Standard for body Surface localization of nervous system

2022-05-29 0 By

Body surface markers are widely used in the examination and treatment of clinical diseases. In clinical practice, if the localization of body surface markers is inaccurate, the treatment of patients will be delayed, and even the best opportunity will be missed.The body surface localization of the nervous system is very important for the diagnosis and surgical treatment of orthopedic diseases, but it is very difficult to master it completely.Today we sorted out a super detailed nervous system body surface positioning, worth learning from!(1) a total of 31 pairs of spinal nerves: cervical nerve 8 pairs of thoracic nerve 12 pairs of lumbar nerve 5 pairs of sacral nerve 5 pairs of caudal nerve 1 pairs of spinal nerve 31 pairs, each pair of spinal nerve connected to a spinal cord segment: borrow anterior root connected to the anterior lateral groove of the spinal cord;The posterior root is connected to the posterolateral sulcus of the spinal cord.Anterior root belongs to motional sex, hind root belongs to sensory sex, every pair of spinal nerve is by anterior root and heel are in intervertebral foramen confluence and become, reason spinal nerve is mixed sex.Spinal nerve the typical branch of spinal nerve: spinal nerve stem divides after giving intervertebral aperture 4, namely before branch, hind branch, spinal film branch and traffic branch.1) spinal cord branch: also known as sinus vertebral nerve (sinuvertebral nerves), each spinal cord branch through the intervertebral foramen, and then through the intervertebral foramen back into the spinal canal, distributed in the spinal cord capsule, blood vessel wall, periosteum, ligament, intervertebral disc and so on.2) Traffic branch: it is the fine branch connecting the spinal nerve and the sympathetic trunk.From the spinal nerve connected to the sympathetic trunk is the white traffic branch;Send from sympathetic stem connect at spinal nerve call ash traffic branch, basically concern with splanchnic nerve.3) Back branch: mixed, thin;- Muscle branches: distributed in the nape, back, lumbosacral deep muscles;- Skin branches: distributed in the occipital, nape, back, waist, sacral, hip skin;4) Anterior branch: thick, mixed, distributed in the anterolateral trunk and the muscles and skin of the limbs.The anterior branches of human thoracic nerves maintained their original segmental running and distribution, but the other anterior branches of spinal nerves interwoven into the cervical, brachial, lumbar and sacral plexus respectively.(2) The composition of the cervical plexus from the cervical nerve: it is composed of the anterior branches of the first to the fourth cervical nerve.Branches of cervical plexus: superficial cutaneous branches: there are mainly occipital minor nerve (C2), auricular great nerve (C2,3) (the above two nerves are in the head) transverse cervical nerve (C2,3) : anterior cervical skin supracclavian nerve (C3,4) : lower neck, upper chest wall, and shoulder skin.The most important branch (sensory) of muscle branches is the phrenic nerve (C3~5, mainly C4).Paralysis of the diaphragm after injury, or asphyxia in severe cases.(3) The composition of the brachial plexus: from the 5th to 8th cervical nerve anterior branch and the first thoracic nerve anterior branch most of the fiber composition.For the record, the body surface location of the brachial plexus is not well defined: it is quite common for a spinal segment to have N nerves and for a nerve to be innervated by N spinal segments, and most diseases in spinal surgery do not involve damage to a particular peripheral nerve.Branch of brachial plexus: a. Upper clavicle branch: 1) long thoracic nerve (C5~7) : originates from nerve root and distributes in serratus anterior muscle and breast.Damage to this nerve may result in a “winglike shoulder”.2) Dorsal scapularis nerve (C5,6) : originates from nerve root and distributes rhomboid muscle and levator scapulae muscle.3) Suprascapular nerve (C4,5) : distributes the supraspinatus muscle, infraspinatus muscle and shoulder joint.B. Subclavicular branch: 1) Subscapular nerve (C5,7) : originates from the posterior cord of the brachial plexus and distributes to the subscapularis muscle and teres major.2) The medial thoracic nerve (C5~T1) : originates from the medial cord of the brachial plexus and distributes in the pectoralis minor and pectoralis major muscles.3) Lateral thoracic nerve (C5~T1) : from the lateral cord of the brachial plexus, through the clavipectoral fascia and distributed to the pectoralis major muscle.4) Thoracic dorsal nerve (C6~8) : originated from the posterior tract and distributed to the latissimus dorsi muscle.5) Axillarv nerve (C5,6) : from the posterior cord of brachial plexus, accompanied by