of consciousness

Meningitis Headache/photophobia/
phonophobia/stiff neck
often subacute onset

Encephalitis Headache, delirious, odd

behaviours, abscences, may be
unconscious

Neurodegeneration Slowly progressive problems

typically involving movement
and cognition

Epilepsy Intermittent episodes typically

Nervios of altered consciousness and/or

odd behavioural attacks

Multiple sclerosis Episodes of altered feeling/

espinales movement control, visual upset

that initially come and go over
days/weeks, developing permanent
symptoms with time

Myelitis/myelopathy Can present acutely or subacutely

with increasing difficulty in walking
+/- use of arms/bladder problems
+/- sensory loss

Plexopathy Present with subacute loss of power

and sensation
JorgeinSanhueza
a limb S., PhD

Neuropathy Present with sensory loss +/-

weakness:
Desarrollo de la médula espinal

2
 Gray Substance and Intrinsic System
1
2 C1
C2
Cervical nerves 3 5
4
4 3
1
5 1
8
2
6 C7 7
19

7 C8 6 13
T1 T1 10 20
8 12
9 11 18
1

Spinal Cord
2 5 6
A Gray substance
–
3 +
and spinal roots
4 D Neuronal relay in
the spinal cord
Thoracic nerves

17
5
6 20
16
7 15
14
8 18 B Somatotopic organization of gray
substance in the cervical spinal cord
9

10
5
11 5
2
12 T 12

1 L1
L1
3

2
Lumbar nerves

3 21
4

4 7 L5
C Spinal cord
S1
S1
5
1 Coccyx
2
Sacral 3
nerves 4 C Somatotopic organization of gray E Fasciculi proprii
5 substance, overview (according to Bossy)
Coccygeal nerves
Kahle, Color Atlas of Human Anatomy, Vol. 3 © 2003 Thieme
A Lateral view of the spinal nerves B Dorsal view of the spinal ganglia All rights reserved. Usage subject to terms and conditions of license.
Organización anatómica
Proyecciones
my of the Spinal Cord
Figure 14.8 Peripheral Nerves and Nerve Plexuses

C1
C2
Cervical spinal C3 C1 Lesser occipital nerve
nerves C4 C2 Great auricular nerve
Cervical C3
C5 plexus C4 Transverse cervical nerve
C6 C5 Supraclavicular nerve
Cervical C6
C7 Brachial C7 Phrenic nerve
enlargement C8
C8 plexus T1
T1 T2
T3 Axillary nerve
T2 T4
T3 T5
T6
T4 T7 Musculocutaneous
T5 T8 nerve
T6 T9 Thoracic nerves
T7 T10
T11
Thoracic T8
T12
spinal Posterior
nerves T9 median sulcus L1 Radial nerve
Lumbar L2
T10 plexus Ulnar nerve
L3
T11 Lumbosacral L4 Median nerve
enlargement L5
T12 S1 Iliohypogastric
Sacral nerve
plexus S2
L1 Conus S3
medullaris S4 Ilioinguinal
S5 nerve
L2 Co1 Genitofemoral
nerve
Lumbar L3 Inferior Femoral nerve
spinal tip of Obturator nerve
nerves spinal cord
L4 Superior
Gluteal
Cauda equina nerves
Inferior
L5
Pudendal nerve

S1 Sciatic nerve
Sacral spinal
S2 Lateral femoral cutaneous nerve
nerves
S3
Saphenous nerve
S4
S5

Coccygeal Filum terminale Common fibular nerve

nerve (Co1) (in coccygeal ligament)
Tibial nerve

Medial sural cutaneous nerve

© 2012 Pearson Education, Inc.

Figure 14.2c The Spinal Cord and Spinal Meninges
Gray matter
White matter

Ventral root
Spinal nerve

Dorsal root Dorsal root

Pia mater ganglion

Figure 14.2a The Spinal Cord and Spinal Meninges

Arachnoid mater Spinal cord

Anterior median
fissure

Dura mater Pia mater

Denticulate
ligaments

Arachnoid mater
(reflected)
Dura mater
(reflected)

Spinal blood
vessel
Posterior view of the spinal cord showing the
meningeal layers, superficial landmarks, and Dorsal root of
distribution of gray and white matter sixth cervical
© 2012 Pearson Education, Inc. nerve
Ventral root of
sixth cervical
nerve

Anterior view of spinal cord showing meninges and spinal nerve

view, the dura and arachnoid membranes have been cut longitud
retracted (pulled aside); notice the blood vessels that run in the
subarachnoid space, bound to the outer surface of the delicate p
© 2012 Pearson Education, Inc.
Figure 14.5a Anatomy of a Peripheral Nerve

Blood vessels

Connective Tissue
Layers
Epineurium covering
peripheral nerve
Perineurium (around
one fascicle)

Endoneurium

Schwann cell

Myelinated
axon
A typical peripheral Fascicle
nerve and its connective
tissue wrappings
© 2012 Pearson Education, Inc.
 Figure 14.4b Sectional Organization of the Spinal Cord

Posterior median sulcus

From dorsal root
Posterior
gray horn
Posterior gray
commissure
Somatic
Sensory
Visceral nuclei

Lateral Visceral
gray horn Motor
nuclei
Anterior Somatic
gray horn
To ventral
Anterior gray root
commissure

Anterior median
fissure

The left half of this sectional view shows important anatomical landmarks; the right half indicates
the functional organization of the gray matter in the anterior, lateral, and posterior gray horns.

