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Roots (anterior rami)
Trunks
Divisions: anterior (to flexors) or posterior (to extensors)
Cords
Supraclavicular branches
Infraclavicular branches
Terminal branches (infraclavicular)
C5
C6
C7
Anteriorrami
C8
T1
Articular disc ofsternoclavicular joint
Costoclavicular ligamentThree posteriordivisions
Cords
Axillary nerve
Musculocutaneous
Terminal branches
nerve
Mediannerve
Radialnerve
Coraco-acromial ligament
Coracoclavicular ligament
Three anterior divisionssuperior, middle, and inferior
Three trunkssuperior, middle, and inferior
Ulnarnerve
Medial
Posterior
Lateral
Pectoralis minor
Spinal ganglion(dorsal root ganglion)
A. Anterior View
Anterior rami
C5
C6
C7
C8
T1
Dorsal scapular nerve
Suprascapular nerveSubclavian
nerve
Long thoracicnerve
Lateral pectoral nerve
Medial pectoral nerve
Medial cutaneous nerve of forearm
Medial cutaneous nerve of arm
Lower subscapular nerve
Thoracodorsal nerve
Upper subscapularnerve
Axillary nerve
Musculocutaneous nerve
Lateral root of median nerve
Medial root of median nerve
Radial nerve
Median nerve
Ulnar nerve
B. Anterior View
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364 SYSTEMIC OVERVIEW OF LOWER LIMB: NERVES
Lateral cutaneous branch ofsubcostal nerve (T12)
Femoral branch
Genitofemoralnerve
Genital branch
Ilioinguinal nerve
Cutaneous branchof obturator nerve
Anterior cutaneousbranches of femoralnerve (lateral group)
Saphenous nerve(from femoral nerve)
Deep fibular(peroneal) nerve
Lateral dorsal cutaneous nerve offoot (termination of sural nerve)
Superficial fibular (peroneal) nervebecoming dorsal digital nerves
Lateral sural cutaneousnerve (from common
fibular nerve)
Infrapatellar branchof saphenous nerve
Lateral cutaneousnerve of thigh,
anterior branches
L1
L3L2
Superiorclunial nerves
(posterior rami)Lateral cutaneous branchof iliohypogastric nerve
Lateral cutaneousnerve of thigh(posterior branches)
Lateral cutaneousnerve of thigh(continuation ofanterior branches)
Posterior cutaneous nerveof thigh
Lateral sural cutaneous nerve(from common fibular nerve)
Medial sural cutaneousnerve (from tibial nerve)
Communicating branch oflateral sural cutaneous nerve
Lateral plantar nerve
Sural nerve
Medial plantar nerve
Medial calcaneal branchesof tibial nerve
Saphenous nerve(from femoral nerve)
Anterior cutaneousbranches of femoralnerve (medial group)
Cutaneous branchesof obturator nerve
Medialclunial nerves
(posterior rami)
S1
S3S2
A. Anterior View B. Posterior View
Inferior clunial nerves
(branches of posterior
cutaneous nerve of
thigh)
CUTANEOUS NERVES OF LOWER LIMB
Cutaneous nerves in the subcutaneous tissue supply the skin of the lower limb. The cutaneous innervation
of the lower limb reects both the original segmental innervation of the skin via separate spinal nerves in its
dermatomal pattern (Fig. 5.8 ) and the result of plexus formation of segmental peripheral nerves. In B, the
medial sural cutaneous nerve (suralis Latin for calf ) is joined between the popliteal fossa and posterior aspect
of the ankle by a communicating branch of the lateral sural cutaneous nerve to form the sural nerve. The level
of the junction is variable and is low in this specimen.
5.5
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36
Lower Limb
SYSTEMIC OVERVIEW OF LOWER LIMB: NERVES
S3
S3
S3
S3
S4
S4
S4
S5
S5
L5
L5
L5
L5
L5
L5
L5
C1
C1
L1
L1
T12T12
T11 T11
T10T10
L1
S1
S1
S1S1
S1
S1
S2S2
S2
S2
S2
S2
S2
L2
L2
L2
L2
L3
L3
L3
L3
L3
L4
L4
L4
L4
L4L4
A. Anterior View C. Anterior ViewB. Posterior View D. Posterior View
Axial line
Axial lin
DERMATOMES OF LOWER LIMB
The dermatomal, or segmental, pattern of distribution of sensory nerve bers persists despite the merging of
spinal nerves in plexus formation during development. Two different dermatome maps are commonly used.
