dropped shoulders, poor “shrugging”;
winged* scapula(e) ; poor abduction of
both ULs, particularly > 20º;
unstable scapula - compromising the
nd
Deltoids, Rhomboids, Serratus and
Spinati muscles - innervation is
L ispilateral hence unilateral injuries
affect the same side
typical aetiologies rare - direct injury in this area
ma
synergism with Trapezius limits

functional loss
associated lesions/ unable to fully assess injuries to
losses brachial plexus with injury to this N
rA
©D
127 © A. L. Neill
eill
aN
nd
L
ma
rA
©D
© A. L. Neill 128
Long Thoracic Nerve

eill
Nerve type motor
Muscular branches to Serratus Anterior (2)
LESIONS “winged scapula” because of
aN
unopposed action of Levator
Scapulae and Rhomboids
cannot lift arm above the
horizontal
typical aetiologies heavy weights crushing the
shoulder injuries to the posterior
nd
triangle* of the neck
L the UL cannot assess shoulder
function little UL abduction
ma
1 Axillary artery
2 Serratus Anterior
3 Glenoid fossa
rA
©D
129 © A. L. Neill
eill
3
aN
nd
1
L
ma
rA
©D
© A. L. Neill 130
Longus Capitus (Nerve to)

CP (deep branches)
eill
Nerve Type motor
Muscular branches to Longus Capitus
LESIONS loss/weakness of flexion of the
aN
neck loss/weakness/asymmetry
of neck rotation
typical aetiologies whiplash injuries from automobile
or athletic injuries
associated lesions/losses part of a C2 radiculopathy seen
with loss of sensation on the neck
nd
L Longus Colli (Nerve to)
CP (deep branches)
ma
Spinal Roots C2-7, ± C8

Nerve Type motor
Muscular branches to Longus Colli
rA
LESIONS loss/weakness of flexion of the

neck ipsilateral
loss/weakness/asymmetry of
neck rotation contralateral
typical aetiologies whiplash injuries from automobile
or athletic injuries
©D
associated lesions/losses part of a brachial plexus root

injury associated with damage to
Scalenus muscles and thoracic
outlet syndrome
131 © A. L. Neill
eill
aN
nd
L
ma
rA
©D
© A. L. Neill 132
Lower Subscapular Nerve

see also Upper Subscapular Nerve
eill
Nerve type motor
Muscular branches to Subscapularis (inferior) (1) & to
Teres major (2)
aN
LESIONS weak adduction & medial rotation
of the Humerus
typical aetiologies BP injuries
associated lesions/losses BP injuries
nd
L
ma
rA
©D
133 © A. L. Neill
eill
aN
nd
L
ma
rA
2
©D
© A. L. Neill 134
Lumbar Plexus - overview of the Branches
Spinal Roots T12, L1-4
eill
Nerve type motor
Muscular branches to Quadratus Lumborum
to Psoas minor (L1)
to Psoas major (L1-3)
aN
LESIONS weakening of hip flexion (L2>L3)
parasthesia over anterior thigh (L2>L1)
all branches pierce Psoas major
1 to Quadratus Lumborum
nd
2 Psoas minor
3 Psoas major
L 4 Iliohypogastric N
5 Ilioinguinal N
6 Lateral femoral cutaneous N
ma
7 Femoral N
8 Genitofemoral N
9 Obturator N
10 Accessory Obturator N
11 upper root of the Lumbosacral trunk
12 inguinal ligament
rA
13 pubic symphysis
14 anterior superior iliac spine
©D
135 © A. L. Neill
eill
1
4
2
aN
5
8
nd
L
7
ma
14 11
9
rA
10
13
©D
12
© A. L. Neill 136
Lumbar Plexus
summary
eill
Spinal Roots T12, L1, L2, L3, L4
MAJOR BRANCHES Muscular branches (1)
Iliohypogastric N (2)
Ilio-inguinal N (3)
aN
Genitofemoral N (4)
from the Ventral Divisions
5 Obturator N
6 Accessory obturator N
nd
from Dorsal Divisions
L 7 Lateral femoral cutaneous N
8 Femoral N
9 Lumbosacral trunk to Sacral plexus
ma
LESIONS from specific Nerve roots

L1 weakness in abdominal muscles / parasthesia
over hip and groin
L2 weak hip flexion / parasthesia to anterior thigh
L3 weak leg adduction / reduced knee reflex /
rA
parasthesia to anterior thigh, knee, leg and foot

L4 commonest from disc L4/5 herniation, degeneration
weak leg adduction / foot drop (tibialis anterior) /
parasthesia to leg and foot
AETIOLOGY disc herniation, neurofibromas, meningiomas,
other neoplasms and trauma
©D
137 © A. L. Neill
eill
2 1
aN
6 1
4
8
nd
6
5
9 L
ma
2
3
4
rA
6 6
7
©D
© A. L. Neill 138
Medial Cutaneous Nerve of the arm

aka Medial brachial cutaneous nerve
eill
Spinal Roots C8, T1 (medial cord - ant divisions)
aN
Cutaneous branches skin on medial aspect of the arm
and over the elbow (see also
intercostobrachial n + second intercostal n)
LESIONS loss of sensation on the area described
Medial Cutaneous Nerve of forearm

nd
aka Medial antebracheal cutaneous nerve
M Spinal Roots C8, T1 (medial cord - ant divisions)
ma

Cutaneous branches skin on medial aspect of the forearm
rA
©D
139 © A. L. Neill
eill
aN
nd
M
ma
rA
©D
© A. L. Neill 140
Medial Pectoral Nerve

eill
Spinal Roots C6-8, T1 (medial and lateral cords -
ant division)
Nerve type motor
Muscular branches to anterior chest muscles (1-2)
aN
LESIONS weakness when touching opposite
shoulder with arm
nd
M
ma
rA
©D
141 © A. L. Neill
eill
1
aN
nd
2
M
ma
rA
1
2
©D
© A. L. Neill 142
Medial Plantar nerve

