목디스크 치료와 상지의 신경 entrapment 치료를 위한 신경해부학 - 대박자료

[문형철]

두부전방자세, 둥근어깨증후군, mid thoracic kyphosis 등의 상부교차증후군에서

수많은 경추의 신경이 포착되어 저림증, 통증을 유발하고 TrP를 만들어낸다.

잘 알아야 해결할 수 있다.

기억해야 할 것이 참으로 많구나.......ㅎㅎㅎㅎㅎ

panic  bird.............

요골신경, 정중신경, 척골신경의 유주만 알면 신경스트레칭은 자연스럽게 알 수 있음.

경추의 상지 신경

nerve root C5, C6, C7, C8 번 신경의 ventral rami of the spinal nerve가  Brachial plexus를 이룸

dorsal rami of the spinal nerve는 경추 뒤의 근육을 지배함. 

brachial plexus

참고) phrenic nerve 횡격신경

C3~5에서 기원

폐와 심장에서 횡격막까지 지배

운동신경, 감각신경, 교감신경을 포함.

횡격막에 운동신경 

The phrenic nerve is a nerve that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. It is important for breathing, as it passes motor information to the diaphragm and receives sensory information from it. There are two phrenic nerves, a left and a right one. The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 5th and 3rd cervical nerves (C3-C5) in humans.^[1] Thus, the phrenic nerve receives innervation from parts of both the cervical plexus and the brachial plexus of nerves.  The phrenic nerves contain motor, sensory, and sympathetic nerve fibers. These nerves provide the only motor supply to the diaphragm as well as sensation to the central tendon. In the thorax, each phrenic nerve supplies the mediastinal pleura and pericardium.

1. supraclavicular part of the brachial plexus

1) dorsal scapular nerve(견갑배측신경)

2) long thoracic nerve(장흉신경)

3) suprascapular nerve(견갑상신경)

4) nerve to the clavius

견갑배측신경 dorsal scapular nerve에 대하여 

C5 ventral ramus 신경근으로부터 유래

능형근, 견갑거근 지배

Dorsal Scapular Nerve Syndrome.pdf

The dorsal scapular nerve arises from the brachial plexus, usually from the plexus root (anterior/ventral ramus) of C5. It provides motor innervation to the rhomboid muscles, which pull the scapula towards the spine and levator scapulae muscle, which elevates the scapula. Injury to this nerve is usually apparent when the scapula on one side is located farther from the midline. Once the nerve leaves C5 it commonly pierces the middle scalene muscle, and continues deep to levator scapulae and the rhomboids. It is accompanied by the one of two arteries. 

견갑배측신경이 질환이 생겨 견갑거근, 능형근이 마비되면 견갑골이 외전됨.

Long Thoracic Nerve

C5~7번 신경근에서 유래

전거근 지배

Long Thoracic Nerve.pdf

The long thoracic nerve (external respiratory nerve of Bell; posterior thoracic nerve) supplies the serratus anterior. This nerve characteristically arises by three roots from the fifth, sixth, and seventh cervical nerves (C5-C7) but the root from C7 may be absent. The roots from C5 and C6 pierce the scalenus medius, while the C7 root passes in front of the muscle. The nerve descends behind the brachial plexus and the axillary vessels, resting on the outer surface of the serratus anterior. It extends along the side of the thorax to the lower border of that muscle, supplying filaments to each of its digitations (finger-like projections).

장흉신경질환으로 전거근이 마비되면 익상견

견갑상신경 suprascapular nerve

C5~6번 신경근으로부터 유래

극상근, 극하근 지배

Suprascapular Nerve Entrapment Technique.pdf

The suprascapular nerve arises from the upper trunk (formed by the union of the fifth and sixth cervical nerves). It innervates the supraspinatus and infraspinatus muscles. It runs lateral beneath the trapezius and the omohyoid, and enters the supraspinous fossa through thesuprascapular notch, below the superior transverse scapular ligament; it then passes beneath the supraspinatus, and curves around the lateral border of the spine of the scapula to the infraspinous fossa. In the supraspinous fossa it gives off two branches to the Supraspinatus muscle, and an articular filament to the shoulder-joint; and in the infraspinous fossa it gives off two branches to the infraspinatus muscle, besides some filaments to the shoulder-joint and scapula.

