Spinal Cord and Nerves

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Learning Objectives: 1) Define the components of the CNS and PNS. CNS: Brain and spinal cord. PNS: All peripheral nerves. (Dorsal and ventral rami and everything lateral; cranial nerves.) 2) Describe the differences between the somatic and autonomic nervous system. Somatic: Innervates limbs and structures of body wall. Autonomic: Innervates internal organs, smooth muscle and sweat glands. 3) Describe the gross morphological features of the spinal cord.

Dorsal

Ventral Blue nerves: Sensory Dorsal horn: Sensory Red nerves: Motor Ventral horn: Motor

4) Know the nerve components found in a primary ramus based on the tissue it innervates (i.e. muscle or skin)

5) Know the nerve components of a dorsal vs ventral root. Dorsal Root: Somatosensory neurons Ventral Root: Somatomotor neurons Dorsal Root Ganglion: Somatosensory neuronal cell bodies

6) Define a dermatome: Answer: The area of skin innervated by the SENSORY fibers of a single spinal nerve.

7) Describe the difference between a voluntary vs non-voluntary response to a sensory stimulus

Blue and red path is a voluntary response. It is processed in the cerebral cortex. Yellow path is a non-voluntary spinal reflex. An efferent signal is sent by the spinal cord before the afferent signal is processed by the brain.

Intro to Imaging

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Intro to Imaging MM, GA 3 1. To describe how a plain radiograph (x-ray) is made. Radiography is not like photography Photography reflects photons off of the subject and into camera lens Radiography transmits x-rays through the subject to a film, turning it from clear to black less dense matter appear darker/more dense matter appears lighter Dense matter absorbs more x-ray photons than non dense (radiolucent) Upright chest radiographs are performed with patient facing the film X-rays pass through the patient back (posterior) to front (anterior) PA chest x-ray standard - Posterior anatomy is a bit larger due to beam divergence Right side of radiograph is the left side of the patient 2. To identify the tissue densities seen on a plain radiograph Air, Fat, Water, Bone, Metal Remember: Air - Fat - Water/Soft Tissue - Bone - Metal. Least dense to more dense. darker to lighter 3. To recognize the following normal structures on a frontal chest radiograph (note: dont expect to accomplish this entire objective just from this onehour lecture! You will have opportunities to study examples of normal chest radiographs in you gross anatomy lab.) My Rendition of Objectives a. Heart i. Lateral margin of the right atrium ii. Lateral wall of the left ventricle b. Aortic knob (the radiographic name for the aortic arch) c. Left pulmonary artery d. Right pulmonary artery e. Trachea f. Left mainstem bronchus g. Right mainstem bronchus Superimposed From Handout 1. Right brachiocephalic vessels arteries, veins 2. Ascending aorta 3. Lateral margin of the right atrium 4. Inferior vena cava (not always seen) 5. Left brachiocephalic vessels 6. Aortic knob / proximal descending aorta 7. Main pulmonary artery

h. Right lung i. Left lung j. Location of the pleura (its too thin to see) k. Spine l. Ribs m. Clavicle

8. Left atrial appendage (not always seen) 9. Lateral wall of Left ventricle

Thoracoabdominal Wall and Breast

Describe the bones and muscles of the thoracic body wall. Bony thorax composed of: Sternum (manubrium, body, xiphoid process), Xiphoid process can calcify. Ribs: (usually) 12 pairs; articulate posteriorly with vertebrae; anteriorly #1-7 articulate directly with sternum via costal cartilages (true ribs), #8-10 cartilages articulate with cartilage of rib immediately

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superior to it, (form costal arch; 8-10 have cartilage to attach to the rib. The design is great in order to allow expansion of the bony rib cage that is necessary for breathing); #11 & 12 are floating ribs which end in the abdominal wall musculature. Thoracic inlet: superior opening of thoracic (chest) cavity, bounded by vertebral body, 1st rib, manubrium of sternum; passage of important structures: trachea, esophagus, large vascular channels=important structure goes through. Thoracic outlet: inferior boundary of thoracic cavity; 12th thoracic vertebral body posteriorly, cartilages of 12thNote these landmarks: trapezius, clavicle; pectoralis major (ant fold of axilla; latissimus forms posterior fold); External abdominal oblique, internal abdominal oblique, tranversversus abdominis muscle and rectus abdominus