© 2012 Pearson Education, Inc.

ure 14.6a Peripheral Distribution of Spinal Nerves
Motor Commands

Postganglionic fibers To skeletal

to smooth muscles, muscles of back
glands, etc., of back Dorsal Visceral Somatic
Dorsal root ganglion root motor motor

Dorsal ramus

Ventral ramus

To skeletal
muscles of body
wall, limbs Ventral
root

Postganglionic fibers to
smooth muscles, glands,
etc., of body wall, limbs
Spinal nerve

Gray ramus Sympathetic ganglion

(postganglionic)
Rami
communicantes White ramus Postganglionic fibers
(preganglionic) to smooth muscles,
glands, visceral organs
Sympathetic nerve in thoracic cavity

KEY
Somatic motor Preganglionic fibers to
commands sympathetic ganglia
innervating abdomino-
Visceral motor
commands pelvic viscera
Figure 14.6b Peripheral Distribution of Spinal Nerves
Sensory Information

From interoceptors From exteroceptors,

of back proprioceptors of back Dorsal Somatic Visceral
root sensory sensory

Dorsal ramus
Ventral ramus

From exteroceptors,
proprioceptors of
body wall, limbs Dorsal
root
ganglion
From interoceptors
of body wall, limbs

Rami
communicantes
Ventral
KEY root
Somatic
sensations

Visceral
From interoceptors
sensations of visceral organs

A comparable view detailing the distribution of sensory neurons and sensory fibers
© 2012 Pearson Education, Inc.
Figure 14.7 Dermatomes
C2–C3

NV

C2–C3
C2
C3 C3
C4
T2 C4
C5
T3
T1
T2 T4
T5 C5
T3 T6
T4 T7
T5 T8
T6 T9 T2
T2 T7 T 10
T 11
T8
T 12
T9 L1 C6
T 10 L2
T 11 L4 L3 T1
C6 C7
T 12 L5
L1
SS
L2 S2 4 3
C8
C8
T1 L3 L1
C7 S5
S1 L5
L4
L2 S2

L5 L3

S1

L4

ANTERIOR POSTERIOR
© 2012 Pearson Education, Inc.
Plexo Cervical
del cuello (hioideos, prevertebrales, trapecio y esternocleidomastoideo) para mover la cabeza y el hombro
rama importante de este plexo es el nervio frénico (C3-C4-C5), motor fundamental del diafragma.

Asa del atlas

Asa del axis

Tercer asa cervical

Figura 2. Esquema de conformación del plexo cervical (Tomado de Bustamante, 2003).

Nervio Segmento Músculo Función

Figure 14.9 The Cervical Plexus

Accessory
nerve (N XI)
Cranial
Hypoglossal
nerves
nerve (N XII)
Great auricular nerve
Lesser occipital
nerve

C1
C2

Nerve roots of C3 Geniohyoid muscle

cervical plexus Transverse
C4
cervical nerve
C5 Thyrohyoid muscle
Ansa cervicalis

Omohyoid muscle
Supraclavicular Phrenic nerve
nerves
Clavicle Sternohyoid muscle

Sternothyroid muscle

© 2012 Pearson Education, Inc.

Plexo cervical superficial
Parte media del M. Esternocleidomastoideo.

• RamaTransversa: Región del supra e

infrahioideo.

• Rama Auricular.

• Rama Mastoidea.

• Rama Supraclavicular:
1. Rama supraesternal.
2. Rama Supraclavicular.
3. Rama Supraacromial
 Hypoglossal nerve (XII) Meningeal branch
(in hypoglossal canal)

Hypoglossal nucleus
Superior
longitudinal
Intrinsic
muscles Transverse
of tongue and vertical
Styloglossus
Inferior muscle
longitudinal

Occipital condyle

Inferior ganglion of
vagus nerve
Plexo cervical
Ventral rami of
C1, 2, 3 form
ansa cervicalis
of cervical plexus
profundo
Las
Superior ramas sensitivas controlan la sensibilidad
cervical
sympathetic
de la piel del cuello, Las ramas motoras contro
del cuello (hioideos, prevertebrales, trapecio y
ganglion esternocleidomastoideo) para mover la cabeza
rama importante de este plexo es el nervio frénico (C3-C4-C5), motor fundamental del diafragm
Superior root of
Genioglossus ansa cervicalis
muscle