A. andB. The dermatome pattern of the lower limb according to Foerster (1933 ) is preferred by many because
of its correlation with clinical ndings. C.and D. The dermatome pattern of the lower limb according to Keegan
and Garrett (1948 ) is preferred by others for its aesthetic uniformity and obvious correlation with development.
Although depicted as distinct zones, adjacent dermatomes overlap considerably, except along the axial line.
5.8
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432
Deep fibular(peroneal) nerve
Patellar ligament
Anterior tibial artery
Deep fascia
Sympathetic branchto vessel
Tibialis anterior
Extensorhallucis longus
Anterior tibialartery
Perforating branch offibular (peroneal) artery
Inferior extensorretinaculum
(cut and retracted)Inferior extensorretinaculum(cut and retracted)
Extensordigitorum longus
Tibialis anteriortendon
B. Anterolateral ViewA. Anterior View
Extensor digitorumbrevis
Common fibular(peroneal) nerve
Superficial fibular(peroneal) nerve
Fibularis (peroneus)longus
Fibularis (peroneus)brevis
Fibularis (peroneus)tertius
Deep fibular(peroneal) nerve
Extensor hallucislongus
Extensor digitorumlongus
Tibialis anterior
5.62 ANTERIOR LEGDEEP MUSCLES, NERVES, AND VESSELS
ANTERIOR AND LATERAL COMPARTMENTS OF LEG, DORSUM OF FOOT
TABLE 5.13 COMMON, SUPERFICIAL, AND DEEP FIBULAR (PERONEAL ) NERVES
Nerve Origin Course Distribution/Structure(S) Supplied
Common bular Sciatic nerve Forms as sciatic nerve bifurcates at the apex of popliteal fossa and followsmedial border of biceps femoris; winds around neck of bula, dividing intosupercial and deep bular nerves
Skin on lateral part of posterior aspect of leg via the lateral suralcutaneous nerve; lateral aspect of knee joint via its articularbranch
Supercial bular Commonbular nerve
Arises deep to bularis longus and descends in la teral compartment ofleg; pierces crural fascia at distal third of leg to become cutaneous
Fibularis longus and brevis and skin on distal third of anterolateralsurface of leg and dorsum of foot
Deep bular Commonbular nerve
Arises deep to bularis longus; passes through extensor digitorum longus,descends on interosseous membrane, and continues on dorsum of foot
Anterior muscles of leg, dorsum of foot, and skin of rst in terdigitalcleft; dorsal aspect of joints crossed via articular branches
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Posterior ramus (cut end)Anterior ramus
Axillary nerve
Radial nerve
C1
C5
T1
T12
L1
L5
S1
S5Co
Ulnar nerve
Superficial branch of radial nerve
Superficial branch of radial nerve
Posterior interosseous nerve
Obturator nerve
Sciatic nerve
Common fibular (peroneal) nerve
Tibial nerve
Superficial fibular (peroneal) nerve
Deep fibular (peroneal) nerve
Medial plantar nerve
Lateral plantar nerve
Anterior ramus
Spinal nerves:
Peripheral nerves:
Peripheral nerves:
Musculocutaneous nerve
Median nerve
Radial nerve
Ulnar nerve
Deep branch of radial nerve
Superficial branch of radial nerve
Femoral nerve
Saphenous nerve
Common fibular (peroneal) nerve
Superficial fibular (peroneal) nerve
