CERVICAL NERVES.

Tural Rajabov.
TSMU. Medicine
Faculitiy.
7th group.

Origination of nerves from spinal cord.

Nerve fibers enter dorsolaterally and emerge ventrolaterally at
both sides of the spinal cord and unite to form the dorsal roots,
posterior roots, and the ventral roots, anterior roots. The roots join
to form short nerve trunks of 1cm in length, the spinal nerves.
Intercalated into the posterior roots are spinal ganglia
containing sensory nerve cells. Only the posterior roots of the first
cervical spinal nerves do not have a spinal ganglion, or only a
rudimentary one.

In humans there are 31 spinal nerves.

The spinal nerves are subdivided into cervical nerves, thoracic
nerves, lumbar nerves, sacral nerves, and coccygeal nerves .
There are
! 8 pairs of cervical nerves (C1C8) (the
first pair emerges between occipital bone
and atlas)
! 12 pairs of thoracic nerves (T1T12) (the
first pair emerges between the first and
second thoracic vertebrae
! 5 pairs of lumbar nerves (L1L5) (the first
pair emerges between the first and second lumbar vertebrae)
! 5 pairs of sacral nerves (S1S5) (the first
pair emerges through the upper sacral
foramina)

Cervical nerves.
Axons from the anterior rami of spinal nerves, except for thoracic
nerves T2T12, do not go directly to the body structures they supply.
Instead, they form networks on both the left and right sides of the body
by joining with various numbers of axons from anterior rami of adjacent
nerves. Such a network of axons is called a plexus ( braid or network).
The cervical plexus (SER-vi-kul) is formed by the roots (anterior rami)
of the first four cervical nerves (C1C4), with contributions from C5
. There is one on each side of the neck alongside the first four cervical
vertebrae.
The cervical plexus supplies the skin and muscles of the head,
neck, and superior part of the shoulders and chest. The phrenic nerves
arise from the cervical plexuses and supply motor fibers to the
diaphragm. Branches of the cervical plexus also run parallel to two
cranial nerves, the accessory (XI) nerve and hypoglossal (XII) nerve.

The first dorsal nerve root.

The first cervical dorsal nerve roots contain afferent somatic and
visceral nerve fibers corresponding to the first cervical spinal cord
segment. They are shorter and smaller than the first ventral nerve
roots and emerge from the postero lateral sulci of the spinal
cord.
The first ventral nerve root.
Contain efferent somatic nerve fibers . The root pass almost over
the superior surface of the transverse processes of C1 (atlas),
posterior to the foramen transversum, to join with the first cervical
dorsal root to form the first spinal cervical nerve.
The joining of dorsal and ventral roots gives us spinal nerve. After
joining immediately forms a spinal ganglia, beside first cervical
segment.

Second cervical ventral spinal rami.

The second cervical ventral spinal rami emerge between the arches C1
and C2. Each ramus ascends between the transverse processes of C1
and C2, passes anterior to the first posterior intertransversari muscle to
emerge lateral to the vertebral artery. The nerves pass between
LONGUS CAPITIS and LEVATOR SCAPULE , and deep to the internal
jugular vein and the sternocleidomastoid muscle. Each ramus divides
into ascending and descending branches, which join the first cervical
ventral rami and the ascending branch of the third cervical ventral rami,
respectively.
The second cervical ventral spinal rami join with the ventral rami of C3
to form the inferior roots of the ansa cervicalis and togather with the
ventral rami of C1, C3 and C4 participate in the foramina of the cervical
plexus..
Supply: the second cervical vantral spinal rami supply the longus capitis
, longus colli and sternocleidomastoid muscles. Superficial branches
supply the skin of the head and neck by the lesser occipital and greater
auricular nerves and the trnasverse cutaneous nerve of the neck.

Third Cervical Ventral Spinal Rami.

The third cervical vebtral spinal rami leave the vertebral column
above the transverse processes of C3 and emerge between
longus capitis and scalenius medius, deep to the internal jugular
vein and the sternocleidomastoid muscle.
Each rami divides into ascending and descending branches of the
second cervical ventral rami and the ascending branches of the
fourth cervical ventral rami.

Supply: the longus capitis, longus colli, scalenus medius, levator

scapulae and sensory innervation for the sternocleidomastoid
and trapezius muscle.

Fourth Cervical Ventral Spinal Rami.