Internal carotid artery

Geniohyoid muscle

Hyoglossus muscle Inferior root of ansa cervicalis

Thyrohyoid muscle Ansa cervicalis

Omohyoid muscle Internal jugular vein

(superior belly)

Sternohyoid muscle Common carotid artery

Sternothyroid muscle

Omohyoid muscle (inferior belly) Efferent fibers

Afferent fibers

34

Figura 2. Esquema de conformación del plexo cervical (Tomado de Bustamante, 2

Plexo Brachial
Raíces
Constitución del Plexo Braquial
C5

Tronco superior
Ramos
C6 División anterior

Fascículo N. Musculocutaneo
externo

C7 Tronco medio División anterior

N. Mediano

División anterior
C8 Tronco inferior
Fascículo
interno

N. Ulnar
T1
Raices Constitución del Plexo Braquial
C5

Ramos
Tronco superior División
C6 posterior
N. Axilar

Fascículo
N. Radial
posterior
Tronco medio
C7 División
posterior

División
posterior
C8 Tronco inferior

T1
-“Hour Glass”
-4 Approaches to BrPl

C5

C6

C7
C8

T1
 Figure 14.10a The Brachial Plexus

KEY Dorsal scapular

Roots (ventral rami) nerve
Trunks Nerve to C5
subclavius muscle
Divisions

Cords SUPERIOR TRUNK

Peripheral nerves C6
Suprascapular nerve

MIDDLE
Lateral cord TRUNK C7 BRACHIAL
PLEXUS
Posterior cord
Lateral pectoral nerve C8

Medial pectoral nerve

Subscapular nerves
T1
Axillary nerve
INFERIOR
Medial cord
TRUNK
Musculocutaneous First
nerve rib Long thoracic
Medial antebrachial nerve
cutaneous nerve Thoracodorsal
nerve
Median nerve
Ulnar nerve

Posterior brachial The trunks and cords of the brachial

Radial nerve
cutaneous nerve plexus

© 2012 Pearson Education, Inc.

rachial
exus
Distal
Anatomy
Brachial
Plexus
! Distal
Anatomy
Table 14.2 The Brachial Plexus
Figure 14.10c The Brachial Plexus
Musculocutaneous
nerve
Axillary nerve

Branches of
axillary nerve

Radial nerve

Ulnar nerve
Median nerve
Posterior antebrachial
cutaneous nerve

Deep branch of
radial nerve

Superficial branch
Radial
of radial nerve
nerve

Ulnar Dorsal digital nerves

nerve

Median
nerve
Posterior
Distribution of
cutaneous nerves

Posterior view of the brachial plexus and

the innervation of the upper limb
Nervio Ulnar
 Brazo:

• En el brazo acompaña la art. Humeral.

• No inerva ningún músculo

Nervio
NEUROANATOMY •
Median Nerve
En el codo ingresa en el canal bicipital interno (Pronador y

Mediano
Anterior view Note: Only muscles innervated by median nerve shown
Biceps).

Musculocutaneous nerve
Antebrazo:

Median nerve (C5, 6, 7, 8, T1) • Entre el flexor

Medial
común
Cords of
superficial y el profundo.
Inconstant contribution
Posterior brachial
Lateral plexus

Pronator teres muscle (humeral head)

• Inerva músculos del grupo anterior: Pronador redondo, Palmar
Medial cutaneous
nerve of arm
Articular branch
menor ycutaneous
Medial mayor, Flexor común sup., haces ext. Flexor común prof.
nerve of forearm
Flexor carpi radialis muscle
Axillary nerve
Palmaris longus muscle de los dedos, Flexor largo del pulgar y Pronador cuadrado.
Radial nerve
Pronator teres muscle (ulnar head)
Ulnar nerve
Flexor digitorum superficialis muscle
(turned up)

Flexor digitorum profundus muscle

(lateral part supplied by median
[anterior interosseous] nerve;
medial part supplied by ulnar nerve)
Anterior interosseous nerve
Flexor pollicis longus muscle
Pronator quadratus muscle
Palmar branch of median nerve Cutaneous
innervation

Abductor pollicis brevis

Opponens pollicis
Thenar Superficial head of
muscles flexor pollicis brevis
(deep head
supplied by
ulnar nerve) Palmar view
 Axillary nerve
Palmaris longus muscle
Radial nerve
Pronator teres muscle (ulnar head)
Mano: Ulnar nerve
Flexor digitorum superficialis muscle
(turned up) • Viaja por el canal del pulso e ingresa al túnel carpiano, entre los tendones
Nervio
Flexor digitorum profundus muscle
(lateral part supplied by median
del M. Palmar mayor y menor.
[anterior interosseous] nerve;
Mediano
medial part supplied by ulnar •nerve)
Anterior interosseous nerve
Al pasar el túnel da origen a la rama Tenariana: M. Abductor corto del

