Cervical Plexus Formation & Branches PDF

ICHEL, VISITACION BY: ORJALO, P CERVICAL PLEXUS  FORMATION The cervical plexus, formed by the C1-C4 nerves, lies deep in the sternocleidomastoid muscle. These nerves communicate with each other and receive sympathetic fibers, known as gray rami communicantes, from the superior cervic...

ICHEL, VISITACION BY: ORJALO, P CERVICAL PLEXUS  FORMATION The cervical plexus, formed by the C1-C4 nerves, lies deep in the sternocleidomastoid muscle. These nerves communicate with each other and receive sympathetic fibers, known as gray rami communicantes, from the superior cervical ganglion, supporting nerve function in the neck region. FORMATION OF THE CERVICAL PLEXUS Nerves Involved: C1-C4 cervical nerves Location: Deep to the sternocleidomastoid muscle, anterolateral to levator scapulae Nerve Communication: C1-C4 nerves communicate in a superior- inferior direction Sympathetic Contribution: Gray rami communicantes from the superior cervical ganglion Supplies sympathetic fibers to the cervical plexus  FIGURE OF CERVICAL PLEXUS FORMATION  SUPERFICIAL SERIES Lesser Occipital nerve (C2) Great Auricular Nerve (C2,C3) Transverse Cervical Cutaneous Nerve (C2,C3) Supraclavicular nerve (C3,C4)  MEDIAL SERIES Rectus Capitis Rectus Capitis Lateralis Anterior Lesser Occipital nerve (C2) Hyoglossal Nerve Great Auricular Nerve (C2,C3) Geniohyoid Transverse Cervical Descendens Hypoglossi Cutaneous Nerve Thyrohyoid (C2,C3) Sup. belly of omohyoid Supracla Ansa Cervicalis vicular nerve Sternohyoid (C3,C4) Sternothyroid Phrenic Nerve Descendens (C3,C4, C5 Cervicalis Inf. belly of omohyoid  LATERAL SERIES Rectus Capitis Rectus Capitis Lateralis Anterior Lesser Occipital nerve (C2) Hyoglossal Nerve Great Auricular Nerve (C2,C3) Sternomastoid (C2) Descendens Geniohyoid Transverse Cervical Hypoglossi Cutaneous Nerve Thyrohyoid (C2,C3) Trapezius (C3,C4) Levator Scapulae (C3,C4) Sup. belly of omohyoid Scalenus Medius Supracl Ansa Cervicalis (C3,C4) avicular nerve Sternohyoid (C3,C4) Sternothyroid Descendens Phrenic Nerve Cervicalis Inf. belly of omohyoid (C3,C4, C5  BRANCHES OF CERVICAL PLEXUS  BRANCHES The cervical plexus consists of sensory (cutaneous) and motor branches Sensory (Cutaneous) Branches: These innervate the skin of the anterolateral neck, superior thorax, and scalp between the auricle and external occipital protuberance. Emerge around the posterior border of the sternocleidomastoid muscle, a region known as the nerve point of the neck. Lesser occipital nerve (C2) Great auricular nerve (C2-C3) Transverse cervical nerve (C2-C3) Supraclavicular nerves (C3-C4)  BRANCHES Motor Branches: The motor branches form the ansa cervicalis (C1-C3) and the phrenic nerve (C3-C5), with additional branches to prevertebral, sternocleidomastoid, and trapezius muscles. Ansa Cervicalis: Sternohyoid (C1-C3) Sternothyroid (C1-C3) Geniohyoid (via hypoglossal, C1) Omohyoid (C1-C3) Thyrohyoid (via hypoglossal, C1) Phrenic Nerve (C3, C4, C5)  SENSORY BRANCHES LESSER OCCIPITAL NERVE Origin: Formed by the second cervical nerve (C2). Pathway: Courses to supply the skin of the neck and scalp posterosuperior to the clavicle. Innervation: Skin in the posterosuperior region of the clavicle.  SENSORY BRANCHES GREAT AURICULAR TRANSVERSE NERVE (C2, C3) CERVICAL NERVE Origin: From the C2 and C3 spinal nerves. Origin: Formed by C2 and C3 nerves. Pathway: Courses upwards diagonally, crossing the Pathway: Curves around the middle of the sternocleidomastoid muscle and extending to the posterior border of the sternocleidomastoid parotid gland. muscle, crossing deep to the platysma. Innervation: Skin over the parotid gland. Innervation: Skin covering the anterior triangle of Posterior aspect of the auricle. the neck. Skin from the angle of the mandible to the mastoid process.  