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The Spinal Nerves
31 pairs:

Cervical    8

Thoracic    12

Lumbar      5

Sacral 5

Coccygeal   1
The Cervical Plexus
The cervical plexus is a network of nerves formed by
communications between the anterior rami of the
               upper 4 cervical nerves.
It lies posterior to the internal jugular vein and
                the SCM muscles.
-supplies the back and
sides of the head, and
front of the neck;
phrenic nerve –
supplies the
diaphragm.
The cervical plexus
The cervical plexus
Branches of the
Cervical Plexus
Branches of the
            Cervical Plexus

• A. Superficial or Cutaneous Branches



• Deep branches or muscular and
  communicating branches
A. Superficial or
Cutaneous Branches
1. Ascending branches
    a. Lesser occipital nerve
    b. Great auricular nerve
    c. Nervus cutaneous colli

2. Descending branches
    a. Medial supraclavicular
    b. Intermediate supraclavicular
    c. Lateral supraclavicular
1.   ASCENDING BRANCHES
a. Lesser occipital
      nerve

b. Great auricular
     nerve

c. Transverse
   cervical nerve
A. LESSER OCCIPITAL NERVE
- Comes from the second cervical ventral ramus
     and sometimes also from the third
- curves around the accessory nerve and ascends along
    the posterior border of the sternocleidomastoid.
- supplies the skin on the upper third of the
           medial auricular aspect
-connects with the posterior branch of the great
                auricular nerve.
B. THE GREAT AURICULAR
    NERVE
This is the largest ascending branch.
It arises from the second and third cervical rami,
        encircles the posterior border of the
                sternocleidomastoid.
supplies the skin over the mastoid process and on
 the back of the auricle, the lobule and concha. .
communicates with the lesser occipital, the auricular
branch of the vagus and the posterior auricular branch
                  of the facial nerve.
C. TRANSVERSE CUTANEOUS NERVE
This arises from the second and third cervical
rami, curves round the posterior border of the
              sternocleidomastoid
It perforates the deep cervical fascia, dividing under the
platysma into ascending and descending branches distributed to
               the anterolateral areas of the neck.
distributed to the skin of the upper anterior areas of
the neck and anterolaterally to the skin of the neck, as
                  low as the sternum.
2. DESCENDING BRANCHES
Supra Clavicular Nerves
• These arise by a common trunk from the third and fourth cervical ventral
  rami and emerge from the posterior border of the sternocleidomastoid, to
  descend under the platysma and the deep cervical fascia;
3 Branches:

1. The medial
   supraclavicular nerves

       - supply the skin as
   far as the midline and
   as low as the second
   rib. They supply the
   sternoclavicular joint.
2. The intermediate
   supraclavicular nerves

       -cross the clavicle
   to supply the skin over
   the pectoralis major
   and deltoid down to
   the level of the
   second rib
3. The lateral
   supraclavicular nerves

   - supply the skin of
   the upper and
   posterior parts of the
   shoulder.
Deep branches or Muscular and
  Communicating Branches
1. Lateral Branches:

a.     Muscular branches going to the following:

      i. SCM
      ii. Trapezius
     iii. Levator scapula
     iv. Scalenius medius
      v. Scalenius posterior

b. Communicating branches to spinal accessory nerves
Deep Branches—Lateral Series
Muscular branches
  Sternocleidomastoid
       C2, 3, 4
  Trapezius
       C2, (3)
   Levator scapulae
       C3, 4
   Scalenus medius
       C3, 4

Communicating branches
  Accessory Nerve
      C2, 3, 4
2. Medial branches:

a. Muscular branches going to the following muscles:
         i. Prevertebral muscles
        ii. Infrahyoid muscles thru the ansa
         hypoglossi
       iii. Diaphragm thru the phrenic nerve

  b. Communicating branches to the vagus, hypoglossal
and sympathetic nerves

  c. Phrenic nerve is the most important branch because it
supplies the diaphragm which is the chief muscle for
respiration. It is derived from cervical nerves 3, 4, and 5.
Communicating and Muscular Branches
                    (Medial Series)



Communicating branches with
  Hypoglossal
       C1, 2
  Vagus
       C1–2
  Sympathetic
       C1, 2
Muscular branches to
  Rectus capitis lateralis   C1

   Rectus capitis anterior   C1, 2

   Longus capitis     C1–4

   Longus colli                 C2–4

   Inferior root of ansa cervicalis
                                 C2, 3

  Phrenic nerve     C3–5
THE ANSA HYPOGLOSSI
Formed by spinal nerves C1, C2, and
                    C3.
• 3 parts:
1. Superior root C1
   - innervates the superior
   belly of omohyoid

2. Inferior root   C2, C3

3. Loop of ansa cervicalis
   - innervates the
   sternothyroid, sternohyoid,
   inferior belly of omohyoid
THE PHRENIC NERVE
• Arises from the
  converging APR of spinal
  nerves C3, C4, and C5.