SP (ventral divisions)
eill
Muscular branches to the big toe Hallicus, and associated
flexor foot muscles (4-6)
Articular Branches to the ankle tarsus and metatarsus
Cutaneous branches to the skin on the medial side of the
aN
sole of the foot and ball of the toes
LESIONS Tarsal tunnel syndrome - “jogger’s foot”
typical aetiologies damage to the tibial nerve in tarsal
tunnel from external pressure from foot
wear ± thickened retinaculum
sensory loss at the heel indicates lesion
nd
above the ankle and tarsal tunnel
associated lesions/ ankle dislocations and trauma
losses
M
1 hallucial medial digital N
ma
2 common plantar digital Ns

3 proper plantar digital Ns
4 Abductor Hallicus
5 Flexor digitorum brevis
6 Flexor hallicus brevis
7 to 1st lumbrical
rA
©D
143 © A. L. Neill
eill
aN
5
4
nd
1 2
M
7
ma
5
rA
6
©D
3 3
© A. L. Neill 144
Median Nerve
eill
Spinal Roots C5-8 T1 (medial + lat cords - ant
division)
NAMED BRANCHES Anterior interosseous (AI)
(1) (terminal) Palmar digital (Pd) (2)
Muscular branches to Pronator teres
aN
to Flexor carpi radialis
to Palmaris Longus
to Flexor digitorum superficialis
to Flexor pollicus longus (Ai)
to Pronator quadratus (Ai)
to Flexor digitorum profundus (Ai)
nd
Articular Branches to the elbow joint
to the radio-ulnar proximal
to the interosseous membrane
M Cutaneous branches supplies the palmar skin on the
lateral side
ma
LESIONS supinated forearm /weak pronation

weak flexion of wrist and middle fingers
radial deviation of wrist
parasthesia on the lateral side of the
hand
typical aetiologies elbow / forearm injuries
rA
associated lesions/ UL injuries

losses
1 Anterior interosseous N
2 Palmar digital Ns
3 Pronator teres
©D
4 Flexor carpi radialis

5 Palmaris Longus
6 Flexor digitorum superficialis
7 Flexor pollicus longus
8 Pronator quadratus
9 Flexor digitorum profundus
145 © A. L. Neill
eill
4
5
6
aN
3
3 1
6
5
nd
4
9
7 8 M
ma
7
5
rA
2
©D
© A. L. Neill 146
Median Nerve -Palmar digital branches

eill
Spinal Roots C5-8 T1 (medial + lat cords - ant
division)
NAMED BRANCHES Lateral branch, Common palmar digital
(terminal) branches, Proper palmar digital
branches (ppd), Palmar cutaneous
aN
branch (pc) (1-4)
Muscular branches to intrinsic hand muscles on the lateral
side of the hand (5-9)
Articular Branches to the finger and wrist joints
Cutaneous branches supplies the skin on the sides and
palm of resective digits (ppd)
nd
LESIONS supf wrist lacerations may result in
parasthesia of the thumb and 1st 2
fingers carpal tunnel syndrome
M weak wrist and finger flexion
Ape hand = cannot oppose the thumb
ma
cannot extend index and middle fingers

deep lacerations of wrist
combination of above
typical aetiologies wrist lacerations / work or suicide
parasuicide attempts carpal tunnel
syndrome
rA
associated lesions/ wrist injuries sport injuries

losses
1 Lateral branch
2 Common palmar digital branches
3 Proper palmar digital branches
©D
4 Palmar cutaneous branch

5 to Abductor Pollicus brevis
6 to Opponens Pollicus
7 Flexor pollicus brevis
8 to 2nd lumbrical
9 to 1st lumbrical
10 flexor retinaculum
147 © A. L. Neill
eill
4 7
10
aN
5
6 1
2
8
nd
7
9 M
ma
rA
3
©D
© A. L. Neill 148
Musculocutaneous Nerve
eill
Spinal Roots C5-7 (lateral cord - ant divisions)
Muscular branches flexors of the UL see also Radial N
Cutaneous branches lateral antebrachial cutaneous
branch to skin on anterolateral surface
aN
of arm forearm from elbow to thumb
inability to flex the elbow while
supinated loss of biceps tendon reflex
1 to Coracobrachialis
nd
2 to Biceps Brachii
3 to Brachialis
4 lateral antebrachial cutaneous branch
M 5 Brachial artery
ma
rA
©D
149 © A. L. Neill
eill
2
aN
nd
M
ma
5
1
3
rA
4
4
©D
© A. L. Neill 150
Obturator nerve
LP (emerges from the anteromedial border of Psoas major)
eill
Spinal Roots L2-4
Muscular branches ANTERIOR
to Adductor longus
to Gracilis
to Adductor Brevis
aN
to Pectineus (see also accessory obturator)
POSTERIOR
to Obturator externus
to Abductor magnus
±to Adductor brevis
Articular Branches to the hip and knee joints
nd
Cutaneous branches to groin / medial thigh
LESIONS inability to stabilze the hip / to
cross legs
associated lesions/ iatrogenic - cut in pelvic surgery
losses causes associated with ovarian cancer /
ma
cancerous groin nodes

referred pain from hip disease may
O present in this site (note femoral N is
also from L2-4 use this in testing
the lesion)
rA
1 to Adductor longus
2 to Gracilis
3 to Adductor Brevis
4 to Pectineus
5 to Obturator externus
6 to Abductor magnus
©D
8 hip joint (anterior)
9 to the knee joint (posterior)
151 © A. L. Neill
eill
aN
nd
8 4
5 1
ma
4 6
3
2 O
rA
1
7
©D
© A. L. Neill 152
Obturator Internus Nerve