)

견갑상신경 질환으로 극상근, 극하근이 마비되면

Nerve to the clavius

The nerve to the Subclavius (or subclavian nerve) is a small filament, which arises from the point of junction of the fifth and sixth cervical nerves.

It descends to the subclavius muscle in front of the third part of the subclavian artery and the lower trunk of the plexus, and is usually connected by a filament with the phrenic nerve.

참고) 상지의 dermatome

2. infraclavicular part of the brachial plexus

1) lateral cord

# musculocutaneous nerve(근피신경)

# lateral pectoral nerve(외측 흉근신경)

# median nerve(lateral root 정중신경 외측지)

musculocutaneous nerve 근피신경

C5~7번 신경근에서 유래

오훼완근, 상완이두근, forearm muscle지배

The musculocutaneous nerve arises from the lateral cord of the brachial plexus, opposite the lower border of the pectoralis major, its fibers being derived from C5, C6 and C7. 

It penetrates the coracobrachialis muscle and passes obliquely between the biceps brachii and the brachialis, to the lateral side of the arm; a little above the elbow it pierces the deep fascia lateral to the tendon of the biceps brachii and is continued into the forearm as the lateral cutaneous nerve of the forearm.

In its course through the arm it innervates the coracobrachialis, biceps brachii, and the greater part of the brachialis.

• The branch to the coracobrachialis is given off from the nerve close to its origin, and in some instances as a separate filament from the lateral cord of the plexus; it is derived from the seventh, cervical nerve.
• The branches to the biceps brachii and brachialis are given off after the musculocutaneous has pierced the coracobrachialis; that supplying the brachialis gives a filament to the elbow-joint.
• The nerve also sends a small branch to the bone, which enters the nutrient foramen with the accompanying artery.

근피신경은 드물게 손상되지만  만약 근피신경이 포착되면 상완이두근의 aponeurosis와 brachialis fascia에서 손상됨. 

근피신경이 손상되면 팔꿈치 굴곡, 상지의 회외 약화가 발생함. 

lateral pectoral nerve(외측 흉근신경)

C6~7번 신경근에서 유래

주로 운동신경이지만 고유수용감각과 통각을 전달하는 것으로 간주됨. 

대흉근 지배

The lateral pectoral nerve (lateral anterior thoracic) arises from the lateral cord of the brachial plexus, and through it from the fifth, sixth, and seventh cervical nerves. It passes across the axillary artery and vein, pierces the coracoclavicular fascia, and is distributed to the deep surface of the Pectoralis major. It sends a filament to join the medial anterior thoracic and form with it a loop in front of the first part of the axillary artery.

Neuromuscular blockade of the lateral pectoral nerve is also needed in cases such as shoulder dislocation and other orthopedic procedures. Spasms of the pectoralis major and severe pain occur which may be reduced by neuromuscular blockade. 

정중신경 median nerve

C5,6,7 lateral cord와 C8, T1 medial cord에서 유래

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve is formed from contributions from the lateral and medial cords of the brachial plexus, originating from ventral roots of C5, C6 & C7 (lateral cord) and C8 & T1 (medial cord).

The median nerve is the only nerve that passes through the carpal tunnel. Carpal tunnel syndrome is the disability that results from the median nerve being pressed in the carpal tunnel.

The median nerve receives fibers from roots C6, C7, C8, T1 and sometimes C5. It is formed in the axilla by a branch from the medial and lateral chords of the brachial plexus, which are on either side of the axillary artery and fuse together to create the nerve anterior to the artery.

The median nerve is closely related to the brachial artery within the arm. The nerve enters the cubital fossa lateral to the brachialis tendon and passes between the two heads of the pronator teres. It then gives off the anterior interosseus branch in the pronator teres.

The nerve continues down the forearm between the flexor digitorum profundus and the flexor digitorum superficialis. The median nerve emerges to lie between the flexor digitorum superficialis and theflexor carpi ulnaris muscles which are just above the wrist. At this position, the nerve gives off the palmar cutaneous branch that supplies the skin of the central portion of the palm.

The nerve continues through the carpal tunnel into the hand, lying in the carpal tunnel anterior and lateral to the tendons of the flexor digitorum superficialis. Once in the hand, the nerve splits into a muscular branch and palmar digital branches. The muscular branch supplies the thenar eminence while the palmar digital branch supplies sensation to the palmar aspect of the lateral 3 ½ digits and the lateral two lumbricals.^[2]

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.^[1]

2) medial cord

# median nerve(medial root)

# ulnar nerve(척골신경)

# medial pectoral nerve

# medial brachial cutaneous nerve

# median antebrachial cutaneous nerve

ulnar nerve(척골신경)

C8-T1 신경근으로부터 유래

인체에서 근육, 뼈로 보호하지 못하는 가장 큰 신경이기 때문에 흔히 손상됨. 