Deep fibular (peroneal) nerve
C. Posterior View D. Anterior View
Ulnarnerve
Ulnarnerve
Median nerve
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362 SYSTEMIC OVERVIEW OF LOWER LIMB: NERVES
Semitendinosus
Popliteus
Sciatic nerve (tibial
and common fibular)
Biceps femoris
(short head)
Superior glutealnerveInferior gluteal
nerve
Common fibular (peroneal) nerve
(L4S2)
Gastrocnemius
Soleus
Tibialis
posterior
Flexor hallucis
longus
Lateral plantar nerve
(S1S2)
All other muscles
in sole of foot
Flexor digitorum brevis
Flexor hallucis brevis
Lumbrical to 2nd digit
Abductor hallucis
Medial plantar nerve
(L4L5)
Flexor digitorum
longus
Gastrocnemius
Tibial nerve
(L4S3)
Semimembranosus
Adductor magnus
Semitendinosus
Biceps femoris
(long head)
Plantaris
Obturator nerve
(L2L4)
Fibularis (peroneus)
tertius
Deep fibular (peroneal) nerve
(L5S2)
Tibialis anterior
Extensor hallucis
longusAnterior
compartment
of leg
Gluteal
compartment
Posterior
compartment
of leg
Medial
compartment
of thigh
Anterior
compartment
of thigh
Posterior
compartment
of thigh
Posterior
compartment
of leg
Lateral
compartment
of legExtensor digitorum
longus
Gracilis
Adductor
magnus
Adductor longus
Adductor brevis
Obturator externus
Femoral nerve
(L2L4)
Rectus femoris
Sartorius
Vastus lateralis
Vastus intermedius
Articularis genu
Psoas
Iliacus
Pectineus
Common fibular (peroneal) nerve
(L4S2)
Superficial fibular (peroneal) nerve
(L4S1)
Fibularis (peroneus)
brevis
Fibularis (peroneus)
longus
Extensor digitorum brevis
A. Anterior View B. Posterior View
Posterior branch
Anterior branch
Vastus medialis
L2
L3
L4
Anterior compartment
Innervation of thigh:
Medial compartment
Posterior compartment
Anterior compartment
Innervation of leg:
Lateral compartment
Posterior compartmentof leg and sole of foot
OVERVIEW OF MOTOR INNERVATION OF LOWER LIMB5.4
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Spinalnerves
C3 C3
C4 C4
C5 C5
C6 C6C7
C7C8
T1T1
T2
C2
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Supinator
Anconeus
Posteriorcompartment
of forearm
Triceps brachii (long head)
Triceps brachii (medial head)
Teres major
Latissimus dorsi
Subscapularis
Levator scapulae
Rhomboids
Supraspinatus
Infraspinatus
Shoulderregion
Shoulderregion
Posteriorcompartmentof arm
Deltoid
Teres minor
Axillary nerve
Radial nerve
Triceps brachii(lateral head)
Brachioradialis
Deep branch of radial nerve
Superficial branch ofradial nerve (sensory)
Extensor carpi radialis longus
Extensor carpi radialis brevis
Posterior interosseous nerve
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Suprascapular nerve
C. Posterior View
Posterior cord of brachial plexus
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Supraclavicular nerves (C3, C4)
A. Anterior View
Intercostobrachial nerve
Medial cutaneous nerve of arm
(from medial cord of brachial plexus)
Medial cutaneous nerve
of forearm
Posterior
branch
Medial cutaneous
nerve of forearm
(from medial cord
of brachial plexus)
Anterior branch
Dorsal (cutaneous) branch of ulnar nerve
Ulnar nerve
Median nervePalmar (cutaneous)
branches ofSuperficial