(= nerve to obturator internus)
SP (ventral division)
eill
Spinal Roots L5, S1, S2
Nerve type motor
Muscular branches to Obturator internus (1)
to Gemellus superior (2)
aN
LESIONS weak external rotation of the thigh
typical aetiologies abdominal injuries - anything damaging
L4/5 discs rare to see isolated
associated lesions/ pelvic, back injuries degeneration
losses
nd
ma
O
rA
©D
153 © A. L. Neill
eill
aN
nd
2
ma
O
rA
1
©D
© A. L. Neill 154
Perforating Cutaneous Nerve

SP (anterior division)
eill
Spinal Roots S2, S3
Nerve type sensory
MAJOR BRANCHES Superficial peroneal
Lateral terminal branch (S1,2)
Medial terminal branch (S1,2)
aN
Cutaneous branches branches to skin over Gluteus
Maximus (1)
LESIONS parasthesia over area described above
typical aetiologies CP injuiries
associated lesions/
nd
losses
ma
P
rA
©D
155 © A. L. Neill
eill
aN
nd
ma
P
rA
1
©D
© A. L. Neill 156
Phrenic Nerve
CP (deep branches) see also Accessory Phrenic Nerve
eill
Spinal Roots C3, C4, C5*
Muscular branches to the Diaphragm including the crura (1-3)
Sensory branches supplies branches to the pleura over
aN
the Diaphragm and the Diaphragm
including the central tendon for
proprioception (1-3)
LESIONS unilateral - paralysis of ½ the
Diaphragm on the same side -
minimal loss of function
bilateral - complete paralysis of the
nd
Diaphragm - severe dyspnea;
coughing; sneezing; respiratory
muscles, atrophy of the diaphragm
typical aetiologies damage to cervical spinal roots and/or
cords trauma to the Chest
ma
iatrogenic surgical trauma in heart or

chest surgery
associated lesions/ deep neck injuries, pneumothorax,
P losses cardiac arrest
1 anterior / sternal branches of nerve

rA
2 anterolateral branches of nerve

3 posterior branches of the nerve
*C34&5 keeps the diaphragm alive

©D
157 © A. L. Neill
eill
3
aN
2
nd
ma
P
rA
©D
© A. L. Neill 158
Piriformis Nerve = nerve to piriformis

eill
Spinal Roots S1, S2
Nerve type motor
Muscular branches to Piriformis
aN
losses
1 to Piriformis
nd
2 Sciatic N
3 Greater Trochanter
ma
P
rA
©D
159 © A. L. Neill
eill
aN
nd
3
1
ma
P
rA
2
©D
© A. L. Neill 160
Posterior Femoral Cutaneous nerve

SP (dorsal + ventral divisions)
eill
Spinal Roots S1, S2
Nerve type sensory
Cutaneous branches Gluteal branches (cluneal)
Perineal branches
aN
branches to the back of the thigh and leg
LESIONS parathesia over the area described
typical aetiologies prolonged bicycle riding
associated lesions/ pelvic and back injuries
losses
nd
1 Gluteal branches
2 Perineal branches
3 branches to the back of the thigh and leg
4 gluteal line inferior border of Gluteus maximus
ma
P
rA
©D
161 © A. L. Neill
eill
aN
nd
1
4 2
ma
P
rA
3
©D
© A. L. Neill 162
Posterior Interosseous Nerve = Deep Radial nerve

from the Radial nerve
BP (Infraclavicular branches) see also Radial nerve
eill
Spinal Roots C5, C6, C7, C8, T1
Nerve type motor
Muscular branches to muscles on the back of the forearm
(1-9)
Articular Branches to the radioulnar joint
aN
to the interosseous membrane
to the RC IC and IMC joints
LESIONS weak extension/flexion of the Elbow
weak extension of the wrist
“wrist drop”
nd
weak supination parasthesia on the
back of the arm and forearm and lateral
surface of the arm
typical aetiologies BP injuries, broken arm, elbow injuries
ma
losses
1 to Ext Carpi Radialis Brevis

P 2 to Supinator
3 to Ext Digitorum
4 to Ext Digiti Minimi
rA
5 to Ext Carpi Ulnaris

6 to Ext Pollicus longus
7 to Ext Indicis
8 to Abductor Pollicus Longus
9 to Ext Pollicis brevis
©D
163 © A. L. Neill
eill
3
5
aN 8
nd
1
7 9
4
6
ma
3
P
rA
©D
© A. L. Neill 164
Pudendal nerve
eill
Spinal Roots S2, S3, S4*
MAJOR BRANCHES Inferior Rectal / Inferior Haemorrhoidal
Perineal
Posterior scrotal or Labial nerves
Dorsal nerve to the Penis (Clitoris)
Muscular branches to the levator ani, external anal sphincter
aN
& coccygeas, muscles of the
anterior perineum
Articular Branches to ligaments and joints of the pelvis -
pubic symphysis and ligaments
Cutaneous branches skin between the anus and the coccyx
and lining the anal canal below the
circumanal line - all areas of the labia
and scrotal areas / clitoris / penis
nd
including sensation of the urethra
LESIONS sagging of the pelvic floor / compromised
rectal and bladder control (particularly in
the female) cystocoele or rectocoele /
prolapse of uterus in older females /
anesthesia of the scrotal and labial area
ma
and lower anal canal / impotence

typical aetiologies pressure on the sacrum
associated lesions/ uterine prolapse / obesity / large
P losses abdominal mass
this nerve is often blocked during birth
this paralyses & numbs the associated
structures near the base of the vagina
rA
and rectal areas

1 Perineal branch
2 Posterior scrotal / labial nerves
3 Dorsal nerve to penis / clitoris
4 to the external anal sphincter and levator ani
©D
from perineal branch

5 superficial posterior scrotal/labial nerves
6 Deep posterior scrotal / labial nerves .
7 Transverse Perineal Superficialis
8 to Bulbospongiosus
9 to Ischiocavernosis
10 to Tranverse Perineal Profundus
11 to Sphincter Urethrae
*(S2, 3 & 4 keeps the penis from the floor)
165 © A. L. Neill
eill
9 10
6
aN
4
7
8
1
nd
7 3
9 11
2
10
ma
P
rA
4
4
©D
© A. L. Neill 166
Quaratus Femoris Nerve

