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PNS -- Torgerud > Exam 3: Thoracic Spinal Nerves, Lumbar Spinal Nerves, Lumbar Plexus > Flashcards

Exam 3: Thoracic Spinal Nerves, Lumbar Spinal Nerves, Lumbar Plexus Flashcards

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1
Q

How many pairs of thoracic nerve roots are there?

A

12 pairs

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2
Q

What will each mixed thoracic spinal nerve divide into?

A

posterior and anterior primary ramus

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3
Q

What will the posterior primary ramus of a thoracic spinal nerve divide into? What type of information do they carry?

A

Medial branch–> motor and sensory function

lateral branch –> motor and sensory function

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4
Q

What do the medial branches of the posterior primary rami of a thoracic spinal nerves supply?

A

Motor:

  • Semispinalis (T1-T6)
  • Longissimus (T7-T12)
  • Multifidi (T7-T12)

Sensory:
- skin paraspinally to T1-T12

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5
Q

Describe how the size of the lateral branches of the posterior ramus of the thoracic spinal nerves changes.

A

lateral branches increase in size from superior to inferior (b/c more inferior costal angles get further apart and therefore supply more = more fibers)

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6
Q

What do the lateral branches of the posterior primary rami of thoracic spinal nerves supply?

A

Motor at all levels to:

  • longissimus
  • iliocostalis
  • levator costarum

Sensory:
- skin near costal angles

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7
Q

What course do the Anterior primary rami of thoracic spinal nerve generally follow?

A

the course of the rib above the nerve

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8
Q

Besdies the intercostal nerve, what will the anterior primary ramus of T1 additionally contribute to?

A

brachial plexus and a smaller branch will form the first intercostal nerve

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9
Q

Besides the intercostal nerve, what will the anterior primary rami of T2 (sometimes T1) additionally contribute to?

A

the intercostobrachial nerve

communicates with medial cutaneous nerve of the arm –branch off medial cord of brachial plexus

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10
Q

What will each intercostal nerve give off? What is supplied?

A

a lateral cutaneous branch –> which divides into an:

  • anterior branch of lateral cutaneous nerve
  • posterior branch of lateral cutaneous nerve
  • —-> supplies overlying skin
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11
Q

What do intercostal nerves terminate as? What do they supply?

A

Anterior Cutaneous branches…an:

  • Medial Branch of Anterior Cutaneous nerve
  • Lateral Branch of Anterior Cutaneous nerve
  • –> supply skin close to midline
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12
Q

What levels of the thoracic have intercostal nerves associated with them? What is the name of any that do not follow this pattern?

A

T1-T11 have intercostal nerves

T12 is called subcostal nerve

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13
Q

What muscles do the intercostal nerves supply as they course along their adjacent ribs?

A
  1. Internal intercostals
  2. External intercostals
  3. Innermost intercostals
  4. Serratus posterior
  5. Transversus thoracis
  6. Transverse abdominal (T7-11)
  7. Internal Abdominal oblique (T7-11)
  8. External abdominal oblique (T7-11)
  9. Rectus abdominus (T7-11)
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14
Q

Besides muscles, what else will the intercostal nerves also supply?

A

adjacent blood vessels, bones (ribs), joints, and ligaments

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15
Q

Which is the largest of the thoracic nerves?

A

the Subcostal Nerve (T12 nerve)

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16
Q

What else does the Subcostal nerve contribute to in addition to following a similar course to the intercostal nerves?

A

the lumbar plexus

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17
Q

What skin may the Subcostal nerve supply? Via what nerves?

A

skin close to the spine as far inferior as superior buttocks via Cluneal Nerves

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18
Q

How does each thoracic nerve communicate with the sympathetic trunk?