branch of
radial nerve
Radial nerve, superficial branch
Anterior branch
Posterior branch
Posterior cutaneous nerve of forearm
(from radial nerve)
Lateral cutaneous nerve of forearm
(from musculocutaneous nerve)
Posterior cutaneous nerve of forearm
(from radial nerve)
Inferior lateral cutaneous nerve
of arm (from radial nerve)
Superior lateral cutaneous
nerve of arm
(from axillary nerve) Intercostobrachial nerve
(from 2nd/3rd intercostal nerve)
B. Posterior View
Supraclavicular nerves
(C3, C4)
Superior lateral
cutaneous nerve of arm
(from axillary nerve)
Inferior lateral
cutaneous nerve
of arm
Posterior cutaneous
nerve of forearm
From
radial
nerve
Posterior cutaneous
nerve of forearm
Lateral cutaneous nerve
of forearm, posterior branch
Radial nerve,
superficial branchDorsal (cutaneous) branch
of ulnar nerve
Medial cutaneous nerve,
of forearm, posterior branches
Posterior cutaneous nerve
of arm (from radial nerve)
Median nerve,
palmar digital
branches
Communicating
branchesDorsal digital
branches
Lateral cutaneousnerve of forearm(from musculo-
cutaneous nerve)
Median nerve
Ulnar nerve,
superficial branch
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11
76
5
4
312
Numbers: approximate age of ossification of carpal bones in years
Trapezoid (Td)
Trapezium (Tz)
Scaphoid (S)
Capitate (C)
Hamate (H)
Pisiform (P)
Triquetrum (Tq)
Lunate (L)
K.Anterior View
Tq
J. Anterior (Right Hand)View
5
4 3 2
Td
1 Metacarpal
TzCH
L S
Distal phalanx
Middle phalanx
Proximal phalanx
L. Antero-posterior View, Right HandEpiphyses in radiographs appear as radiolucent lines
Tq
54 3
2
1
R
L
CH
H
P
PP
C
Td Tz
S
RL
Tq
U
54 3 2
1
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C4
C5
C6
C7
C8
T1
C4
C5
C6
C7
T1
T2
Coracobrachialis
Thenarmuscles
Flexorpollicislongus
Pronator teres
Brachialis
Biceps brachii
Musculocutaneous nerve
Median nerve
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorumsuperficialis
Flexor digitorumprofundus (lateralhalf to digits 2, 3)
Lumbricals
to digits 2, 3
Dorsal interossei
Adductor pollicis
Flexor digitorum profundus(medial half to digits 4, 5)
Ulnar nerve
Flexor carpi ulnaris
Palmaris brevis
Hypothenar muscles
Lumbricals to digits 4, 5
Palmar interossei
T1
C8
C7
C6
C7
T1
T2
A. Anterior View B. Anterior View
Anteriorcompartment
of arm
Anteriorinterosseous
nerve
Pronatorquadratus
Anteriorcompartmentof forearm
Deep branch of ulnar nerve
Anteriorcompartmentof forearm
Anteriorcompartment
of forearm
Lateral cord of brachial plexus
Medial cord ofbrachial plexus
Deep head, flexorpollicis brevis
Medial cord ofbrachial plexus
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C3
C4
C4C4
C5
C5
C5
T3T2
T2 T2
T2
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3L3L4
S2 S2
S2 S2
S3 S3S3
S3 S3
S3
L1
L2
C2
C6
C6
C6
C6C8
C8 C7C7C7
T1 T1T1 T1
S4S4S5
S1 S1S1 S1
S1
S1
L5
L4
L3L3
L4
L4
L5
L5
L5
L5
L5
C7C7
C6
Co
C3
C2
C4 C4
C5
C5C5
C6
C6
C6
C8C7
C7
C8
T2
T2T2
T1
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
S2
S2
S2
S2
S2
S2
S3S3
S4
S3S3
S1
S1
S1
S1
L2
L3
L3
L5
L5
L5
L4
Inferior View
Anterolateral View
Posterior View
A.