Flexor pollicis longus muscle pulgar, M. oponente del pulgar, Has sup. del flexor corto del pulgar y M.
Pronator quadratus muscle
Palmar branch of median nerve lumbricales externos. Cutaneous
innervation

Abductor pollicis brevis

Opponens pollicis
Thenar Superficial head of
muscles flexor pollicis brevis
(deep head
supplied by
ulnar nerve) Palmar view
Communicating branch
of median nerve with
1st and 2nd ulnar nerve
lumbrical muscles
Common palmar
digital nerves

Proper palmar
digital nerves
Dorsal branches to
dorsum of middle and
distal phalanges

Posterior (dorsal) view

4. Pronation-Pron Teres/Quad
 Nervio
Mediano

Ramas
sensitivas

N. Mediano
 Brazo:

Nervio • Desciende por el brazo y perfora al M.

Coracobraquial y se hace profundo.

Musculocutaneo • Inerva: M. Biceps, M. Coracobraquial y M. Braquial

anterior

Antebrazo:

• En el canal bicipital externo se hace superficial, se

divide en dos ramas e inerva sensitivamente la

porción externa del borde radial del antebrazo.

 Flexion
Supination

Biceps/Brachialis
Coracobrachialis
 Brazo:

• Desciende por el brazo hasta el codo y se

NEUROANATOMY
Nervio Ulnar introduce en el Canal epitrocleo-olecraneano.
muscles innervated
rve shown Antebrazo:
Ulnar nerve (C7, 8, T1)
(no branches above elbow)
Inconstant contribution • Pasa hacia anterior y bajo el M. Flexor carpo ulnar y

viaja con la Art. Ulnar.

Medial epicondyle

• Inerva: M. Flexor carpo ulnar y Haces internos del

Articular branch
(behind condyle)
M. Flexor común profundo de los dedos.
Flexor digitorum profundus
muscle (medial part only;
lateral part supplied by
anterior interosseous
branch of median nerve)

Flexor carpi ulnaris muscle

(drawn aside)

Dorsal branch of ulnar nerve

Palmar branch

Superficial branch

Deep branch
 Inconstant contribution

Mano:
Medial epicondyle
• Ingresa por el canal de Guyon.
Articular branch

Nervio Ulnar • Inervación:

Cutaneous
innervation
(behind condyle)

Flexor digitorum profundus

1. Músculos Hipotenares: M. Oponente del meñique, M. Flexor corto del
muscle (medial part only;
lateral part supplied by
anterior interosseous
branch of median nerve)
meñique, M. Abductor del meñique y M. Cutaneo palmar.
Palmar view
2. Músculos Tenares: Has profundo del flexor corto del pulgar y M.
Flexor carpi ulnaris muscle
(drawn aside)
Abductor largo del pulgar.

3. Músculos interoseos dorsales y Dorsal branch of ulnar nerve

palmares.
Posterior
(dorsal) view
4. Músculos lubricares internos.Palmar branch
Flexor pollicis brevis muscle
(deep head only; superficial Superficial branch
head and other thenar muscles
supplied by median nerve) Deep branch

Palmaris brevis
Adductor pollicis muscle
Abductor digiti minimi
Flexor digiti minimi brevis Hypothenar muscles
Opponens digiti minimi

Common palmar digital nerve

Communicating branch of median nerve with

ulnar nerve

Palmar and dorsal interosseous muscles

3rd and 4th lumbrical muscles (turned down)

Proper palmar digital nerves

(dorsal digital nerves are from dorsal branch)

Dorsal branches to dorsum of middle and distal phalanges

Nervio Ulnar

Ramas
sensitivas

N. Ulnar
NEUROANATOMY Radial Nerve in Arm and Nerves of Posterior Shoulder

Dorsal scapular nerve (C5) Posterior view

Supraspinatus muscle

Levator scapulae
muscle (supplied
Nervio Radial Suprascapular nerve (C5, 6)

Brazo:
Deltoid muscle
also by branches
from C3 and C4)
Teres minor muscle • Viaja por el triángulo húmero-
Axillary nerve (C5, 6)
tricipital, luego por el canal de torsión
Rhomboid Superior lateral
minor muscle cutaneous nerve of arm

Radial nerve
hasta la parte externa del codo.
(C5, 6, 7, 8, T1 )
Inconstant contribution
Rhomboid Inervación:
major muscle

Inferior lateral
cutaneous nerve of arm
Músculo Tríceps.