rotating brachial posterior vessels through the quadrilateral holes, around the surgical neck of humerus, distribution of deltoid muscle, teres minor;The residual fibers are called the lateral brachial epithelial nerve and are distributed in the skin of the shoulder and upper lateral region of the arm.6) Musculocutaneous nerve (C5-7) : it originates from the lateral cord of the brachial plexus, passes outwards through the coracobrachial muscle, descends between the biceps brachial muscle and brachial muscle, innervates the three muscles, and the other fibers pass through the deep fascia slightly below the elbow joint and transfer to the lateral cutaneous nerve of the forearm, managing the skin sensation of the lateral forearm.7) Median nerve (C5~T1) : generally has no branch at the arm. In the forearm, except for the anterior interosseous nerve, it innervates the anterior group of muscles of the forearm and adjacent joints except the brachioradialis, flexor carpi ulnar and flexor digitorum profundus.It gives off a return branch in the palm and innervates the thenar muscles except the adductor pollicis;Three digital palmar general nerves are emitted, which descend to the vicinity of the metacarpal head and divide into digital palmar intrinsic nerves, which run along the relative edge of the finger to the fingertip.The median nerve is concerned with the palmar, and manages the skin sensation of the radial 2/3 of the palm and the palmar side of the three and a half fingers of the radial and dorsal middle and distal digits, and innervates the 1st and 2nd lumbrical muscles.8) Ulnar nerve (C7~T1) :From the medial of brachial plexus, under the biceps inside groove to the points in the arm, wearing inside muscle interval to medial arm after area, next to the ulnar nerve ditch, which in turn down wear wrist flexor, feet side line on foot between lateral wrist flexor and refers to the deep flexor, a lateral branch dominant ruler deep flexor wrist flexor and fingers and a half feet side to about 5 cm above the radiocarpal joint, cent gives back to the back of hand,Distribution of dorsal hand ulnar half and little finger, ring finger and middle finger ulnar half dorsal skin;The superficial side of the flexor trunk support zone is divided into shallow and deep branches. The shallow branches are distributed in the ulnar 1/3 of the palm, the ulnar half volar skin of the little finger and the ring finger.The deep branches are distributed in the thenar muscle, adductor hallucis, interosseous muscle and the 3 and 4 lumbrical muscles.9) Radial nerve (C5~T1) : from the brachial plexus posterior tract, accompanied by deep brachial artery along the radial nerve groove, in the upper part of the external epicondyle of the humerus through the lateral muscle interval between brachioradialis and brachialis muscle down, to the front of the external epicondyle of the humerus divided into shallow, deep two end branches.Branches in the arm: ① cutaneous branches have brachial cutaneous nerve, lateral inferior cutaneous nerve and posterior cutaneous nerve of the forearm;② The muscle branches are distributed in the triceps brachii muscle, elbow muscle, brachioradialis muscle and flexor carpi radialis muscle;③ Elbow branches are distributed in the joint.The superficial branch of the radial nerve, one of the final branches, runs on the deep surface of the brachioradialis muscle, turns dorsalally at the junction of the middle and lower 1/3 of the forearm, and divides into 4-5 dorsal digital nerves to the dorsalis of the hand, which are distributed on the skin and joints of the dorsal radial half of the hand and the two half fingers near the back of the joint.The other terminal branch is the deep branch of the radial nerve, the muscular branch, which passes through the pronator muscle to the back of the forearm and migrates to the posterior interosseous nerve, which distributes in the extensor muscle of the forearm, distal ulnar joint, wrist joint and intermetacarpal joint.10) Medial brachial cutaneous nerve and medial forearm cutaneous nerve (C8,T1) : originated from the medial cord of brachial plexus and distributed in corresponding areas.The sensorimotor localization of the above nerves is very clear, but the specific segment from which is vague, so the localization effect is not obvious.(4) Anterior branches of thoracic nerves: there are 12 pairs in total. The first to 11th pairs are located in the corresponding intercostal space respectively, called intercostal nerves; the 12th pair is subcostal nerve.