RANCHES SENSORY B Supraclavicular Nerves (C3, C4) Origin: From C3 and C4 spinal nerves, emerging as a common trunk under the sternocleidomastoid muscle. Branches: Divides into medial, intermediate, and lateral branches. Innervation: Skin of the neck and shoulder, with some branches crossing the clavicle.  SUMMARY OF SENSORY BRANCHES Lesser Occipital Nerve: C2, innervates the neck and scalp region. Great Auricular Nerve: C2, C3, innervates the area around the parotid gland and auricle. Transverse Cervical Nerve: C2, C3, supplies the anterior neck. Supraclavicular Nerves: C3, C4, supply the skin over the neck and shoulder.  MOTOR BRANCHES ANSA CERVICALIS Origin: Arises from C1-C3 nerves Function: Controls the infrahyoid muscles in the neck. Sternohyoid: Lowers the hyoid bone during swallowing. Sternothyroid: Lowers the larynx after swallowing. Omohyoid: Lowers the hyoid bone and stabilizes it during swallowing and speech. Thyrohyoid: Elevates the larynx or lowers the hyoid bone.  MOTOR BRANCHES PHRENIC NERVE Origin: Arises mainly from C4, with input from C3 and C5 Function: Controls the diaphragm. It also provides sensation to the diaphragm, mediastinal pleura, and heart's pericardium. DISEASES AFFECTING THE CERVICAL PLEXUS  DISEASES CERVICAL RADICULOPATHY CERVICAL SPONDYLOSIS Description: Nerve root compression Description: Age-related degeneration of Causes: Herniated discs, osteophytes cervical vertebrae Symptoms: Pain, weakness, numbness Causes: Affects nerve function, leading to pain and stiffness  DISEASES TRAUMA INFECTIONS Impact: Injuries from accidents causing nerve Conditions: Meningitis and other infections damage Symptoms: Nerve dysfunction, pain Examples: Whiplash, sports injuries TUMORS Types: Benign or malignant growths Effects: Compression or invasion of cervical nerves CLINICAL NOTES  CLINICAL NOTES PHRENIC NERVE SEVERANCE Overview: Phrenic nerve controls the diaphragm. Severance of this nerve leads to diaphragm paralysis. Causes: Nerve block temporary paralysis from anaesthetic injected near the nerve. Surgical crush longer paralysis lasting weeks, often following hernia repair.  CLINICAL NOTES CERVICAL PLEXUS BLOCK Overview: a regional anaesthesia technique. anaesthetic injected along the sternocleidomastoid muscle at the nerve point of the neck. Phrenic Nerve Impact: can also cause diaphragm paralysis. not recommended for patients with lung or heart conditions due to this risk. THANK YOU!  GROUP 2 BRACHIAL PLEXUS CAYANAN, ELVA, PENING, REYES  WHAT IS BRACHIAL PLEXUS? A network of nerves that provides motor and sensory functions to the upper limb. Location: Passes from the neck to the axilla. Originates from spinal cord levels C5 to T1. WHAT IS BRACHIAL PLEXUS?  STRUCTURE OF THE BRACHIAL PLEXUS PARTS: Roots - C5, C6, C7, C8, T1 Trunks - Upper (C5-C6), Middle (C7), Lower (C8-T1) Divisions - Each trunk splits into anterior and posterior divisions. Cords - Lateral, Posterior, Medial Branches - Musculocutaneous, Axillary, Radial, Median, Ulnar nerves  MNEMONICS ROOTS, TRUNKS, DIVISIONS, CORDS, BRANCHES REMEMBER TO DRINK COLD BEER  ROOTS Root- Brachial Plexus The c5 to t1 ventral remise C5,C6,C7,C8 and t1 Location of Root - Behind scalenus anterior, emerge between scalene muscle ROOTS Root- Brachial Plexus C5-T1 Ventral rami The roots of the brachial plexus are the same thing as the ventral ramus ROOTS Root- Brachial Plexus C5-C8 roots course above associated vertebrae ROOTS ROOTS Dorsal scapular n., Lev scap, Rhomdoid maj. the roots include one called the dorsal scapular nerve that innervates or levator scapulae and rhomboid muscles ROOTS Long thoracic n., Serratus anterior m. The long thoracic nerve that innervates or serratus anterior