• This is the sole motor
  supply to the diaphragm,
  and also contains
  widespread sensory
  fibres.

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The cervical plexus

  • 2. 31 pairs: Cervical 8 Thoracic 12 Lumbar 5 Sacral 5 Coccygeal 1
  • 4. The cervical plexus is a network of nerves formed by communications between the anterior rami of the upper 4 cervical nerves.
  • 5. It lies posterior to the internal jugular vein and the SCM muscles.
  • 6. -supplies the back and sides of the head, and front of the neck; phrenic nerve – supplies the diaphragm.
  • 10. Branches of the Cervical Plexus • A. Superficial or Cutaneous Branches • Deep branches or muscular and communicating branches
  • 12. 1. Ascending branches a. Lesser occipital nerve b. Great auricular nerve c. Nervus cutaneous colli 2. Descending branches a. Medial supraclavicular b. Intermediate supraclavicular c. Lateral supraclavicular
  • 13. 1. ASCENDING BRANCHES
  • 14. a. Lesser occipital nerve b. Great auricular nerve c. Transverse cervical nerve
  • 16. - Comes from the second cervical ventral ramus and sometimes also from the third
  • 17. - curves around the accessory nerve and ascends along the posterior border of the sternocleidomastoid.
  • 18. - supplies the skin on the upper third of the medial auricular aspect
  • 19. -connects with the posterior branch of the great auricular nerve.
  • 20. B. THE GREAT AURICULAR NERVE
  • 21. This is the largest ascending branch.
  • 22. It arises from the second and third cervical rami, encircles the posterior border of the sternocleidomastoid.
  • 23. supplies the skin over the mastoid process and on the back of the auricle, the lobule and concha. .
  • 24. communicates with the lesser occipital, the auricular branch of the vagus and the posterior auricular branch of the facial nerve.
  • 26. This arises from the second and third cervical rami, curves round the posterior border of the sternocleidomastoid
  • 27. It perforates the deep cervical fascia, dividing under the platysma into ascending and descending branches distributed to the anterolateral areas of the neck.
  • 28. distributed to the skin of the upper anterior areas of the neck and anterolaterally to the skin of the neck, as low as the sternum.
  • 30. Supra Clavicular Nerves • These arise by a common trunk from the third and fourth cervical ventral rami and emerge from the posterior border of the sternocleidomastoid, to descend under the platysma and the deep cervical fascia;
  • 31. 3 Branches: 1. The medial supraclavicular nerves - supply the skin as far as the midline and as low as the second rib. They supply the sternoclavicular joint.
  • 32. 2. The intermediate supraclavicular nerves -cross the clavicle to supply the skin over the pectoralis major and deltoid down to the level of the second rib
  • 33. 3. The lateral supraclavicular nerves - supply the skin of the upper and posterior parts of the shoulder.
  • 34. Deep branches or Muscular and Communicating Branches
  • 35. 1. Lateral Branches: a. Muscular branches going to the following: i. SCM ii. Trapezius iii. Levator scapula iv. Scalenius medius v. Scalenius posterior b. Communicating branches to spinal accessory nerves
  • 36. Deep Branches—Lateral Series Muscular branches Sternocleidomastoid C2, 3, 4 Trapezius C2, (3) Levator scapulae C3, 4 Scalenus medius C3, 4 Communicating branches Accessory Nerve C2, 3, 4
  • 37. 2. Medial branches: a. Muscular branches going to the following muscles: i. Prevertebral muscles ii. Infrahyoid muscles thru the ansa hypoglossi iii. Diaphragm thru the phrenic nerve b. Communicating branches to the vagus, hypoglossal and sympathetic nerves c. Phrenic nerve is the most important branch because it supplies the diaphragm which is the chief muscle for respiration. It is derived from cervical nerves 3, 4, and 5.
  • 38. Communicating and Muscular Branches (Medial Series) Communicating branches with Hypoglossal C1, 2 Vagus C1–2 Sympathetic C1, 2
  • 39. Muscular branches to Rectus capitis lateralis C1 Rectus capitis anterior C1, 2 Longus capitis C1–4 Longus colli C2–4 Inferior root of ansa cervicalis C2, 3 Phrenic nerve C3–5
  • 41. Formed by spinal nerves C1, C2, and C3. • 3 parts: 1. Superior root C1 - innervates the superior belly of omohyoid 2. Inferior root C2, C3 3. Loop of ansa cervicalis - innervates the sternothyroid, sternohyoid, inferior belly of omohyoid
  • 43. • Arises from the converging APR of spinal nerves C3, C4, and C5. • This is the sole motor supply to the diaphragm, and also contains widespread sensory fibres.