= nerve to quadratus femoris
SP (ventral division)
eill
Spinal Roots L4, L5, S1
Nerve type motor
Muscular branches to Quadratus Femoris (1)
to Gemellus inferior (2)
aN
Articular Branches to the hip joint
losses
nd
ma
Q
rA
©D
167 © A. L. Neill
eill
aN
nd
2
ma
Q
rA
1
©D
© A. L. Neill 168
Radial Nerve
BP (Infraclavicular branches) see also Posterior interosseous
and Radial nerve - terminal branches
eill
Spinal Roots C5, C6, C7, C8, T1 post cord
NAMED BRANCHES Superficial Terminal (ST)
terminal Deep radial = Posterior interosseous
nerve (PIN)
aN
Muscular branches to muscles on the back of the arm and
forearm (3-9) see also Musculocutaneous nerve
Articular Branches to the elbow joint carpo/metacarpo/and
phalangeal joints of thumb to middle finger (ST)
Cutaneous branches supplies the skin on the back of the
arm and the lateral part of the forearm
and back of the wrist (1, 10-12) - and
nd
thumb to middle finger (ST)
LESIONS weak extension/flexion of the Elbow
weak extension of the wrist
“wrist drop”
back of the arm and forearm and
ma
lateral surface of the arm and thumb

and fingers
typical aetiologies BP injuries, broken arm
elbow injuries
losses
rA
R
1 Superficial terminal branch
2 Posterior interosseous N = Deep Radial N
3 Triceps long head
4 Triceps medial head
5 Triceps lateral head
©D
6 Anconeus
7 Brachioradialis
8 Extensor carpi radialis longus
9 Brachialis
10 Posterior Brachial cutaneous
11 Inferior lateral brachial cutaneous branch
12 Posterior antebrachial cutaneous branch
169 © A. L. Neill
eill
5
5
3
aN 9
nd
4
7
ma
6
rA
2 R
8
10 11
©D
12 1
© A. L. Neill 170
Radial Nerve - terminal branches

Superficial terminal (ST)
Posterior Interosseous nerve (PIN) = Deep Radial
eill
nerve
BP (Infraclavicular branches) see also Radial nerve
Spinal Roots C5, C6, C7, C8, T1 post cord

aN
Muscular branches 1-10 listed below
(all from posterior
interosseous nerve- PIN)
Articular Branches to all the distal forearm, wrist and hand
joints (PIN) to proximal and distal
phalangeal jts. (ST)
Cutaneous branches supplies the skin on the back of the
nd
(all from ST) arm and the lateral part of the forearm
and back of the wrist and thumb to
middle finger (10)
LESIONS weak extension of the wrist
“wrist drop”
ma

back of the arm and forearm and lateral
surface of the arm and thumb and first
2 fingers
typical aetiologies injuries below the elbow
rA
R losses
1 to Extensor Carpi Radialis Brevis

2 to Supinator
3 to Extensor Digitorum
4 to Extensor Digiti Minimi
©D
5 to Extensor Carpi Ulnaris

6 to Extensor Pollicus Longus
7 to Extensor Indicis
8 to Abductor pollicus longus
9 to Abductor Pollicus Brevis
171 © A. L. Neill
eill
3
aN
8
5
1
7 9
4
nd
6
3
10
ma
rA
10
©D
© A. L. Neill 172
Rectus Capitus Anterior (Nerve to)

CP (deep branches)
eill
Spinal Roots ±C1, C2, C3
Nerve Type motor
Muscular branches to Rectus Capitus Anterior (1)
aN
LESIONS loss/weakness of flexion of the head at
the atlanto-occipital jt part of a C2
radiculopathy
typical aetiologies whiplash injuries from automobile or
athletic injuries
nd
Rectus Capitus Lateralis (Nerve to)
CP (deep branches)
Spinal Roots ±C1, C2, C3

Nerve Type motor
ma
Muscular branches to Rectus Capitus Lateralis (2)

LESIONS loss of lateral flexion of the head on the
affected side (ipsilateral)
rA
R
©D
173 © A. L. Neill
eill
aN 1
nd
ma
rA
2 R
©D
© A. L. Neill 174
Sacral Muscular nerves

eill
Spinal Roots S4
Nerve type motor
MAJOR BRANCHES Peroneal (then to the anal sphincter)
Muscular branches to the levator ani and coccygeus
aN
Cutaneous branches skin between the anus and the coccyx
LESIONS sagging of the pelvic floor /
compromised rectal and bladder
control (particularly in the female)
cystocoele or rectocoele / prolapse of
uterus in older females
typical aetiologies pressure on the Sacrum
nd
associated lesions/ uterine prolapse / obesity / large
losses abdominal mass
1 Peroneal branch of S4
2 to Levator ani
ma
3 to Coccygeus
4 to the external anal sphincter
rA
S
©D
175 © A. L. Neill
eill
aN
4
1
3
nd
ma
2
rA
4
S
3
©D
© A. L. Neill 176
Sacral Plexus summary

eill
MAJOR BRANCHES from the Ventral Divisions only

1 N to Quadratus femoris
2 N to Obturator Internis
Perforating Cutaneous N
Pudendal N
aN
Sacral muscular Ns
MAJOR BRANCHES from Dorsal Divisions only

3 N to Piriformis
4 Superior gluteal N
5 Inferior gluteal N
nd
MAJOR BRANCHES from both Divisions
6 Posterior femoral cutaneous N
7 Sciatic N
8 Sciatic N - Tibial division
9 Common Peroneal N = Tibialis anterior N
ma
other Cutaneous branches

10 Sural N
11 Median Calcanean N
12 Medial plantar N
13 Lateral plantar N
14 Lateral Sural N
rA
15 Medial branch of deep peroneal N

