Quiz for those who have not taken it already

Spinal nerves – 31 pairs, emerging at each vertebral level

Fundamentals of Anatomy & Physiology, 7eby Frederic H. Martini, Ph.D.

Copyright © 2005 Pearson Education, Inc.,publishing as Benjamin Cummings.

Figure 13-10: The Cervical Plexus

Cranial nerves

Transverse cervical nerve

Great auricular nerve

Accessory nerve (XI)

Hypoglossal nerve (XII)

Lesser occipital nerve

Supraclavicular nerves

Clavicle

Sternothyroid muscle

Sternohyoid muscle

Phrenic nerve

Omohyoid muscle

Ansa cervicalis

C1

C2

C3

C4

C5

Thyrohyoid muscle

Geniohyoid muscle

Nerve roots of cervical plexus

Cervical Plexus

Brachial Plexus

Lumbarsacral plexus

MYOTOMES & DERMATOMES Myotomes

Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve.

Dermatomes

~Greek for"skin cutting" ~An area of the skin supplied by specific nerve fibers.

Sensory

                                                                                                      

                  

Dermatomes and Myotomes

Dermatome- sensory region of skin innervated by a nerve root

Myotome- muscles innervated by a single nerve root

Common Dermatomal Levels

C5- Shoulder

C6- Lateral Arm and Digits 1&2

C7- Middle Digit

C8- Digits 4 & 5

Common Dermatomal Levels

L4- Anteromedial Shin

L5- Anterolateral Shin, dorsum of foot to big toe

Common Dermatomal Levels

S1- toe, lateral foot, sole and calf

ASIA, 2006

Neurologic Level C5

The muscles found within this myotomal pattern are the deltoid and the biceps brachii. Because the latter is also innervated by C6, the deltoid is the most "pure" C5 muscle.

One of the most commonly used tests for shoulder abduction is to instruct the patient to flex the elbow at 90 degrees, then offer gradual resistance to abduction

Neurologic Level C6

the biceps brachii is innervated by C5 and C6. C6 also innervates the most powerful wrist extensors, carpi radialis longus and brevis, which do radial extension. To test for wrist extension, stabilize the patient’s forearm and wrist extension

Neurologic Level C7

The muscles found within this myotomal pattern are the triceps, wrist flexors. The triceps muscle primarily does elbow extension. A common test for this action is to ask the patient to fully flex the arm, offer firm, constant resistance until discerning the maximum resistance h/she can overcome.

Neurologic Level C8:

The muscles found within this myotomal pattern are finger flexors—flexor digitorum superficialis, flexor digitorum profundis, and the lumbricals. To test for finger flexion, the patient fully flexes h/her fingers at all joints while you curl your fingers into them. Ask the patient to resist your attempt to pull h/her fingers out of flexion.

Neurologic level T1: The muscles found

within this myotomal pattern are those involved in finger abduction—dorsal interossei and abductor digiti minimi, and adduction—palmar interossei.

To test for finger adduction, ask the patient to extend h/her fingers and hold a piece of paper (or a dollar bill) between two of h/her fingers. Then you pull it out

Neurologic Levels T12 to L3:

The muscles found within this myotomal pattern are the iliopsoas, quadriceps, and the adductors Because this myotomal pattern includes multiple muscle groups an injury to this nerve root level can be more easily evaluated by sensory testing of the dermatomal patterns.

Neurologic Level L4:

The muscle predominantly innervated at this root nerve level is the tibialis anterior, which does dorsiflexion.

Instruct the patient to dorsiflex and invert h/her foot. With your free hand, hold the patient’s foot and ask h/her to resist your attempt to move the foot into plantarflexion

Neurologic Level L5:

The muscles found within this myotome are the extensor hallucis longus (big toe extensor) & extensor digitorum (heel walk)

Neurologic Level S1:

The muscles found within this myotome are the peroneus longus (eversion) & peroneus brevis (eversion)