Chapter 6: Nervous System

Nervous Tissue
● Dendrites - fiber branches that receive impulses from other parts of the nervous system;
bring impulses towards the body
● Axons - transmit impulses away from the body
● Myelin - fatty sheath
● Grey matter - unmyelinated fibers
● White matter - myelinated fibers
● Synapse - small gap between neurons involving complex physiological actions
● Motor (efferent) neuron - away from CNS towards the muscle
● Sensory (afferent) neuron - convert external stimuli into internal impulses.

Cranial Nerves
● 12 pairs

Spinal Nerves
● Muscles take innervation form more than one spinal level
○ Ex. elbow flexion receives innervation from C5 and C6 spinal levels. An injury at
C5 may weaken elbow flexion but, the function will not be fully lost
● General innervation levels of major muscles
 ● Spinal nerves in the cervical exit the spinal cord above the vertebra
● Thoracic level = innervation at each spinal level
● Muscles at lumbar/ sacral regions are controlled by plexus innervation

Cervical Plexus: Anterior rami of C1-C4 join together to for ​cervical plexus
● C2 innervates the sternocleidomastoid
● C3 innervates trapezius, levator scapulae, and middle scalene
● C4 innervates trapezius, anterior scalene, and middle scalene
● C5 innervates the levator scapulae
● Phrenic nerve​ - formed by branches C3 - C5 and innervates the diaphragm

Dermatomes: the area of skin supplied with the s​ensory fibers​ of a spinal nerve
● Contiguous dermatomes often overlap
● Complete anesthesia of the area will not occur unless more than two spinal nerves have
lost function
● If injury involves only one spinal nerve, sensation will be decreased but, not lost

Nerve Root Sensory Testing Motor Testing Reflex Testing

Level
C1-C2 Front of Face Neck Flexion n/a

C3 Lateral Face and Skull Lateral Flexion n/a

C4 Supraclavicular Region Shoulder Shrug n/a

C5 Lateral Shoulder/ Shoulder Abduction Biceps brachii

Upper Arm (musculocutaneous)

C6 Thumb Elbow Flexion and Wrist Brachioradialis

Extension (musculocutenous)

C7 Long Finger Elbow Extension and Triceps (radial)

Wrist Flexion

C8 Small Finger Finger Flexion and n/a

Thumb Abduction

T1 Medial Elbow Finger Abduction n/a

Plexus Formation

Cervical Plexus: C1 to C4 split and join together in a specific pattern

● Innervations
○ C2→sternocleidomastoid
○ C3 &C4 →trapezius 
○ C3,C4,C5 → Levator Scapula
○ C4 →anterior scalene
○ C3, C4 →middle scalene
○ C3, C4,C5 →phrenic nerve →diaphragm
■ Most significant nerve of C.P.

Brachial Plexus: anterior rami C5 to T1

● Read That Dang Cadaver Book

● Anterior Divisions​ of the S ​ uperior and Middle Trunks​ form the​ Lateral Cord
● Anterior Divisions​ of the I​ nferior Trunk​ form continue as the ​Medial Cord
● Posterior Divisions​ of ​ALL 3 Trunks​ unite to form the ​Posterior Cord

Roots Trunks Divisions Cords Branches

C5&C6 Upper (superior) Anterior Lateral Nerves:

C7 Middle Posterior Posterior Musculocutaneo
C8&T1 Lower (inferior) Anterior Medial us
Axillary
Nerves: Nerves (upper): Nerves: Median
-dorsal scapular -subclavian -Lateral Pectoral Radial
(C5) -suprascapular -subscapular Ulnar
-long thoracic (posterior cord)
(C5-C7) -thoracodorsal
- Medial
antebrachial
cutaneous
- medial brachial
cutaneous
Medial pectoral