16 Superficial peroneal branches
S
Lesions from specific Nerve roots
L4 lumbosacral trunk - weak hip, leg adduction / weak knee
extension / “foot drop” (tibialis anterior) / parasthesia to
leg and foot
©D
L5 Trendelenburg’s sign / weak knee flexion / foot drop =

weak dorsiflexion of foot / weak eversion of foot / weak
toe extension / parasthesia of the foot dorsum and soul
S1 weak hip extension / weak plantar flexion and toe fexion
S2/S3 weak inversion of foot / weak flexion of toes /
parasthesia of back of leg / loss of control of pelvic floor
and anal sphincter 9pudendal nerve)
177 © A. L. Neill
eill
4
5
aN
1
3 6
nd
2
9
8
ma
7
rA
6
11 10 S
13
12 14
©D
16
10
15
12
© A. L. Neill 178
Scaleni and Longus Colli (Nerves to)

see also Longus Colli nerve (CP) and Scalenus Medius nerve (CP)
eill
Spinal Roots ±C4, C5, C6, C7 C8
Nerve type motor
Muscular branches to the Scaleni muscles and Longus Colli
aN
LESIONS ± TOS with resultant muscle spasm in
injury innervation is ispilateral hence
unilateral injuries affect the same side -
weakness of neck flexion and weak
contralateral rotation of the neck
(loss limited by synergism with
nd
Sternocleidomastoid)
losses BP with injury to this N
ma
1 to Scalaneus anterior
2 to Scalenus Medius
3 to Scalenus Posterior
4 to Longus Colli
rA
S
©D
* TOS = Turn to opposite side

179 © A. L. Neill
eill
aN
2
4
nd
3
ma
1
rA
S
©D
© A. L. Neill 180
Scalenus Medius (Nerve to)

CP (deep lateral branches)
eill
Spinal Roots C3, C4, C5-C8
Nerve type motor
Muscular branches to Scalenus Medius
aN
LESIONS ± TOS innervation is ispilateral hence
unilateral injuries affect the same side
(weak neck flexion and turning, function
may be taken over by SCM.
synergism with Trapezius and SCM
nd
limits functional loss
losses BP with injury to this N
ma
rA
S
©D
* TOS = Turn to opposite side

181 © A. L. Neill
eill
aN
nd
ma
rA
S
©D
© A. L. Neill 182
Sciatic nerve
LP SP (dorsal + ventral divisions)
eill
Muscular branches hamstrings, all the muscles of the leg
and foot and adductor magnus
Articular Branches to the hip joint
Cutaneous branches to the back and sides the thigh and all
aN
of the leg and foot
LESIONS complete - paralysis of leg and foot
with parasthesia in the leg and foot /
weak hip adduction DD injuries of
common peroneal only
typical aetiologies car accidents, hip trauma, spinal
nd
injuries, L4/5 disc damage
associated lesions/ pelvic and back injuries
losses
1 Tibial division through ventral root

ma
2 Fibular division through dorsal root (common peroneal)

3 to Biceps femoris (short head)
4 to biceps femoris (long head)
5 to Semitendinous
6 to Semimembranous
7 to Adductor magnus
rA
S
©D
183 © A. L. Neill
eill
7
aN
nd
4 5
ma
5 3 6
6
7
6
rA
3 5 S
7
2
©D
© A. L. Neill 184
Second Thoracic Intercostal Nerve
Spinal Roots T2 thoracic ventral ramus
eill
NAMED BRANCHES Anterior Cutaneous branch (ac) (1)
-terminal Lateral Cutaneous branch /
intercostobrachial nerve (ic) (2)
Muscular branches to the intercostal muscles (3,4,7) and
accessory muscles of respiration
aN
joints (ac)
Cutaneous branches supplies skin over the 2nd intercostals
space (ac) supplies skin to axilla floor
/upper half of arm on medial and
posterior side (ic)
nd
LESIONS loss of sensation in areas described - in
particular underarm numbness
typical aetiologies iatrogrenic - in breast cancer surgery
associated lesions/ surgery in thoracic region as in
losses mastectomies
ma

2 Lateral Cutaneous branch / intercostobrachial nerve
3 to Internal intercostal
4 to External intercostal
5 to Serratus posterior superior
rA
6 to Tranverse thoracis
7 to intercostals intimi
S
©D
185 © A. L. Neill
eill
4 5
3 aN
nd
7
2 1 2
2
ma
6
rA
3
4 S
©D
© A. L. Neill 186
Spinal Nerves - Cervical
Spinal Roots C1-C8*
eill
LESIONS see sensory / motor map of the SNs
typical aetiologies VC damage accidents
1 dorsal rootlets = dorsal root

2 dorsal ramus
aN
3 dorsal root ganglion
4 ventral ramus
5 grey rami communicans
6 sympathetic chain imput from thoracic Ns
7 vertebral artery
8 white matter - myelinated axons
nd
9 grey matter - nerve cell bodies - unmyelinated nerve
processes
10 dura mater
11 arachnoid mater
12 spinous process of the VB
ma
*note 8 cervical Ns and 7 cervical vertebrae C8 exits b/n C7 and T1 C2-7 b/n C1-C7.
rA
S
©D
187 © A. L. Neill
eill
aN
6
5
7
4
nd
9
8
3
ma
10 2
1
11
rA
12
©D
© A. L. Neill 188
Spinal Nerves - Lumbar
Spinal Roots L1-L5*
eill

2 dorsal ramus
aN
4 ventral ramus
4A ventral root
6 sympathetic chain
7 vertebral artery
nd
8 white matter - myelinated axons t
processes
10 dura mater
11 arachnoid mater
ma
note the SC finishes in the adult at L1/2, hence the SN may exit at a level lower
than their Spinal roots the roots running down in the VC until their exit - L1 - arises
at the level of T10, but exits b/n T12/L1 / L2-3 arise at T11 / L4-5 arise at T12
*SC terminates L1/2 in adults L3/4 in children.