so there is the c5,c6,c7 ROOTS Each Brachial Plexus root Have an associated DERMATOME  ROOTS THING TO REMEMBER IS THIS: -Sensory neurons in each upper limb dermatome course to an associated brachial plexus root Each brachial plexus root have an associated myotome MYOTOME isa movement associated with specific spinal nerve level ROOTS Each Brachial Plexus root Have an associated MYOTOME C5 root it is associated. with a deduction of the shoulder ROOTS Each Brachial Plexus root Have an associated MYOTOME C6 root associated with flexion of the elbow. ROOTS Each Brachial Plexus root Have an associated MYOTOME C7 root extension of the elbow ROOTS Each Brachial Plexus root Have an associated MYOTOME C8 root finger flexion ROOTS Each Brachial Plexus root Have an associated MYOTOME T1 root finger Abduction  ROOTS THING TO REMEMBER: This motor neurons from each Bp root course to an associated Upper Limb myotome with an associated movement  TRUNKS Formed by the convergence of the roots. COMPONENTS: Upper trunk - Formed by C5 and C6 Middle trunk - Formed by C7 Lower trunk - Formed by C8 and T1  TRUNKS SUPRASCAPULAR NERVE branches of the upper trunk innervate more of the scapular region. SUBCLAVIAN NERVE branches of the upper trunk innervate the subclavius muscle.  TRUNKS SUPRASCAPULAR NERVE Runs from superior to posterior Dips under the spine of the scapula before spreading out onto the posterior side.  TRUNKS SUPRASCAPULAR NERVE Innervates the supraspinatus muscle and Infraspinatus muscle.  TRUNKS SUBCLAVIAN NERVE Innervates the subclavius muscle.  DIVISIONS The trunks give rise to anterior and posterior divisions.  DIVISIONS 3 Anterior Divisions 3 Posterior Divisions  DIVISIONS Anterior Division ventral muscle mass (flexors) Posterior Division dorsal muscle mass (extensors) DIVISIONS  DIVISIONS Function: Distribute nerve signals to different parts of the arm.  CORDS Comes after Divisions Named in relation to the Axillary Artery  CORDS Total of 3 Cords: Lateral Cord Medial Cord Posterior Cord  CORDS CORD BRANCHES MUSCLE Lateral Pectoralis LATERAL pectoral Major nerve  CORDS CORD BRANCHES MUSCLE Lateral Pectoralis LATERAL pectoral Major nerve CORDS CORD BRANCHES MUSCLE/SKIN Medial pectoral Pectoralis MEDIAL nerve major and minor Medial cutaneous Medial aspect MEDIAL nerve of the arm of the arm Medial cutaneous Medial aspect nerve of the of the forearm forearm CORDS CORD BRANCHES MUSCLE Medial pectoral Pectoralis MEDIAL nerve major and minor Medial cutaneous nerve of the arm Medial cutaneous nerve of the forearm  CORDS CORD BRANCHES MUSCLE Upper MEDIAL subscapular nerve Subscapularis Lower POSTERIOR subscapular nerve Thoracodorsal Latissimus dorsi nerve CORDS CORD BRANCHES MUSCLE Upper MEDIAL subscapular nerve Lower subscapular nerve Thoracodorsal Latissimus dorsi nerve  BRANCHES Known as the terminal branches of the brachial plexus Cords give rise to the branches BRANCHES formed by the cords lateral cord posterior cord medial cord BRANCHES Lateral cord gives rise to the musculocutaneous nerve BRANCHES Musculocutaneous nerve: innervates our biceps brachii, brachialis, and coracobrachialis muscle BRANCHES Musculocutaneous nerve: provides sensation to the lateral cutaneous nerve of the forearm BRANCHES Posterior cords give rise to the axillary nerves and radial nerves BRANCHES Axillary nerve: innervates our deltoid and teres minor muscles, BRANCHES Axillary nerve: a teres minor is part of the rotator cuff that provides sensation to the lateral cutaneous nerve of the arm BRANCHES Radial nerve: innervates our triceps and forearm extensor muscles BRANCHES Radial nerve: provides sensation to superficial cutaneous branch BRANCHES Medial cord goes primarily to the ulnar nerves BRANCHES Ulnar nerve: innervates the flexor