List the layers of the thoracic body wall from the skin to the pleural cavity. EpidermisDermisSuperficial fasciadeep fascia(muscle depending on region, but if over pectoralis major thenpectoralis majorpectoralis minor)external intercostal musclesinternal intercostal musclestransverse thoracis musclesendothoracic fasciaparietal pleura Diagram a typical intercostal space showing the muscles and neurovascular bundle. External intercostal: most external; hands in pocket orientation; continuous posteriorly but membranous anteriorly; Internal intercostals: next layer; fibers are at right angles to those of ext intercostals; membranous posteriorly; seen well just lateral to sternum Innermost intercostals are included for completeness; they are inconstant and not necessary for you to know. Neurovascular bundle runs under the ribs. Discuss the dermatomes of the body, including specific levels Each area represents cutaneous innervation from 1 spinal cord level, is continuous around the thorax or abdomen with the back, and is derived from the dorsal and ventral rami of the given spinal cord level. T4 spinal nerve innervates the body wall at the level of the nipple

T10 spinal nerve innervates the body wall at the level of the umbilicus Realize also that there is considerable overlap of the dermatomes.

Describe the muscles of the anterolateral abdominal wall, and compare them to the muscles of the thoracic body wall, including fascicle orientation and segmental innervation. Anterolateral abdominal wall muscle External abdominal oblique Internal abdominal oblique Fibers perpendicular to external Orientation Thoracic body wall muscle External intercostal muscle Internal intercostal muscles Transverse thoracis muscles Lies lateral to the sternum, perpendicaular to external Inconstant, know tranvsverse thoracis muscle as representative position of the vein, artery and nerve Orientation

hands in pocket

hands in pocket

Transversus Fibers are abdominis muscle oriented transversely

Rectus Abdominis

Vertical muscle

Muscles of the anterolateral abdominal wall: Protect and support contents of abdominal cavity Compress abdominal cavity and contents Flexion and rotation of torso; maintaining posture The intercostal nerves are the ventral rami of the spinal nerves T1-T11; T12 is called the subcostal nerve. These nerves segmentally innervate the thoracic wall, with somatomotor fibers going to the intercostal muscles and somatosensory to the overlying skin and the fascia.

The anterolateral abdominal wall is innervated by extensions of intercostal nerves from T7-T11, the subcostal nerve T12, and two branches from L1. These nerves begin as ventral rami and course laterally and anteriorly between the internal abdominal oblique and transversus abdominus.

Rectus Abdominis

Vertical muscle

Describe the functions and

boundaries of the breast:

Boundaries: comprised principally of fat, connective tissue, and mammary glands (modified apocrine sweat gland specialized for milk production) lies anterior chest wall between the 2nd and 6th ribs from the sternum almost to the midaxillary line mostly overlies the pectoralis major muscle (2/3) but extends inferolateral over the serratus anterior (1/3) axillary tail: extension of the female breast toward and into the axilla Nipple: no hair, fat, or sweat glands; termination of the lactiferous ducts; in males is over 4th intercostal space (variable in women) (T4 Innervation) Structure: Suspensory (Coopers) ligaments: help support weight of the breast and partition breasts fat and glandular tissue into lobules; well-developed skin ligaments attaches to underside of the dermis and to a connective tissue layer on the deep surface of the breast overlying but separable from the deep fascia of chest muscles. dimpling occurs through attachment to dermis when breast cancer causes the suspensory ligaments to contract (shorten). Mammograms: contrast between radiolucent lobules of fat and more radiodense connective tissue network can be seen and differentiated from tumors and calcifications that appear as abnormal radiodensities. Mammary gland: 15 to 20 lobules of glandular tissue embedded in and interspersed throughout the fatty superficial fascia of breast. Breast size increases during lactation as the glandular tissue hypertrophies. In aged female atrophied mammary gland cannot be differentiated from fat and connective tissue. Lactiferous ducts: begin in each mammary lobule, converge beneath the areola, and end on the nipple. Lymphatic drainage

Axillary nodes: located in the fatty connective tissue of the axilla (receive lymph from lateral 75% of the breast) Parasternal nodes: receive lymph from the medial 25% of the breast nearest the sternum contralateral breast may receive lymph that drains across the midline of the chest (normal but minor) - may be more likely if the axillary and/or parasternal pathways nodes are blocked by cancer Cervical (supraclavicular) nodes: located in the supraclavicular fossa; may receive lymph from the breast if the axillary and/or parasternal pathways are blocked (very metastatic cancer)