rA
S
©D
189 © A. L. Neill
eill
aN
9
1
8
6
nd
4A 4
3
ma
2
rA
10 S
11
©D
© A. L. Neill 190
Spinal Nerves - Sacral and coccygeal
Spinal Roots S1-Co1
eill

2 dorsal ramus
aN
4 ventral ramus
6 sympathetic chain
7 vertebral artery
nd
processes
10 dura mater
11 arachnoid mater
ma
13 cauda equina
14 sacrum with S1-5 N foraminae
rA
S
©D
191 © A. L. Neill
eill
7
aN
nd
13
14
ma
14
14
14 1
rA
S
14
14 4
©D
15
© A. L. Neill 192
Spinal Nerves - Thoracic
Spinal Roots T1-T12*
eill

2 dorsal ramus
aN
4 ventral ramus
4A ventral root
5 grey and white rami communicans
6 sympathetic chain
7 vertebral artery
nd
processes
10 dura mater
11 arachnoid mater
ma

13 Aorta
*SNs T1-12 exit b/n VBs T1-L1

rA
S
©D
193 © A. L. Neill
eill
6
aN
5
13 4A
4
nd
ma
4
3
rA
1
3 S
©D
© A. L. Neill 194
Sternocleidomastoid (Nerve to)

CP (deep branches) see also Trapezius (Nerve to)
eill
Spinal Roots + Cranial Ns Cranial XI (Accesssory) C1-C5
Muscular branches to the Sternocleidomastoid (1)
to Trapezius (2)
aN
LESIONS unilateral - cannot rotate head to
the affected side, cannot shrug
ipsilateral shoulder bilateral -
cannot rotate head or shrug
shoulders, cannot lift chin - head
drops forwards
nd
typical aetiologies intracranial damage to Accessory
nerve as in stroke
head trauma affecting jugular
foramen
associated lesions/ any injury to the jugular foramen
ma
losses may involve other cranial Ns

particularly IX, X, and XII*
*these syndromes include

Vernet’s = lesions of IX-XI
Villaret’s = lesions of IX-XII + VII
Jackson’s = lesions of IX, XI & XII
rA
Schmidt’s = lesion in nucleus ambiguous (XI) affecting swallowing & phonation
S
Discussed in gretaer detail in the A to Z of the brain
©D
195 © A. L. Neill
eill
aN
2
nd
1
ma
rA
S
©D
© A. L. Neill 196
Subclavius Nerve (Nerve to Subclavius)

see also Accessory nerve (CP)
eill
Spinal Roots C5, C6
Nerve type motor
Muscular branches to Subclavius
aN
LESIONS none unless the Accessory
Phrenic nerve is injured -
diaphragm weakness
typical aetiologies broken clavicle (collar bone)
associated lesions/losses
nd
ma
rA
S
©D
197 © A. L. Neill
eill
aN
nd
ma
rA
S
©D
© A. L. Neill 198
Subcostal Nerve
part of the LP (twelfth thoracic nerve)
eill
Spinal Roots T12 (ventral ramus)
Muscular branches to the muscles of the abdominal
wall (1-6)
aN
Articular Branches to the 12th costovertebral joint (10)
Cutaneous branches to the skin overlying pubis, greater
trochanter and gluteal area (8-9)
LESIONS weakness and bulging of the lower
abdominal wall (Beever’s sign)
typical aetiologies spinal injuries
associated lesions/losses any injuries involving the SC and
nd
VC , iatrogenic laminectomy and
other operations in this area.
1 to Quadratus lumborum
2 to Transverse abdominus
ma
3 to Internal oblique
4 to External oblique
5 to Rectus Abdominus
6 to Pyramidalis
7 Inguinal ligament
8 lateral Cutaneous N
rA
9 anterior Cutaneous N
S 10 to costovertebral joint
©D
199 © A. L. Neill
10
eill
4 3
1
2
aN
nd
6 5
8
ma
7 8
9 9
rA
S
©D
© A. L. Neill 200
Suboccipital Nerve (first dorsal ramus)
eill
Muscular branches to the capitus muscles in the
head and neck
Articular Branches to the craniovertebral joints
aN
Cutaneous branches to the dorsum neck and head
crosses and supplies similar area
to the lesser occipital nerve
typical aetiologies whiplash injuries to the neck in
car accidents
nd
ma
1 to Rectus Capitus posterior major

2 to Rectus Capitus posterior minor
3 to Obliquus Capitus superior
4 to Obliquus Capitus inferior
5 to Semispinalis Capitus
rA
6 Medial branch
7 Lateral branch
S
©D
201 © A. L. Neill
eill
1
aN 3
nd
2
ma
6
4
7
5
rA
S
©D
© A. L. Neill 202
Superficial Peroneal nerve

LP/SP (dorsal division)
eill
Spinal Roots L4, L5, S1, S2
Named branches medial (1)
lateral (2)
dorsal digital (3)
Muscular branches to Peroneus longus (4) and brevis (5)
aN
LESIONS weak eversion of the foot /
unopposed inversion of the foot
parasthesia on the lateral side of
the lower leg
nd
typical aetiologies abdominal injuries - anything
damaging L4/5 discs
iatrogenic pudendal block etc
incorrect rare to see isolated
ma
1 medial
2 lateral
3 dorsal digital
4 to Peroneus longus
5 to Peroneus brevis
rA
S
©D
203 © A. L. Neill
eill
4
5
aN 4
nd
4
ma
1
2
rA
S
©D
© A. L. Neill 204
Superior Gluteal nerve

eill
Spinal Roots L4, L5, S1
Nerve type motor
Muscular branches superior and inferior branches to
muscles in the buttock and the
hip abductors (1-5)
Articular Branches to the sacroiliac joint
aN
LESIONS Trendelenburg’s sign = dropping
1
of pelvis to opposite side when

elevating leg /instability of core
when walking etc.
typical aetiologies abdominal injuries - anything
nd
damaging L4/5 discs iatrogenic
pudendal block etc incorrect rare
to see isolated
ma
1 superior branch to gluteus medius