Posterior cutaneous
nerve of forearm
Infraspinatus muscle

Teres major muscle

Lateral intermuscular
septum
Lower subscapular nerve (C5, 6)

Posterior cutaneous nerve of arm

(branch of radial nerve in axilla) Brachialis muscle (lateral
part; remainder of muscle
supplied by musculo-
Long head cutaneous nerve)
Triceps brachii muscle Lateral head
Medial head
Brachioradialis muscle
Triceps brachii tendon

Medial epicondyle Extensor carpi radialis

longus muscle
Olecranon
dial Nerve in Forearm NEUROANATOMY

Nervio Radial
Radial nerve (C5, 6, 7, 8, T1 ) Inconstant contribution

Superficial (terminal) branch

Deep (terminal) branch Posterior view
Lateral epicondyle
Anconeus muscle
Antebrazo:
Brachioradialis muscle
• Rama Externa: Sensitiva
Extensor carpi radialis longus muscle
Supinator muscle
• Rama Posterior:
Extensor carpi radialis brevis muscle
Extensor carpi ulnaris muscle Extensor- supinator
group of muscles • Perfora al M. Supinador corto (canal
Extensor digitorum muscle and
extensor digiti minimi muscle
Extensor indicis muscle de Fröze).
Extensor pollicis longus muscle
Abductor pollicis longus muscle • Inerva:
Extensor pollicis brevis muscle

Posterior interosseous nerve

(continuation of deep branch of
radial nerve distal to supinator muscle)

Superficial branch of radial nerve

Superior lateral
From axillary nerve cutaneous nerve
of arm

Inferior lateral
cutaneous nerve
 Superficial branch of radial nerve

Nervio From axillary nerve

Superior lateral
cutaneous nerve
of arm
Radial
Inferior lateral
cutaneous nerve
Ramas of arm
sensitivas Posterior cutaneous
nerve of arm
From radial nerve
Posterior cutaneous
nerve of forearm

Superficial branch of
radial nerve and dorsal
digital branches

Dorsal digital nerves

Cutaneous innervation from
radial and axillary nerves

47
4. Elbow Extension
5. Supination (Brachio-
radialis;supinator)
Nervio Axilar
Dorsal scapular nerve (C5) Posterior view

Supraspinatus muscle
Suprascapular nerve (C5, 6)

Levator scapulae
muscle (supplied Deltoid muscle
also by branches
from C3 and C4)
Teres minor muscle

Axillary nerve (C5, 6)

Rhomboid Superior lateral

minor muscle cutaneous nerve of arm

Radial nerve
(C5, 6, 7, 8, T1 )
Inconstant contribution
Rhomboid
major muscle

Inferior lateral
cutaneous nerve of arm

Posterior cutaneous
nerve of forearm
Infraspinatus muscle

Teres major muscle

Lateral intermuscular
Plexo Lumbar y Sacral
Figure 14.12a The Lumbar and Sacral Plexuses, Part I

T12

T12 subcostal nerve

L1

Iliohypogastric nerve L2 LUMBAR

PLEXUS
Ilioinguinal nerve
L3
Genitofemoral nerve
Lateral femoral
cutaneous nerve
L4
Branches of
Femoral branch
genitofemoral
nerve Genital branch
L5
Femoral nerve
Obturator nerve Lumbosacral
trunk
The lumbar plexus, anterior view
© 2012 Pearson Education, Inc.
Figure 14.12b The Lumbar and Sacral Plexuses, Part I

L5

Lumbosacral trunk

S1
SACRAL
Superior gluteal nerve PLEXUS
S2
Inferior gluteal nerve
S3

S4
Sciatic nerve S5

Posterior femoral Co1

cutaneous nerve
Pudendal nerve

The sacral plexus, anterior view

© 2012 Pearson Education, Inc.
Quadratus
lumborum

T12
1

Ilio-
hypogastric N. 2

Ilio-
inguinal N.
3

Psoas
4 minor
lying on
Lat. cut. N. psoas
of thigh major

Genito- 5
femoral N.

Femoral N.
4th lumbar
sympathetic
ganglion
Inguinal
ligament

Obturator N.
 N. Iliohipogástrico
• Atraviesa el M. Psoas y perfora al M. Tranverso y al M.
Oblicuo menor, viaja entre los oblicuos abdominales.
• Rama perforante: piel del gluteo.
• Rama abdominal: Músculos del abdomen.
• Rama genital: Piel del escroto/Labios mayores.
N. Ilioinguinal
• Continua su recorrido y aporta ramas al
iliohipogástrico y continua su recorrido hasta el
cordón espermático o la vulva.
 N. Lateral femoral cutaneo y
N. Genitofemoral

N. Lateral femoral
cutaneo

N. Femorocutaneo

N. Ilioinguinal

N. Lateral femoral cutaneo N. Femorocutaneo

• Recorre el trayecto inguinal junto con el N. • Nervio sensitivo.
Iliohipogástrico e Ilioinguinal. • Entre el gluteo y la cresta iliaca.
• Sensitivo del triangulo femoral. • Rama glutea y Rama femoral.
N. Femoral
Ramas colaterales:
M. Psoas mayor.

Ramas terminales:
Ramas profundas: N. del Cuadriceps, N. del safeno interno, Rama
sensitiva cara interna de la pierna.