A

by way of BOTH white and gray rami communicans

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19
Q

The gray ramus communicans is more _____, while the white ramus communicans is more______. (ass. with thoracic nerves)

A

medial

lateral

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20
Q

What type of neurons is the white ramus communicans carrying? What about the grey ramus communicans? Describe where the neurons are going.
(ass. with thoracic nerves)

A

white ramus–> myelinated preganglionic sympathetic nurons to sympathetic trunk

gray ramus–> unmyelinated postganglionic sympathetic neurons away from the sympathetic trunk to the spinal nerve

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21
Q

How many pairs of lumbar spinal nerves are there? How are they named in relationship to the vertebra?

A

five pairs; named for vertebra above the nerve

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22
Q

What does each lumbar nerve root divide into?

A

anterior primary ramus and a posterior primary ramus

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23
Q

When the posterior primary ramus of the lumbar nerve travels posteriorly, what will it divide into and why type of fibers do they carry?

A

Medial branch–> motor
Lateral branches –> motor

(MOTOR ONLY)

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24
Q

What makes the posterior primary rami of lumbar nerves different than those of thoracic and cervical nerves?

A

only carries MOTOR info; whereas C and T’s carry sensory and motor

recall– T12 will supply skin over lumbar spine

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25
What does the medial branch and lateral branch of the posterior primary rami of lumbar nerves supply?
medial branch--> multifidi | lateral branch--> erector spinae group
26
What do the anterior primary rami of lumbar spinal nerves contribute to?
lumbar plexus --> L1-L4 | sacral plexus --> L4 and L5
27
Do the lumbar nerves have communication with the sympathetic trunk?
yes-- there are usually 4 lumbar sympathetic ganglia
28
How many lumbar sympathetic ganglia are there?
usually 4
29
What lumbar spinal nerves will have association white rami communicans? Which will have gray rami communicans?
white rami communicans--> L1, L2, and (sometimes L3) grey rami communicans --> ALL lumbar nerves
30
What forms the lumbar plexus?
anterior primary rami of L1-L3 and part of L4 also receives contribution from T12 via communication with L1 nerve
31
What lumbar nerve roots is the quadratus lumborum supplied by?
L1, L2, L3, L4
32
What lumbar nerve roots is psoas minor supplied by?
L1
33
What lumbar nerve roots is psoas major supplied by?
L2, L3, L4
34
What are the Muscular Branches from the anterior rami of lumbar spinal nerves supplying?
quadratus lumborum --> L1-L4 psoas minor--> L1 psoas major --> L2-L4
35
What are the six major nerves of the Lumbar Plexus?
1. Iliohypogastric Nerve (T12, L1) 2. Ilioinguinal Nerve (T12, L1) 3. Genitofemoral Nerve (L1, L2) 4. Lateral Cutaneous Nerve of the Thigh (L2,L3) 5. Femoral Nerve (L2,L3,L4) 6. Obturator Nerve (L2,L3,L4)
36
Describe the path of the iliohypogastric nerve.
Travels anterior and inferior b/w quadratus lumborum and the kidney then through the transverse abdominal muscle then travels b/w the internal abdominal oblique
37
What branch does the iliohypogastric nerve give off? What does it supply?
Lateral Cutaneous Branch --> posterolateral gluteal region
38
What does the iliohypogastric nerve continue as? What does that supply?
the Anterior Cutaneous Branch--> skin of pubic
39
What muscles does the iliohypogastric nerve supply?
1. internal abdominal oblique | 2. Transverse abdominal
40
Overall, what does the iliohypogastric nerve supply?
Motor: - internal abdominal oblique - transverse abdominal Sensory: - posterolateral gluteal region (via Lateral cutaneous branch) - skin of the pubic region (via Anterior Cutaneous branch)
41
What nerve fibers make up the iliohypogastic nerve?
T12 and L1 (motor and sensory)
42
What nerve fibers make up the ilioinguinal nerve?
T12 and L1 (motor and sensory)
43
Describe the path of the ilioinguinal nerve.