(5) the composition of the lumbar plexus: it is composed of part of the anterior branch of the 12th thoracic nerve, part of the anterior branch of the 1st to 3rd lumbar nerve and part of the anterior branch of the 4th lumbar nerve.Femoral nerve (T12,L1), ilioinguinal nerve (L1), obturator nerve (T12,L1)The cutaneous branches are distributed in the lateral gluteal area, groin area, skin of the lower abdomen, scrotum or labia majora, and muscle branches are distributed in the abdominal wall muscles.L1: Body surface location: inguinal area • Lateral femoral cutaneous nerve (L2, 3) : distributes in the skin of anterolateral thigh.• The femoral nerve (L2~4) is the largest branch of the lumbar plexus, passing through the lateral margin of the psoas major, descending between the psoas major and iliac muscles, and entering the femoral triangle at the depth of the midpoint of the inguinal ligament. It is divided into muscle branches, which are distributed in the iliac muscle, pectineus muscle, quadriceps femoris muscle, and sartorius muscle.② Cutaneous branch: the shorter cutaneous branch is the medial and medial femoral cutaneous nerve, which distributes the skin in front of the thigh and knee joint.The longest cutaneous branch is the saphenous nerve, which passes through the medial side of the knee joint with the great saphenous vein, along with the femoral artery into the adductor canal, and distributes in the subpatellar, medial side of the calf and the skin of the medial edge of the foot.• Obturator nerve (L2~4) : it passes through the medial edge of psoas major, and then passes through the obturator canal to the inner side of the thigh. The hair branch innervates the obturator internus muscle, the longus, brevis, adductor magnus and gracilis muscle, and the skin branch distributes the skin of the inner side of the thigh.• Genital femoral nerve (L1,2) cutaneous branches: scrotum (labia majora) and adjacent skin;Muscle branch: Innervate the testicular muscles.The composition of the sacral plexus: it is composed of the lumbosacral trunk synthesized by the remainder of the anterior branch of the 4th lumbar nerve and the anterior branch of the 5th lumbar nerve, as well as all the anterior branches of the sacral nerves and caudal nerves.1) The superior gluteal nerve (L4~S1) gives out the superior orifice of the piriformis muscle, running between the gluteus medium and minor muscles, and divides the upper and lower two branches to innervate the gluteus medium and minor muscles and tensor fascia lata.2) The inferior gluteal nerve (L5~S2) exits the inferior piriformis foramen and distributes in the gluteus maximus muscle.3) The pudendal nerve (S2-4) exits the inferior piriformis foramen, bypats the sciatic spine and enters the sciatic rectal fossa through the sciatic foramen. The main branches are: the anal nerve, the perineal nerve, the penile (clitoral) dorsal nerve, and distributes in the muscles and skin of the perineum, external genitalia and anus.4) Sciatic nerve (L4~S3) is the largest and longest nerve in the body. After leaving the pelvic cavity through the subpiriformis muscle foramen, it descends from the sciatic tuberculum to the posterior femoral region between the greater trochanter and the sciatic tuberculum, and divides into the tibial nerve and the common peroneal nerve above the popliteal fossa.The biceps femoris, semitendinosus and semimembrane muscles are distributed in the posterior femoral region.The branches of the tibial nerve are as follows: the muscular branches are distributed in the posterior group of the lower leg;The cutaneous branches mainly have the medial sural cutaneous nerve with small saphenous vein descending, and anastomose with the lateral sural cutaneous nerve from the common peroneal nerve in the lower part of the calf to form the sural nerve, which moves forward along the lateral foot through the posterior lateral malleolus and distributes in the dorsum of the foot and the lateral skin of the little toe.Common peroneal nerve: Divided into the superficial peroneal nerve and the deep peroneal nerve.Superficial peroneal nerve: the skin of the lateral leg, dorsum of the foot, and dorsum of the 2nd to 5th digits;The deep peroneal nerve is distributed in the anterior calf muscles, dorsolis of the foot, and the skin at the opposite edges of the first and second toes.(seven) spinal nerve anterior branches most spinal nerve anterior branches interweave into a cluster attached: the significance of nerve reflex examination biceps brachii reflex: reflex center is C5, 6;Triceps reflex: the reflex centers are C7, 8;Radial membrane reflex: the reflex centers are C5, 6;Knee jerk reflex: the reflex center is L2 ~ 4 (quadriceps femoris);Ankle reflex (Achilles tendon reflex) : the reflex center is S1, 2;Babinski and Chaddock signs: vertebral bundle lesions;Hoffmann sign: cervical spinal cord lesion;Ankle clonus and patellar clonus: meaning with tendon reflex hyperfunction, basically be spastic paralysis when appear.Did you gain from sharing the above content?If you want to learn more, you can join us