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Spinalnerves
C3 C3
C4 C4
C5 C5
C6 C6C7
C7C8
T1T1
T2
C2
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Supinator
Anconeus
Posteriorcompartment
of forearm
Triceps brachii (long head)
Triceps brachii (medial head)
Teres major
Latissimus dorsi
Subscapularis
Levator scapulae
Rhomboids
Supraspinatus
Infraspinatus
Shoulderregion
Shoulderregion
Posteriorcompartmentof arm
Deltoid
Teres minor
Axillary nerve
Radial nerve
Triceps brachii(lateral head)
Brachioradialis
Deep branch of radial nerve
Superficial branch ofradial nerve (sensory)
Extensor carpi radialis longus
Extensor carpi radialis brevis
Posterior interosseous nerve
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Suprascapular nerve
C. Posterior View
Posterior cord of brachial plexus
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Anterior cerebral artery
Blood is supplied to the cerebral hemispheres by the:
Middle cerebral artery
Posterior cerebral artery
Anterior communicating*
Anteromedial central
Anterolateral central
striate (lenticulostriate)
Anterior choroidal
Posteromedial central
Distal medial striate
*Anterior cerebral
Anterior cerebral
Ophthalmic
Internal carotid
Hypophysial
Middle
cerebral
*Posterior cerebral
Posterolateral
central
Superior cerebellar
Pontine
LabyrinthineBasilar
Anterior inferior
cerebellar
Vertebral
Posterior inferior
cerebellar
Anterior spinal
*Posterior communicating
A.Inferior (Ventral) View
B.Lateral View
C. Medial View* Components of cerebral arterial circle (Willis)
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820 OVERVIEW OF CRANIAL NERVES
Motor: lateral rectus
muscle of eye
AbducentCN VI
Sensory: smell
OlfactoryCN I
VestibulocochlearCN VIII
Vestibular nerve, sensory:
orientation, motion
Cochlear nerve, sensory:
hearing
Motor (efferent)
Sensory (afferent)
Cranial nerve fibers
FacialCN VII
Intermediate nerve
Motor: lacrimal, nasal, palatine,
submandibular, and sublingual
glands
Sensory: taste to anterior two
thirds of tongue, soft palate
Motor: superior oblique
muscle of eye
TrochlearCN IV
TrigeminalCN V
Sensory root
Sensory: face; oral, nasal
and sinus mucosa; teeth
and anterior two thirds of
tongue
TrigeminalCN V
Motor root
Motor: muscles of
mastication and 4 other
muscles (see table 9.1)
HypoglossalCN XII
Motor: all intrinsic and
extrinsic muscles of tongue
(excluding palatoglossus
a palatine muscle)
Spinal accessoryCN XI
Motor: sternocleidomastoid
and trapezius
VagusCN X
Motor: palate, pharynx,
larynx, trachea, bronchial
tree, heart, GI tract to left
colic flexure
Sensory : pharynx, larynx;
reflex sensory from tracheo-
bronchial tree, lungs, heart,
GI tract to left colic flexure;
taste to epiglottis, palate
GlossopharyngealCN IX
Motor: stylopharyngeus,
parotid gland
Sensory: pharynx, tonsillar
sinus, pharyngotympanic
tube, middle ear cavity;
taste to posterior third of
tongue
FacialCN VII
Primary root
Motor: muscles of facial
expression and 3 other
muscles (see table 9.1)
Sensory: vision
OpticCN IIOculomotorCN III
Motor: ciliary muscles,
sphincter of pupil, all
extrinsic muscles of eye
except those listed for
CN IV and VI
CN I
CN II
CN III
CN VI
CN V
CN V
CN XII
CN XI
CN X CN IX
CN VIII
CN VIICN VII
CN IV
SUMMARY OF CRANIAL NERVES9.3
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Supraclavicular nerves (C3, C4)
A. Anterior View
Intercostobrachial nerve
Medial cutaneous nerve of arm
(from medial cord of brachial plexus)
Medial cutaneous nerve
of forearm
Posterior
branch
Medial cutaneous
nerve of forearm
(from medial cord
of brachial plexus)
Anterior branch
Dorsal (cutaneous) branch of ulnar nerve
Ulnar nerve
Median nervePalmar (cutaneous)
branches ofSuperficial
branch of
radial nerve
Radial nerve, superficial branch
Anterior branch
Posterior branch