Similar to iliohypogastric nerve--> but enters/ goes through the inguinal canal and leaves the canal via the superficial inguinal ring a--> and travels with the spermatic cord (round lig. in females)
44
What muscles does the ilioinguinal nerve supply?
1. internal abdominal oblique 2. transverse abdominal (same as iliohypogastric nerve)
45
What sensory supply does the ilioinguinal nerve have?
- skin of upper medial thigh - base of penis - anterior scrotum or - mon pubis - labium majus
46
What fibers does the genitofemoral nerve contain?
L1 and L2 (motor and sensory)
47
What muscles does the genitofemoral nerve pass through? Then what does it do?
goes anteriorward throught psoas major muscle--> then divides into a Genital Branch and a Femoral Branch
48
What are the branches of the genitofemoral nerve?
1. Genital Branch (M and S) | 2. Femoral Branch (S)
49
What is the path of the Genital Branch of the Genitofemoral nerve? What does it supply?
enters and travels through the inguinal canal Motor--> cremaster muscle Sensory --> skin of superior anterior scrotum (males) and skin of mons pubis and labium majus (females) (sensory overlap with ilioinguinal N.)
50
What is the Cremasteric reflex?
scrap skin on medial thigh and the testicle should rise up
51
What is the path of the femoral branch of the genitofemoral nerve? What does it supply?
passes into thigh posterior to inguinal ligament and supplies skin of upper anterior thigh
52
What fibers does the Lateral Cutaneous Nerve of the Thigh contain?
L2 and L3 (sensory)
53
What does the Lateral Cutaneous Nerve of the Thigh of the Lumbar plexus supply?
skin of lateral thigh, superior to knee
54
How does it leave the abdominal cavity and what is the path of the Lateral Cutaneous nerve of the thigh?
leaves abdominal cavity by passing under the inguinal ligament--> travels anterior to Sartorius and through the tensor fascia lata to reach the skin
55
What fibers does the Femoral Nerve of the lumbar plexus contain?
L2, L3, L4 (motor and sensory)
56
What is the largest branch of the lumbar plexus?
Femoral Nerve (L2,3,4)
57
Describe the path of the femoral nerve of the lumbar plexus.
forms posterior to psoas major and emerges lateral to psoas major and anterior to iliacus--> passes posterior to inguinal ligament --> enters femoral triangle just lateral to femoral artery --> runs inferior and medially through adductor canal --> and into the leg, medially to the knee
58
Where are the two places the femoral nerve, of the lumbar plexus, only gives off branches?
in abdomen and the femoral triangle
59
What muscles does the femoral nerve give off muscular branches to in the abdomen?
iliacus and pectineus also sends some fibers to the femoral artery
60
What does the femoral nerve do once it is beyond the inguinal ligament?
divides into: | Anterior Divison and Posterior Division
61
How many and what nerves does the anterior division of the femoral nerve gives rise to?
1. intermediate cutaneous nerve of the thigh (S) 2. medial cutaneous nerve of the thigh (S) 3. nerve to the sartorius (M)
62
What does the Intermediate cutaneous nerve of the thigh, from the anterior division of the femoral nerve, do and supply??
branches into two branches and supplies skin on: - anterior thigh down to knee - --> lateral branch will communicate with the Femoral Branch of the genitofemoral nerve
63
As it crosses anterior to the femoral artery, what does the Medial Cutaneous nerve of the thigh, from the anterior division of the femoral nerve, supply?
skin of: - medial thigh - medial knee - knee across to lateral side of the patella - -> some supply skin of medial thigh via communications with Saphenous Nerve
64
What does the Nerve to the sartorius supply?
(from anterior division of femoral nerve) | - sartorius muscle
65
What does the posterior division of the Femoral nerve gives rise to?
1. Muscular Branches 2. Vascular Branches 3. Articular Branches to knee joint --> then continues into leg as Saphenous Nerve
66
What does the posterior division of the femoral nerve end up continuing into the leg as?
the Saphenous Nerve
67
What do the muscular branches of the posterior division of the femoral nerve, given off in the femoral triangle supply?