팔꿈치 굴곡상태에서 상완골 내측상과 타박상을 입을때 흔히 손상됨. 

In human anatomy, the ulnar nerve is a nerve which runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest unprotected nerve in the human body (meaning unprotected by muscle or bone), so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, supplying the palmar side of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds. One method of injuring the nerve is to strike the medial epicondyle of the humerus from posteriorly, or inferiorly with the elbow flexed. The ulnar nerve is trapped between the bone and the overlying skin at this point.

The ulnar nerve can be trapped or pinched as it proceeds from the brachial plexus to the fingertips. One common cause is cubital tunnel syndrome. In this syndrome, a tunnel on the medial side of the elbow traps the nerve. Pinching of the ulnar nerve often causes paraesthesiae (tingling) in the fourth and fifth digits. Temporary paraesthesiae can be caused by sleeping or poor posture while awkwardly placing weight on one's arm, or by cycling for extended periods of time. In severe cases, surgery is performed to move the nerve. Severe entrapment or complete severing of the ulnar nerve can present clinically as an ulnar claw.

내측 흉근신경

C8, T1 신경근 지배

소흉근 지배

The medial pectoral nerve (medial anterior thoracic) arises from the medial cord of the brachial plexus and through it from the eighth cervical and first thoracic. It passes behind the first part of the axillary artery, curves forward between the axillary artery and vein, and unites in front of the artery with a filament from the lateral nerve. It then enters the deep surface of the Pectoralis minor, where it divides into a number of branches, which supply the muscle.

3) posterior cord

# radial nerve

# axillary nerve

# subscapular nerve

# thoracodorsal nerve

요골신경  Radial nerve

C5, C6, C7, C8 & T1 신경근에서 유래

The radial nerve is a nerve in the human body that supplies the upper limb. It supplies the medial, lateral, and long heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin. It originates from the posterior cord of the brachial plexus, carrying fibers from the ventral roots of spinal nerves C5, C6, C7, C8 & T1.

The radial nerve and its branches provide motor innervation to the dorsal arm muscles (the triceps brachiiand the anconeus) and the extrinsic extensors of the wrists and hands; it also provides cutaneous sensory innervation to most of the back of the hand. The ulnar nerve provides cutaneous sensory innervation to the back of the little finger and adjacent half of the ring finger.

The radial nerve divides into a deep branch, which becomes the posterior interosseous nerve, and a superficial branch, which goes on to innervate the dorsum (back) of the hand.

Injury to the radial nerve at different levels causes different syndromes with varying motor and sensory deficits.

At the axilla

• Common mechanisms of injury: Saturday night palsy, crutch palsy
• Motor deficit:
  • Loss of extension of forearm, weakness of supination, and loss of extension of hand and fingers.
  • Presence of wrist drop, due to inability to extend the hand and fingers.
• Sensory deficit: Loss of sensation in lateral arm, posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial 3½ digits, excluding their nail beds.

At mid-arm

• Common mechanism of injury: Mid-shaft humeral fracture
• Motor deficit:
  • Weakness of supination, and loss of extension of hand and fingers.
  • Presence of wrist drop, due to inability to extend the hand and fingers.
• Sensory deficit: Loss of sensation in posterior forearm, the radial half of dorsum of hand, and dorsal aspect of radial 3½ digits, excluding their nail beds.

Just below the elbow

• Common mechanism of injury: Neck of radius fracture, elbow dislocation or fracture, tight cast, rheumatoid nodules, injections due to tennis elbow, injuring the deep branch of the radial nerve that pierces the radial head, causing posterior interosseous nerve syndrome
• Motor deficit:
  • Weakness in extension of hand and loss of extension of fingers.
  • Presence of finger drop, and partial wrist drop, since the extensor carpi radialis longus and brachioradialismuscles are working.
• Sensory deficit: None, as sensation is supplied by the superficial radial nerve

Within the distal forearm:

• Common mechanism of injury: Wartenberg's syndrome, (not to be confused with Wartenberg's sign), due to nerve entrapment beneath the tendinous insertion of brachioradialis, tight jewellery, and watch bands.
• Motor deficit: None
• Sensory deficit: Numbness and tingling in radial half of dorsum of hand, and dorsal aspect of radial 3½ digits, excluding their nail beds.
• In Wartenberg's syndrome, there is significant radial wrist pain, and close resemblance to symptoms in de Quervain's tenosynovitis. Finkelstein's test may be positive.

axillary nerve 액와신경

C5, 6 신경근에서 유래

흔히 어깨의 탈구시 손상되어 삼각근의 위약, 위축을 초래하고 어개의 감각이상을 초래

The axillary nerve or the circumflex nerve is a nerve of the human body, that comes off the of thebrachial plexus (upper trunk, posterior division, posterior cord) at the level of the axilla (armpit) and carries nerve fibers from C5 and C6. The axillary nerve travels through the quadrangular space with the posterior circumflex humeral artery and vein.

Axillary nerve palsy is a neurological condition in which an axillary (also called circumflex) nerve has been damaged by shoulder dislocation. It can cause weak deltoid and sensory loss below the shoulder.^[1] Since this is a problem with just one nerve, it is a type of Peripheral neuropathy calledmononeuropathy.^[2] Of all brachial plexus injuries, axillary nerve palsy represents only .3% to 6% of them.

subscapular nerve(견갑하 신경)

견갑하근과 대원근 지배

C5, 6 신경근에서 유래

Subscapular nerves can refer to:

• Upper subscapular nerve
• Lower subscapular nerve

The subscapular nerves are innervated by the posterior division of the brachial plexus. These nerves are part of a group of nerves that innervate the muscles that move the scapula.^[1] The upper subscapular nerve inserts directly into the upper portion of the subscapularis muscle, thus innervating it. The lower subscapular nerve contains two branches. One branch inserts into the lower portion of the subscapularis muscle and the other branch inserts into the teres major.^[2]

The middle subscapular nerve, known as the thoracodorsal nerve also branches from the posterior division of the brachial plexus. This nerve innervates the latissimus dorsi muscle.^[3]

thoracodorsal nerve 흉배신경

C6, 7, 8 신경근에서 유래

광배근 지배

middle 견갑하신경이라고 하기도 함. 

The thoracodorsal nerve is a nerve present in humans and other animals. It is also known as the middle subscapular nerve or the long subscapular nerve. It supplies the latissimus dorsi muscle.

It arises from the brachial plexus. It derives its fibers from the sixth, seventh, and eighth cervical nerves. It is derived from their ventral rami, in spite of the fact that the latissimus dorsi is found in the back. The thoracodorsal nerve is a branch of the posterior cord of the brachial plexus, and is made up of fibres from the posterior divisions of all three trunks of the brachial plexus.

It follows the course of the subscapular artery, along the posterior wall of the axilla to the Latissimus dorsi, in which it may be traced as far as the lower border of the muscle. It supplies latissimus dorsi on its deep surface. The latissimus dorsi is occasionally used for transplantation, and for augmentation of systole in cardiac failure. In these cases, the nerve supply is preserved.

intercostobrachial nerves

[장병선]

감사합니다~ 잘 보겠습니다~

[문형철]

ㅎㅎㅎㅎ

아직 정리중...
상지하고 나면 하지도 정확하게 정리해봐야 할 듯 ㅎㅎㅎ

[조알]

잘봤습니다^^

[건스]

감사합니다. 요새 좀 나태해져있다가 다시 공부 시작해야지 하고 있었는데... 큰 도움 될 거 같습니다.

[박수홍]

읽기 목과 상지 신경해부학

[이상진]

늘 느끼는 거지만...정리의 달인...이십니다..

[문형철]

아직 번역을 목했네요 ㅎㅎㅎ

[Now Here]

정말 좋은자료입니다^^~~감사하게 잘 봤습니다.

[su76]

고맙습니다 ^^

[인이]

아..다봐야 퇴근할텐데. ㅋ
대단하셔요.필요한 자료 검색하다보면 항상 이 까페에 있어요, ㅎㅎ

[문형철]

ㅎㅎㅎ

[최기한]

좋은 자료 감사합니다. 공부에는 끝이 없는거 같습니다.

[gait1004]

항상 고맙습니다..ㅎㅎ

[gait1004]

해답이있어요 ㅎㅎㅎㅎㅎ