Ramas superficiales:
N. Musculocutaneo interno: M. Pectineo, M. Adductor medio, Ramas
cutaneas externas.

N. Musculocutaneo externo: M. Sartorio, Piel anterior del muslo, N.

safeno interno.
 Femoral vein and
artery
Lateral cutaneous
N. of thigh

Sartorius Femoral nerve

(cut)

Adductor longus

Saphenous nerve

Intermediate
cutaneous N.
of thigh
Medial cutaneous
N. of thigh

Sartorius
(cut)
Rectus femoris
Vastus
lateralis

Vastus medialis
N. Obturador
Tronco posterior:
M Adductor mayor.
M. Obturador externo.

Tronco anterior:
Ramas articulares.
M. Pectineo
M Adductor medio.
M. Adductor menor.
M. Gracilis.
Rama cutanea para la cara interna del muslo.
 L2

Obturator
externus
Adductor
longus (cut) and
Adductor
N. to
brevis
adductor
and
longus
N. to
gracilis
adductor
(cut) and
brevis
N. to
gracilis

Anterior and
posterior
Adductor branches of
magnus obturator N.

Terminal
cutaneous
branches

Terminal
articular
branch
 Tronco lumbosacro del
plexo sacro

Plexo sacro
Plexo lumbosacro
DIVISIÓN
POSTERIOR
Tronco
lumbosacro

N. Glúteo
superior.
N. femoral

N. Del piriforme

N. Glúteo
inferior

N. Peroneo
común Nervio
ciático
N. anococcígeo
 Plexo Lumbosacro
DIVISIÓN ANTERIOR

N. Obturador interno
(y gemelo superior).

Ramo perineal
N. Del cuadrado del 4to nervio
femoral(y gemelo sacro
inferior)

N. Elevador
del ano y
coccígeos

N. Obturador
accesorio

Nervio ciático N.
pudendo N. obturador
*N. tibial
 Tronco lumbosacro

N. obturador

N. Glúteo
superior

N. Obturador
interno

N. pudendo

N. Del musculo
elevador del
ano.
Visión medial
 Recorrido del nervio
pudendo

Nervio pudendo

Nervios rectales inferiores

Fosa Isquioanal

Nervio dorsal del clítoris. Nervio perineal

Sympathetic
chain
Internal iliac
A. and V.

Ureter
Ext. iliac A. and V.

L
5 Obturator N.
S
1 Superior
and
inferior
2 gluteal arteries
3
4
5

Pudendal N.
210 The Peripheral Nerves

Dorsal clitoral NS.

Perineal branches

Ischial tuberosity

Pudendal nerve

Inferior rectal NS.

Fig. 147 Distribution of the pudendal nerve in the female.

NEUROANATOMY Sciatic Nerve and Posterior Cutaneous Nerve of Thigh

N. Ciático
NEUROANATOMY Sciatic Nerve and Posterior Cutaneous Nerve of Thigh

Posterior cutaneous
nerve of thigh
(S1, 2, 3) Posterior cutaneous
nerve of thigh
(S1, 2, 3)
Greater sciatic foramen
Greater sciatic foramen
Inferior cluneal nerves
Inferior cluneal nerves

Sciatic nerve (L4, 5, S1,

Sciatic 2, (L4,
nerve 3) 5, S1, 2, 3)
Perineal branches Perineal branches

Tibial division Common fibular (peroneal)

Tibial division of sciatic nerve Common fibulardivision
(peroneal)
of sciatic nerve
of sciatic nerve division of sciatic nerve
Long head (cut) of
Short head of
biceps femoris muscle
biceps femoris muscle
Cutaneous innervation
Long head (cut) of
Short head of
biceps femoris muscle Adductor magnus muscle biceps femoris muscle
Cutaneous innervation
(also partially supplied Long head (cut)
by obturator nerve) of biceps femoris
muscle
Adductor magnus muscle
(also partially supplied Semitendinosus muscle Long head (cut)
by obturator nerve) of biceps femoris
Common fibular
Semimembranosus muscle muscle (peroneal) nerve

Semitendinosus muscle
Tibial nerve
Articular
Common fibular
branch Posterior
cutaneous nerve
Semimembranosus muscle Articular branch (peroneal) nerve of thigh

Lateral sural
Plantaris muscle cutaneous nerve
Tibial nerve
Articular
branch Posterior
Medial sural
cutaneous nerve Sural cutaneous nerve
Articular branch of thigh
communicating
Figure 14.13a The Lumbar and Sacral Plexuses, Part II

Gluteus maximus

Superior gluteal nerve

Inferior gluteal nerve

Gluteus medius
Gluteus minimus
Tibial branch
Internal
pudendal Common fibular Components of
artery branch sciatic nerve
Greater trochanter of femur
Pudendal
nerve Posterior femoral
cutaneous nerve
Nerve to
gemellus
and
obturator
internus Gluteus
maximus