The fourth cervical ventral spinal leave the vertebral column
above the transverse processes of C4 and emerge between
scalenus anterior and scalenus medius, deep to the internal
jugular vein and sternocleidomastoid muscle.
Each ramus receives at least one gray ramus communicans from
the superior cervical sympathetic ganglion.
Supply : the fourth cervical ventral spinal rami supply the longus
colli, scalenus anterior. Scalenus medius, and levator scapulae.
Superficial branches supply the skin of the neck via the
supraclavicular nerves.

Fifth Cervical Ventral Spinal Rami.

The fifth cervical ventral spinal rami leave the vertebral column
above the transverse processes of C5 and emerge between
scalenus anterior and scalenus medius, deep to the internal
jugular vein and the sternocleidomastoid muscle.
Each ramus receives at least ane gray ramus communicans from
the middle cervical ganglion.
Supply : the fifth cervical ventral spinal rami supply longus colli,
scalenus anterior, scalenus medius, rhomboideus major and
minor, serratus anterior, subclavius, supraspinatus and
infraspinatus muscles and muscles of the upper limb via the
brachial plexus. Cutaneous branches to the upper limb are also
distributed via the brachial plexus.

Sixth Cervical Ventral Spinal Rami.

The sizth cervical ventral spinal rami leave the vertebral column
above the transverse processes of C6 and scalenus anterior and
scalenus medius, deep to the internal jugular vein and
sternocleidomastoid muscle.
Supply: the sixth cervical ventral spinal rami supply the longus
colli, scalenus anterior, subclavius ,supraspinatus and
infraspinatus muscles and the muscle of the upper limb via the
brachial plexus. Cutaneous branches to the upper limb are also
distributed via the brachial plexus.

Seventh Cervical Ventral spinal Rami.

The seventh cervical ventral spinal rami leave the vertebral
column above the transverse processes of C7 and emerge
between scalenus anterior and scalenus medius, deep to the
internal jugular vein and the sternocleidomastoid muscle.
Each ramus receives at least one gray ramus communicans
from the inferior cervical or stellate ganglion
Supply : the longus colli , scalenius medius , scalenus posterior

and serratus anterior muscle and the muscles of the upper limb
are also distributed via the brachial plexus.

Eight Cervical Ventral Spinal Rami.

The eighth vertebral spinal rami leave the vertebral column above
transverse processes of T1 and emerge between scalenus
anterior and scalenus medius, deep to the internal jugular vein
and the sternocleidomastoid muscle.
The eight cervical ventral spinal rami join with the ventral rami of
T1 to form the lover trunk of the BRACHIAL PLEXUS.
Each ramus recieves at last one gray ramus communicans from
the inferior cervical or stellate ( cervicothoracic) ganglion.
Supply: the longus colli , scalenus medius , scalenus posterior
muscles and the muscles of the upper limb via the brachial
plexus. Cutaneous branches to the upper limb are also distributed
via also distributed via the brachial plexus.

Brachial Plexus.
The roots (anterior rami) of spinal nerves C5C8 and T1 form the
brachial plexus , which extends inferiorly and laterally on either side of the
last four cervical and first thoracic vertebrae. It passes above the first rib
posterior to the clavicle and then enters the axilla.
Since the brachial plexus is so complex, an explanation of its various parts is
helpful. As with the cervical and other plexuses, the roots
are the anterior rami of the spinal nerves. The roots of several spinal
nerves unite to form trunks in the inferior part of the neck. These are
the superior, middle, and inferior trunks. Posterior to the clavicles, the
trunks divide into divisions, called the anterior and posterior divisions.
In the axillae, the divisions unite to form cords called the lateral, medial, and posterior cords. The cords are named for their relationship to
the axillary artery, a large artery that supplies blood to the upper limb.
The principal nerves of the brachial plexus branch from the cords.
The brachial plexus provides almost the entire nerve supply of the
shoulders and upper limbs . Five important nerves arise
from the brachial plexus: (1) The axillary nerve supplies the deltoid and
teres minor muscles. (2) The musculocutaneous nerve supplies the anterior
muscles of the arm. (3) The radial nerve supplies the muscles on the
posterior aspect of the arm and forearm. (4) The median nerve supplies
most of the muscles of the anterior forearm and some of the muscles of
the hand. (5) The ulnar nerve supplies the anteromedial muscles of the
forearm and most of the muscles of the hand.

Thank you.