Lumbosacral Plexus

● Lumbar Plexus: L1-L4 innervates muscles of the thigh and sacral plexus
● Sacral Plexus: formed by lumbosacral trunk L4 and L5 and the anterior rami of S1-S3
and innervates muscles of the leg and foot
● 8 roots
● Upper L1 branch - Iliohypogastic and ilioinguinal nerve
● Lower L1 and upper L2 branch - Genitofemoral N.
● Anterior divisions of L2-L4: Obturator N.
● Posterior divisions of L2-L4: Femoral N.
● Posterior divisions of L4-S1: Superior Gluteal N.
● Posterior divisions L5-S2: Inferior gluteal N.
● L4-S3 branch: Sciatic N.
○ Tibial and common fibular nerves joined and separated above knee
● Posterior divisions of L4-S2: Common Fibular N.
● Anterior divisions of L4-S3: Tibial N.
 Chapter 7: Circulatory System
Heart
● Atria - 2 top chambers; propel blood into ventricles
● Ventricles - 2 bottom chambers; thick walls for pumping force
Valves - blood flows in one direction
● Atrioventricular valve - lie between the atria and ventricles; prevents backflow of blood
○ Tricuspid valve - 3 flaps; between R atrium/ventricle
○ Bicuspid/mitral valve - 2 flaps, between L atrium/ventricle
● Semilunar - between ventricles and arteries leading out of the heart
○ Pulmonary valve - leads to lung; between R ventricle and pulmonary arteries
○ Aortic valve - between L ventricle and aorta
Blood Vessels
● Arteries - carry blood away to rest of body
○ Aorta - largest artery
○ Arterioles - smallest arteries
● Veins - blood towards heart
○ Vena cavae - largest veins
○ Venules - smallest veins

● Common caratoid artery - runs up each side of neck beside trachea

○ L -arise from aortic arch
○ R - brachiocephalic trunk of aortic arch
● External carotid artery - supplies external head - face, jaw, scalp, skull
● Internal carotid artery - supplies anterior portion of brain
● internal/external jugular veins - drain head and neck region
● Veterbral artery - first and largest branch of subclavian artery; supplies posterior portion
of brain

● Vertebral vein - drains blood from cervical spinal cord, vertebrae, and posterior surface
of skull

● Brachiocephalic trunk (artery) - major blood source from the right arm and right side of
head
● Subclavian artery- delivers blood to upper extremity, chest wall and neck
● Subclavian vein - parallel to subclavian artery
Common Sites for feeling pulse
● Radial artery (Wrist)
● Brachial artery (Anterior elbow; cubital fossa)
Major Arteries (pg. 91)
● Aortic Arch →Left subclavian (left side of UE supplied) & Right subclavian (right side of 
UE supplied)
● Subclavian →Axillary (UE) 
 ○ Clinically important when it becomes compressed between the clavicle and first
rib in a crowded space called the ​thoracic outlet
● Axillary →Brachial (arm)
● Brachial →radial and ulnar (forearm and hand)
○ Used to measure blood pressure; cubital fossa
Major Veins

● Radial and ulnar veins

○ drain the lateral/ medial forearm and hand
○ joins the brachial vein
● Brachial vein
○ Drains upper arm
○
● Cephalic vein
○ Drains forearm
● Basilic vein
○ Empties into the brachial vein
● Medial cubital vein
○ In cubital fossa
○ Unites basilic and cephalic
○ Common for drawing blood
Lymphatic System
● Right lymphatic duct
○ Upper extremity empties here; which then empties into the right subclavian vein
○
● Lymphadema
○ Abnormal drainage = excessive lymph and swelling in arms and legs
 Chapter 14: Temporomandibular Joint

Describe the joint motion that occurs at TMJ; include appropriate planes and axis. Describe the
normal range of motion at this joint
● Mandibular depression - opening mouth
● Elevation - closing mouth
● Lateral deviation - side to side jaw movement
● Protrusion (protraction) - moving the jaw forward
● Retrusion (retraction) - moving the jaw posteriorly; returning to anatomical position
Bones and Landmarks
● Madibular bone - horse shoe
● Maxilla bone - upper jaw
● See anatomy structure list
Ligaments
● Temporomandibular ligament - aka lateral ligament; anteriorly attaches on the neck of
the mandibular condyle and disk then runs superiorly to articulate tubercle of the
temporal bone.
○ Limits downward, posterior and lateral motion of the mandible
● Stylomandibular ligament - styloid process of temporal to mandibular’s ramus
● Sphenomandibular ligament
○ Limits excessive anterior motion
Occupations of TMJ
○ Chewing, swallowing, yawning, talking