1. sartorius 2. Rectus femoris 3. vastus lateralis 4. vastus medialis 5. vastus intermedialis
68
What is the Saphenous nerve transmitted through? What does it does once in that structure?
transmitted through adductor canal --> then crosses femoral artery to lay medial to the artery once they emerge from the canal
69
What does the Saphenous Nerve supply?
(terminal nerve of posterior diviision of femoral nerve) - skin medial and anterior to patella - in leg--> skin of medial leg and foot
70
What does the Saphenous Nerve travel with once it is in the leg?
with the Great Saphenous vein
71
What are some clinical considerations associated with the Femoral Nerve?
1. Patellar Reflex 2. Sensory deficits 3. Osgood-Schlatter Disease (not directly related to femoral N)
72
What is something we could do to test the functioning of the femoral nerve?
test extension of leg since the femoral nerve supplies the quadriceps
73
What is Osgood-Schlatter Disease? Who does it manifest in?
related to quads and insertion point manifests in teenage years when not done growing, but participate in sports
74
What fibers make up the Obturator nerve? Which is the principle contributor?
L2, L3, L4 | L3 = principle contributor L2 contribution is minimal
75
How doe the Obturator nerve travel compared to the psoas major? What does it travel posterior to? How does it travel into the pelvis? How does it leave the pelvis?
medial to psoas major and posterior to common iliac vessels--> descends into pelvis on the obturator internus--> leaves pelvis via obturator foramen
76
What does the Obturator nerve do once it leaves the obturator foramen?
divides into an Anterior Branch and a Posterior Branch
77
How are the Anterior and Posterior Branches of the obturator nerve separated? Which muscles are they named in relationship to?
initially by the obturator externus and then by the adductor brevis** adductor brevis
78
How does the Anterior branch of the obturator nerve travel? What does it pass anterior and posterior to?
``` travels inferiorly--> travels: Anterior to: - obturator externus - adductor brevis Posterior to: - pectineus - adductor longus ```
79
What will the Anterior branch of the obturator nerve send some branches to communicate with? What does this form?
branches of the femoral nerve (medial cutaneous nerve of the thigh)--> forming the Subsartorial plexus --> supplies skin on the medial thigh
80
What forms the Subsartorial plexus and what does it supply?
branch off the Anterior branch of Obturator nerve and branches of the femoral nerve (the medial cutaneous nerve of the thigh) -- supplies skin over medial thigh
81
What does the termination of the anterior branch of the obturator nerve supply?
the femoral artery
82
Where does the anterior branch of the obturator nerve send articular branches to?
the hip joint
83
What muscles does the anterior branch of the obturator nerve send fibers to?
1. adductor longus 2. gracilis 3. pectineus 4. adductor brevis
84
What may the anterior branch of the obturator nerve send fibers to connect with? (if it is present)
the accessory obturator nerve
85
What may the anterior branch of the obturator nerve send fibers to communicate with that would have it contributing to the skin on the upper medial side of the leg?
- medial cutaneous nerve of the thigh (ass. with subssartorial plexus) - saphenous nerve
86
What does the posterior branch of the obturator nerve travel through? What does it travel posterior and anterior to?
through the --> obturator externus posterior to --> adductor brevis anterior to --> adductor magnus
87
What muscles does the posterior branch of the obturator nerve supply?
1. obturator externus 2. adductor magnus 3. adductor brevis (if it isn't supplied by the anterior branch)
88
What does the posterior branch of the obturator nerve send articular fibers to?
knee joint
89
If something in wrong with the obturator nerve, how would we test the muscle weakness?
test hip adduction
90
Where would the sensory deficits associated with the obturator nerve be?
medial thigh, overlaps with femoral nerve

PNS -- Torgerud (17 decks)

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