carpi ulnaris and half of the flexor digitorum profundus BRANCHES Ulnar nerve: the intrinsic hand muscles provides sensation to the superficial cutaneous branch of ulnar nerves BRANCHES together the lateral and medial cord give rise to the median nerve BRANCHES Median nerve: innervates the forearm flexors and thenar muscles (group of muscles at the thumb) BRANCHES BRANCHES Median nerve: It provides sensation through the superficial cutaneous branch  CLINICAL EXAMINATION Lesion of long thoracic nerve CAUSES: -Sudden heavy loads on shoulder - Carrying heavy loads on shoulder SYMTOM AND SIGN: -Winging of scapula -Prominence of medial border of scapula  CLINICAL EXAMINATION Lesion of long thoracic nerve -Loss of pushing and punching actions. -Abduction of arm affected. Demonstrated by - asking the patient to push against resistance with the forearm extended at the elbow and flexed to 90° at the shoulder.  CLINICAL EXAMINATION Lesion of long thoracic nerve  CLINICAL EXAMINATION Upper trunk lesions: ERB'S PALSY Cause of injury ⁃ Forceful separation of head from shoulder e.g. during birth ⁃ fall on shoulder. Nerve roots involved - C5, C6 position of limb-  CLINICAL EXAMINATION Upper trunk lesions: ERB'S PALSY ⁃ Arm hangs by side - Adducted - (no abduction) ⁃ medially rotated -(no lateral rotation) ⁃ Extension at elbow.- (no flexion) ⁃ Forearm is pronated.- (no supination) POLICEMAN'S TIP OR WAITER TIP HAND CLINICAL EXAMINATION Upper trunk lesions: ERB'S PALSY  CLINICAL EXAMINATION LOWER TRUNK PALSIES: Klumpke's palsy Site of Injury ⁃ Lower trunk (C 8, T1). ⁃ Medial Cord involved (ulnar, medial cut N of Arm and forearm) Cause of injury ⁃ Birth injury (klumpke' s paralysis) ⁃ Cervical rib ⁃ Undue abduction of arm while holding something with hands during fall from height.  CLINICAL EXAMINATION LOWER TRUNK PALSIES: Klumpke's palsy  CLINICAL EXAMINATION LOWER TRUNK PALSIES: Klumpke's palsy Muscle Involved ⁃ Ulnar N ⁃ paralysis of Intrinsic muscle of hand, ulnar flexors of wrist and fingers Symptom and Sign ⁃ Claw hand (medial two fingers more affected) due to unopposed action of long flexors fingers and extensors paralysis of all interossei and medial two lumbricals. ⁃ Sensory loss on ulnar side of hand and forearm.  CLINICAL EXAMINATION LOWER TRUNK PALSIES: Klumpke's palsy  GENERAL ANATOMY LABORATORY LUMBAR PLEXUS Group 3 Balmaceda, Redell Jenna Althea A. Seraus, Grabriel Torrocha, Ayesha T. Tuiza, Krisstel E. WHAT IS LUMBAR PLEXUS? Main Function: Supplies nerves to the lower abdomen, pelvis, and legs. Formation: the anterior rami of nerves forms the lumbar plexus. L1 to L3 and most of the anterior ramus of L4. It also receives a contribution from the T12 (subcostal) nerve. Location: Forms within the psoas major muscle, anterior to its attachment to the lumbar vertebrae. All nerves of lumbar plexus emerge from the lateral aspect of PSOAS MAJOR: except genitofemoral (Anteriorly), and obturator (Medially) MNEMONIC FOR NERVE ROOTS TO NERVE ORIGIN NERVE INNERVATION BRANCHES TO ROOT ILLIOHYPOGASTRIC N. 2 BRANCHES FROM 1 ROOT ILLIOINGUINAL N. GENITOFEMORAL N. 2 BRANCHES FROM 2 ROOT LATERAL CUTANEOUS N. OF THIGH OBTURATOR N. 2 BRANCHES FROM 3 ROOT FEMORAL N. Iliohypogastric Nerve (L1): Origin: Anterior ramus L1 Spinal Segments: L1 Function (sensory): It passes across the quadratus lumborum and supplies posterolateral gluteal skin and the pubic region. Funtion (motor): Innervates parts of the abdominal muscles (internal oblique and transversus abdominis) Ilio-inguinal Nerve (L1): Origin: Anterior ramus L1 Function (sensory): It runs similar to illiohypogastric and provides sensation to the upper medial thigh and genital areas (penis/scrotum or mons pubis/labium majus). Function (motor): Innervates parts of the abdominal muscles (internal oblique and transversus abdominis) Genitofemoral Nerve (L1, L2): Origin: Anterior rami L1 and L2 Function (sensory): Divides into: 1. Genital branch: Innervates the cremasteric muscle in men and the skin of genital areas. 