A dissection of the right gluteal region

© 2012 Pearson Education, Inc.
Gluteus maximus (Gluteus medius
has been removed)

Superior gluteal
N.
Gluteus minimus
Sciatic N. Piriformis

Obturator internus
(between the
gemelli)

Quadratus
femoris
Posterior cutaneous
N. of thigh
Fascia lata

Branch from
Semitendinosus lateral aspect of
sciatic N.
to biceps short
head
Adductor magnus

Biceps femoris

Popliteal artery
and vein Common peroneal
nerve
Tibial nerve
Figure 14.13c The Lumbar and Sacral Plexuses, Part II (Part 1 of 2)

Gluteus maximus
(cut) Gluteus medius
(cut)
Inferior gluteal Gluteus minimus
nerve
Pudendal nerve Superior gluteal
nerve
Perineal branch
Hemorrhoidal Piriformis
branch

Posterior femoral
cutaneous nerve

Perineal branches
Sciatic
nerve

Descending
cutaneous
branch

Semitendinosus Biceps femoris

(cut)

A diagrammatic posterior view of the

right hip and lower limb detailing the
distribution of peripheral nerves
© 2012 Pearson Education, Inc.
 The Sacral and Coccygeal Plexuses 201

Semimembranosus Semitendinosus

Biceps

Common
Tibial N. peroneal N.

Popliteal Lat. cut. N.

A. of calf
and sural
Small (short) commun-
saphenous V V.
icating N.

Sural N.
Sural
communicating
N.
Post. tibial N. Sural N.
Heads of gastrocnemius

(a) (b)

Fig. 142 The popliteal fossa: (a) superficial dissection; (b) deep dissection.
 (also partially supplied Long head (cut)
by obturator nerve) of biceps femoris
muscle
Semitendinosus muscle

Common fibular
Semimembranosus muscle (peroneal) nerve

Tibial nerve
Articular
branch Posterior
cutaneous nerve
Articular branch of thigh

Lateral sural
Plantaris muscle cutaneous nerve

Medial sural
cutaneous nerve Sural
communicating
branch
Common fibular
Gastrocnemius muscle (peroneal) nerve
via lateral sural
cutaneous nerve
Sural nerve
Medial sural
cutaneous nerve
Soleus muscle From sciatic
nerve Superficial fibular
(peroneal) nerve
Tibial nerve
Sural nerve
Lateral calcaneal Tibial nerve
Medial branches via medial
calcaneal branches calcaneal
branches
Lateral dorsal
Medial and lateral cutaneous nerve
plantar nerves

48
Semimembranosus
and
Semitendinosus Biceps femoris

Gastrocnemius (cut)

Common peroneal N.
Branch to popliteus
Sural and sural
communicating nerves

Branch to soleus
Soleus (cut)
Peroneal A. (cut)
Flex. digit. longus Tibialis posterior
Flex. hallucis longus

Tibial N. and
Posterior tibial A.

Peroneus longus

Tendon of tibialis Sural N.

posterior

Medial calcanean N.
Figure 14.13b The Lumbar and Sacral Plexuses, Part II

Biceps femoris
Tibial nerve
Sartorius
Gracilis Lateral sural
cutaneous nerve
Semimembranosus
Common fibular
Popliteal artery nerve

Semitendinosus Plantaris

Nerve to Nerve to lateral head

medial head of gastrocnemius
of gastrocnemius
Gastrocnemius,
Gastrocnemius, lateral head
medial head

Medial sural
cutaneous nerve

A dissection of the popliteal fossa

© 2012 Pearson Education, Inc.
 Lateral sural cutaneous nerve (phantom)
Common fibular
(peroneal) nerve
(phantom)
Articular branches

Biceps femoris tendon

Recurrent articular nerve

Common fibular (peroneal)

nerve (L4, 5, S1, 2)
Extensor digitorum longus muscle (cut)

Head of fibula
Deep fibular (peroneal) nerve

Fibularis (peroneus)
longus muscle (cut) Tibialis anterior muscle

Superficial fibular Cutaneous innervation

(peroneal) nerve

Branches of lateral Extensor digitorum

sural cutaneous nerve longus muscle

Fibularis (peroneus)
longus muscle Extensor hallucis
longus muscle

Fibularis (peroneus)
brevis muscle
Lateral sural
cutaneous nerve

Medial dorsal cutaneous nerve Superficial fibular

(peroneal) nerve

Intermediate dorsal Lateral branch of

cutaneous nerve deep fibular
(peroneal) nerve to
Extensor hallucis brevis
and
Inferior extensor Extensor digitorum brevis
muscles Deep
retinaculum (partially cut) fibular
(peroneal)
Medial branch of nerve
deep fibular
Lateral dorsal cutaneous nerve (peroneal) nerve
(branch of sural nerve)
Sural nerve
via lateral dorsal
Dorsal digital nerves cutaneous branch
Figure 14.12c The Lumbar and Sacral Plexuses, Part I
Subcostal nerve