2 superior branch to gluteus minimus
3 inferior branch to gluteus medius
4 inferior branch to gluteus minimus
5 inferior branch to tensor fascia lata
6 Sciatic nerve
rA
S
©D
205 © A. L. Neill
eill
aN
1
3
2
5
nd
4
1
ma
9
rA
6 S
©D
© A. L. Neill 206
Supraclavicular Nerve
eill
Spinal Roots C3, C4
Nerve type sensory
Cutaneous branches skin above the clavicle anterior (1)
aN
lateral (2) and posterior (3)
nd
ma
rA
S
©D
207 © A. L. Neill
eill
aN
nd
1
ma
1
rA
3 S
©D
© A. L. Neill 208
Suprascapular Nerve
eill
Spinal Roots C5, C6
Nerve type motor ±sensory
Muscular branches to the dorsal muscles around the
Scapula (1, 2)
Articular Branches to the shoulder joints (3, 4)
Cutaneous branches to the skin over the Deltoid
aN
LESIONS weak abduction and lateral
rotation of the Humerus atrophy
of muscles around the Scapula
typical aetiologies Injuries to the BP
injuries to Clavicle
associated lesions/losses BP injuries, neck injuries
nd
1 to Supraspinatus
2 to Infraspinatus
3 to Glenohumeral joint
4 to Acromioclavicular joint
ma
5 Clavicle
6 Acromian
7 spine of Scapula
rA
S
©D
209 © A. L. Neill
eill
4 1
aN
3 7
2
nd
6
4
2
ma
1
5
rA
S
©D
© A. L. Neill 210
Third Dorsal ramus
eill
Muscular branches to the capitus muscles in the neck
and head (3-5)
Articular Branches to the atlanto-occipital and atlanto-
axial joints (6)
aN
Cutaneous branches to the dorsum neck and head to
the level of the ear
typical aetiologies whiplash injuries to the neck in car
accidents
nd
ma
1 Medial branch
2 Lateral branch
3 to Splenius capitus
4 to Semispinalis capitus
5 to Longissimus capitus
rA
T
©D
211 © A. L. Neill
eill
aN
1
6
nd
3
2
ma
5
rA
T
©D
© A. L. Neill 212
Thoracic Nerves
Summary
eill
do not form plexi - remain segmental, ventral rami do not
fuse and do not communicate form the intercostal Ns (IC Ns)
T12 - passing under the 12th rib = Subcostal N = Twelfth

thoracic N
aN
T6-12 = thoraco-abdominal Ns
= lower thoracic IC Ns
T1±T2 = intercostobrachial Ns (contribute to the BP)

supply the muscles and skin of the abdomen and
thorax
nd
T8-12 auxillary supply to the diaphragm dorsal rami supply
the muscles and skin of the backsupply the intrinsic
muscles of the back supply the intervertebral discs
and vertebral joints
ma
1 IC Ns to Rectus Abdominus
2 abdominal wall muscles segmentally supplied by the
IC Ns.
3 inguinal ligament
rA
4 Pubic Symphysis
5 ASIS = anterior superior iliac spine
6 costal cartilages
T 7 IC spaces
8 IC muscles
©D
213 © A. L. Neill
eill
aN
8
7
nd
ma
1 6
2
rA
T
5
©D
3
4
© A. L. Neill 214
Thoracodorsal Nerve
= Middle Subscapular nerve
eill
Nerve type motor
Muscular branches to Latissimus Dorsi
aN
LESIONS weak adduction, extension and
medial rotation of the Humerus
typical aetiologies BP injuries, clavicular injuries
nd
ma
rA
T
©D
215 © A. L. Neill
eill
aN
nd
ma
rA
T
©D
© A. L. Neill 216
Tibial nerve
SP (ventral divisions) from sciatic N
eill
Muscular branches to the back of the leg and soul of the
foot
Articular Branches to the knee and ankle joints
Cutaneous branches to the skin on the sole and medial heel
aN
LESIONS uncommon due to deep placement of
the N cannot flex or abduct or adduct
toes toes / cannot stand on tip toes /
weak knee flexion / weak plantar
flexion
some parasthesia of the foot and toes
nd
typical aetiologies car accidents, leg - knee trauma, L4/5
disc damage
associated lesions/ leg and knee injuries
losses
ma
1 Medial Sural Cutaneous nerve

2 to Gastrocnemius (lateral head)
3 to Gastrocnemius (medial head)
4 to Plantaris
5 to Soleus
6 to Popliteus
rA
7 to Tibialis posterior
8 to knee joint
9 to tibiofibular joints
T 10 Medial calcaneal cutaneous nerve
11 Medial plantar nerve
12 Lateral plantar nerve
©D
13 Sural nerve
14 to flexor digitorum longus
15 to flexor hallicus longus
217 © A. L. Neill
1 4
3
2 13
eill
5
5
6
7
aN
7 14 15
10
nd
7 12
11 14
15
ma
6
15
3 4 14
1 2
rA
8 10
9 7
12 T
14
5
©D
6 11
9
© A. L. Neill 218
Trapezius (Nerve to)

CP (deep branches)
see also Sternocleidomastoid (Nerve to)
eill
Spinal Roots + Cranial Ns Cranial XI (Accesssory) C3, C4
(proprioceptive)
Muscular branches to Trapezius
aN
LESIONS unilateral - dropped ipsilateral
shoulder ; winged* scapula
bilateral - cannot properly move
arms at all particularly not over 20º
compromising the function of
nd
Deltoids, Rhomboids, Serratus
and Spinati muscles
typical aetiologies damage to Accessory nerve in the
posterior triangle
iatrogenic eg when sampling
ma
regional lymph nodes in biopsy

associated lesions/losses unable to assess injuries to
brachial plexus with injury to this N
*winged scapula definition = inability of the upper scapula to adhere to the

posterior chest wall flails away from the body and destabilizes the scapula
rA
and its associated muscles
T
©D
219 © A. L. Neill
eill
aN
nd
ma
rA
T
©D
© A. L. Neill 220
Ulnar Nerve
eill
Spinal Roots C8, T1 (medial card - ant division)
NAMED BRANCHES Dorsal (Do) (1)
(terminal) Superficial (ST) (2)
Deep (De) (3)
Muscular branches to Flexor Carpi Ulnaris (4)
aN
to Flexor Digitorum Profundus (5)
to Palmaris Brevis (ST)
to all the intrinsic hand muscles (De)
Articular Branches to the elbow joint
to the joints in the little and ring fingers (Do)
to some of the wrist joints (De)
nd
Cutaneous branches supplies the palmar skin on the ulnar
side and the little and ring fingers (ST) F
LESIONS weak flexion and ulna deviation of the
wrist “clawed hand”
wasting of Palmaris brevis in the
ma
Hypothenar eminence (ST)

parasthesia on the ulna side of the
hand and fingers described above
typical aetiologies BP injuries, broken arm
elbow injuries
rA
losses
1 Dorsal branch (terminal)

2 Superficial branch (terminal)
3 Deep branch (terminal)
U 4 to Flexor carpi ulnaris
©D
5 to Flexor digitorum profundus (medial half)

6 Palmar cutaneous branch
7 1st dorsal digital branch
8 2nd dorsal digital branch
9 3rd dorsal digital branch
221 © A. L. Neill
eill
1 9
aN
7
4
nd
5
1
ma
1
6
2 7
rA
8
3
U
©D
© A. L. Neill 222
Ulnar Nerve -
Deep Terminal branch (De)
eill
Spinal Roots C8, T1 (medial card - ant division)
Muscular branches to Abductor digiti minimi (1)
to Flexor Digiti Minimi (2)
aN
to Opponens digiti minimi (3)
to Dorsal interossei (4)
to Palmar interossei (5)
to 3rd and 4th Lumbricals (6)
to Adductor Pollicus (7)
Articular Branches to some of the wrist joints
nd
LESIONS inability to spread fingers and
extend little finger wasting and
paralysis of the hypothenar
muscles no thumb adduction
typical aetiologies elbow injuries
ma
associated lesions/losses UL injuries

rA
U
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223 © A. L. Neill
eill
8 aN 3
2
1
nd
5
ma
6
7
4
4
5
4
4
rA
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© A. L. Neill 224
Upper Subscapular Nerve

see also Lower Subscapular Nerve
eill
Nerve type motor
Muscular branches to Subscapularis (superior)
aN
LESIONS weak medial rotation of the
Humerus
typical aetiologies BP injuries
nd
ma
rA
U
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225 © A. L. Neill
eill
aN
nd
ma
rA
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© A. L. Neill 226
eill
aN
nd
ma
rA
©D
227 © A. L. Neill
Dr. A. L. NEILL
www.amandasatoz.com
0410 018 681
fax: 61 2 9365 1000

The A To Z of Peripheral Nerves

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A to Z Peripheral Nerves™6B:A to Z Nerves 14/07/09 8:58 AM Page A

The A to Z of the Special Senses

The A to Z of Peripheral Nerves

The A to Z of Anatomical, Medical and Histological terms

The A to Z of Peripheral Nerves

How to use this book

have been cross-referenced so that the nerve may be found with

on format or inclusions will be gratefully received.

ISBN 1 74138 166 5

The A to Z of Peripheral Nerves

Guide to Anatomical Planes and Relations 27

The Brachial plexus - overview 65

The A to Z of Peripheral Nerves

DH = dorsal horn (of the spinal cord)

fl. = flexor (as in muscle to flex across a joint)

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

Common terms in Neurology

Canal tunnel / extended foramen as in the carotid canal, at the base of

the skull adj canular (canicular - small canal)

(Orbital fossa-Orbital cavity).

The A to Z of Peripheral Nerves

Crest Prominent sharp thin ridge of bone formed by the attachment of

Efferent outgoing as in Motor nerves - see Motor

Fascicle bundle, as in bundle of fibres in each PN there are a number of

Ganglion collection of N cell bodies outside the SC (also isolated islands of N

The A to Z of Peripheral Nerves

Impulse a depolarization of the N membrane resulting in the promulgation

Lacerum something lacerated, mangled or torn eg foramen lacerum small

Magnum large pl magna

Multipolar referring to a neuron which has many dendrites + 1 axon (see

“Nerve” (N) N cell (neuron) capable of transmitting or firing off a signal

The A to Z of Peripheral Nerves

Pars A part of.

in the mandibular process, in neurology the nerve process either

Ramus branch pl. Rami/branches - 2 main branches Ventral supplying all

structures in front of the SC and Dorsal supplying al structures

The A to Z of Peripheral Nerves

Sagittal an arrow, the sagittal suture is notched posteriorly, making it look

(where the neurotransmitter is released) / post synaptic after the

Telodendria axon terminal branches

Trunk when SNs join together as large combined large Ns to supply

The A to Z of Peripheral Nerves

The Nervous system

PROTECTIVE CENTRAL NERVOUS PERIPHERAL NERVOUS

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

The Nerve Cells

1 nucleus and nucleolus

13 myofibril of skeletal muscle

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

Structure and Substructure of

A band - myosin to myosin filaments

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

9 skeletal muscle nuclei

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

The Spinal nerves (SN) = NERVES which

Cervical 8 (Nerve - C2 exits b/n vertebrae C1 & C2 and - nerve C8 b/n

The A to Z of Peripheral Nerves

The A to Z of Peripheral Nerves

7 dorsal root - pure sensory