2. Femoral branch: Supplies upper anterior thigh. Function (motor): Genital branch- male cremasteric muscle Lateral Cutaneous Nerve of the Thigh (L2, L3): Origin: Anterior rami L2 to L3 Function (sensory): Skin on anterior and lateral thigh to the knee Obturator Nerve (L2 to L4): Origin: Anterior rami L2 to L4 Innervates muscles of the medial thigh (e.g., adductors) and supplies sensation to the medial thigh. Function (motor): obturator externus, pectineus, and muscle in medial compartment of thigh Femoral Nerve (L2 to L4): Origin: Anterior rami of L2 to L4 Largest branch. Supplies muscles in the anterior thigh (e.g., quadriceps) and anterior thigh and medial leg skin. Function (motor): iliacus, pectineus, and muscles in the anterior compartment of the thigh Additional information: Flexion of the hip is controlled primarily by L1 and L2. Extension of the knee is controlled mainly by L3 and L4. Simplified mnemonic to remember the nerves of the lumbar plexus: “I, I, Get Lunch On Fridays” I - ILLIOHYPOGASTRIC I - ILLIOINGUINAL G - GENITOFEMORAL L - LATERAL CUTANEOUS NERVE OF THIGH O - OBTURATOR F - FEMORAL CLINICAL EXAMS AND INJURIES Lumbar Radiculopathy Lumbar radiculopathy is a condition that happens when a nerve in the lower back gets pressed or irritated. This can be caused by things like a herniated disc or spinal narrowing. Symptoms often include: Pain: Usually running down the leg. Numbness: Tingling or loss of feeling in the leg or foot. Weakness: Trouble moving the leg or foot. Diabetic Neuropathy Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is caused by high blood sugar levels over time, which can injure the nerves throughout the body, including those in the lumbar plexus area. Symptoms: It can cause pain, tingling, numbness, or weakness, especially in the legs and feet. Some may also have balance problems. Types: The most common types are peripheral neuropathy (affecting limbs) and autonomic neuropathy (affecting internal organs). Diagnosis: Doctors figure it out through medical history, exams, and tests to check how the nerves are working. Management: There’s no cure, but managing blood sugar levels, relieving symptoms, and preventing issues are important. This can include medication and lifestyle changes. Meralgia Paresthetica Meralgia paresthetica is a condition that occurs when the lateral femoral cutaneous nerve, which runs from the lower back to the outer thigh, gets compressed or irritated. This nerve is part of the lumbar plexus. Causes: It can be caused by factors such as tight clothing, obesity, pregnancy, or certain medical conditions that put pressure on the nerve. Symptoms: Common symptoms include tingling, numbness, and pain in the outer thigh. The discomfort can be worsened by standing or walking. Diagnosis: Doctors usually diagnose it based on symptoms, medical history, and a physical exam. Imaging tests may be used to rule out other conditions. Treatment: Treatment often includes lifestyle changes, such as losing weight or adjusting clothing. Pain relief methods like medications or physical therapy may also be recommended. Lumbar Herniated Disc A herniated disc happens when the soft center of a spinal disc pushes out through a tear in its outer layer. This can pinch nearby nerves in the lumbar plexus, which is a group of nerves in the lower back. Pain: Often feels like shooting pain down the leg (sciatica). Numbness and Tingling: You might feel weird sensations in the legs. Weakness: Some muscles in the legs may feel weak. THANK YOU!