Posterior cutaneous nerve of forearm
(from radial nerve)
Lateral cutaneous nerve of forearm
(from musculocutaneous nerve)
Posterior cutaneous nerve of forearm
(from radial nerve)
Inferior lateral cutaneous nerve
of arm (from radial nerve)
Superior lateral cutaneous
nerve of arm
(from axillary nerve) Intercostobrachial nerve
(from 2nd/3rd intercostal nerve)
B. Posterior View
Supraclavicular nerves
(C3, C4)
Superior lateral
cutaneous nerve of arm
(from axillary nerve)
Inferior lateral
cutaneous nerve
of arm
Posterior cutaneous
nerve of forearm
From
radial
nerve
Posterior cutaneous
nerve of forearm
Lateral cutaneous nerve
of forearm, posterior branch
Radial nerve,
superficial branchDorsal (cutaneous) branch
of ulnar nerve
Medial cutaneous nerve,
of forearm, posterior branches
Posterior cutaneous nerve
of arm (from radial nerve)
Median nerve,
palmar digital
branches
Communicating
branchesDorsal digital
branches
Lateral cutaneousnerve of forearm(from musculo-
cutaneous nerve)
Median nerve
Ulnar nerve,
superficial branch
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828 CRANIAL NERVES III, IV, AND VI: OCULOMOTOR, TROCHLEAR, AND ABDUCENT
Superior rectusand inferior oblique
MedialrectusRest position
Lateralrectus
Inferiorrectus
Inferior rectus
Superiorrectus
Inferioroblique
Superiorrectus
Oculomotor nerve
CN III
CN III
Cavernous sinus
Superior oblique
Levator palpebraesuperioris (cut)
Superior rectus
Lateral rectus (cut)
Lateral rectus (cut)
Internal carotid artery
Internal carotid artery
Medial rectus
Inferior oblique
Inferior rectus
Nucleusof CN III
CN IV
Nucleusof CN IV
CN VI
Nucleusof CN VI
CN V1
CN V2
Trochlear nerve
CN IV
Abducent nerve
CN VI
Inferioroblique
Lateralrectus
Medialrectus
Superioroblique
Superior oblique
Superioroblique
Inferiorrectus
A
B
CN III
CN IV
CN VI
9.9 OCULOMOTOR (CN III), TROCHLEAR (CN IV), AND ABDUCENT (CN VI) NERVES
A. Schematic overview. B. Binocular movements and muscles producing them. All movements start from the
rest (primary) position.
TABLE 9.4 OCULOMOTOR (CN III), TROCHLEAR (CN IV), AND ABDUCENT (CN VI) NERVESa
Nerve FunctionalComponents
Cells of Origin/Termination Cranial Exit Distribution and Functions
Oculomotor Somatic motor Nucleus of CN III
Superior orbitalssure
Motor to superior, inferior, and medial recti, inferior oblique, and levator palpebrae superiorismuscles; raises upper eyelid, directing gaze superiorly, inferiorly, and medially
Visceral motor(parasympathetic)
Presynaptic: midbrain (Edinger-Westphalnucleus); Postsynaptic: ciliary ganglion
Motor to sphincter pupillae and ciliary muscle that constrict pupil and accommodate lens ofeyeball
Trochlear Somatic motor Nucleus of CN IV Motor to superior oblique that assists in directing gaze inferolaterally
Abducent Somatic motor Nucleus of CN VI Motor to lateral rectus that directs gaze laterally
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C4
C5
C6
C7
C8
T1
C4
C5
C6
C7
T1
T2
Coracobrachialis
Thenarmuscles
Flexorpollicislongus
Pronator teres
Brachialis
Biceps brachii
Musculocutaneous nerve
Median nerve
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorumsuperficialis
Flexor digitorumprofundus (lateralhalf to digits 2, 3)
Lumbricals
to digits 2, 3
Dorsal interossei
Adductor pollicis
Flexor digitorum profundus(medial half to digits 4, 5)
Ulnar nerve
Flexor carpi ulnaris
Palmaris brevis
Hypothenar muscles
Lumbricals to digits 4, 5
Palmar interossei
T1
C8
C7
C6
C7
T1
T2
A. Anterior View B. Anterior View
Anteriorcompartment
of arm
Anteriorinterosseous
nerve
Pronatorquadratus
Anteriorcompartmentof forearm
Deep branch of ulnar nerve
Anteriorcompartmentof forearm
Anteriorcompartment
of forearm
Lateral cord of brachial plexus
Medial cord ofbrachial plexus
Deep head, flexorpollicis brevis
Medial cord ofbrachial plexus