Iliohypogastric nerve

Ilioinguinal nerve
Genitofemoral nerve
Lateral femoral
cutaneous nerve
Femoral nerve

Superior gluteal nerve

Inferior gluteal nerve

Pudendal nerve
Posterior femoral
cutaneous nerve (cut) Obturator nerve

Sciatic nerve

Saphenous
nerve

Sural
Saphenous nerve nerve
Fibular
nerve

Common fibular
nerve

Superficial fibular Tibial

nerve nerve
Saphenous
Deep fibular Sural nerve
nerve nerve

Saphenous Sural
nerve nerve

The lumbar and sacral Tibial Fibular

nerve nerve
plexuses, anterior view
© 2012 Pearson Education, Inc.
Figure 14.12d The Lumbar and Sacral Plexuses, Part I

Superior gluteal nerve

Inferior gluteal nerve

Posterior femoral
Pudendal
cutaneous nerve
nerve

Sciatic nerve

Saphenous
nerve

Sural
nerve
Fibular
Tibial nerve
nerve Common fibular
nerve

Medial sural
cutaneous nerve

Lateral sural
Tibial cutaneous nerve
nerve
Saphenous
Sural nerve
nerve
Sural nerve

Saphenous Sural
nerve nerve Medial plantar
nerve
Lateral plantar
Tibial Fibular The sacral plexus,
nerve
nerve nerve
posterior view
© 2012 Pearson Education, Inc.
 Peroneus
longus (cut)
Tibialis anterior

Extensor digitorum
longus Saphenous branch
of femoral N.

Superficial
peroneal N.

Subcutaneous
surface of tibia

Deep peroneal N.
and
Anterior tibial artery
Tibialis anterior

Extensor hallucis longus

Extensor
retinaculum

Fig. 146 Dissection of the deep peroneal nerve and the superficial peroneal nerve at the front
Figure 14.13c The Lumbar and Sacral Plexuses, Part II (Part 2 of 2)
Tibial nerve
Common fibular
Popliteal artery
nerve
and vein

Medial sural
cutaneous Lateral sural
nerve cutaneous
nerve
Gastrocnemius

Small saphenous
vein

Sural nerve

Calcaneal tendon

Tibial nerve
(medial calcaneal
branch)

A diagrammatic posterior view of the

right hip and lower limb detailing the
distribution of peripheral nerves
© 2012 Pearson Education, Inc.
 Cutaneous innervation of sole

Flexor
Lateral calcaneal
retinaculum
branch of sural nerve
(cut)
Tibial Lateral plantar
nerve nerve
Medial Nerve to abductor
calcaneal digiti minimi muscle
branch Quadratus plantae
Medial plantar muscle and nerve
nerve Abductor digiti
Flexor digitorum minimi muscle
brevis muscle Tibial Nerve
Deep branch to
NEUROANATOMY
and nerve interosseous
Abductor hallucis muscles,
muscle and nerve 2nd, 3rd and 4th
Flexor hallucis lumbrical muscles
and Common fibular (peroneal) nerve
brevis muscle Tibial nerve
and nerve (L4, 5, S1, 2, 3) Adductor hallucis Articular branch
muscle Lateral sural cutaneous nerve (cut)
1st lumbrical
muscle and Medial sural
Superficial
nerve cutaneous nerve (cut) branch to Medial calcaneal
4th interosseous branches
Common muscle (S1, 2)
plantar Articular branches and Medial
digital From
Flexor digiti minimi tibial nerve plantar nerve
nerves brevis muscle (L4, 5)
Plantaris muscle Lateral
Proper Common and plantar nerve
plantar Proper plantar (S1, 2)
digital Gastrocnemius digital nerves
nerves muscle (cut) Saphenous nerve
(L3, 4)
Sural nerve
Nerve to popliteus muscle (S1, 2) via
lateral calcaneal
Note: Articular branches not shown and lateral dorsal
Popliteus muscle cutaneous
branches

Interosseous nerve of leg 49 Cutaneous innervation of sole

Table 14.3 The Lumbar and Sacral Plexuses
 of consciousness

Meningitis Headache/photophobia/
phonophobia/stiff neck
often subacute onset

Encephalitis Headache, delirious, odd

behaviours, abscences, may be
unconscious

Neurodegeneration Slowly progressive problems

typically involving movement
and cognition

Epilepsy Intermittent episodes typically

Nervios of altered consciousness and/or

odd behavioural attacks

Multiple sclerosis Episodes of altered feeling/

espinales movement control, visual upset

that initially come and go over
days/weeks, developing permanent
symptoms with time

Myelitis/myelopathy Can present acutely or subacutely

with increasing difficulty in walking
+/- use of arms/bladder problems
+/- sensory loss

Plexopathy Present with subacute loss of power

and sensation
JorgeinSanhueza
a limb S., PhD

Neuropathy Present with sensory loss +/-

weakness: