Outline I. a. b. c. II.
Limb dermatomes- complicated dermatomal innervation due to embryological rotation of the limb buds as they as they grow out from the trunk
Segmental Innervation of Skin Trunk Dermatomes Face Dermatomes Limb dermatomes Segmental Innervation of Muscles y Biceps brachii tendon reflex y Triceps tendon reflex y Brachioradialis tendon reflex y Abdominal superficial reflexes y Patellar tendon reflex (Knee Jerk) y Achilles tendon reflex Muscle Tone & Muscle Action y Motor unit y Muscle tone o Muscle spindles o Tendon spindles Summation of Motor Units Muscle Fatigue Posture y Line of gravity in Standing Position
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IV. V. VI.
SEGMENTAL INNERVATION OF SKIN DERMATOME- Area of skin supplied by a single spinal nerve (a single segment of spinal cord) Trunk dermatomes- extend round the body from posterior to anterior median plane Overlapping of Dermatomes To produce a region of complete anesthesia at least three contiguous spinal nerves have to be sectioned Area of Tactile loss > Area of loss of pain & temperature o Reason: Degree of overlap of fibers carrying pain & temperature is more extensive than overlap of fibers carrying tactile sensations
SEGMENTAL INNERVATION OF MUSCLES Muscles are innervated by more than one spinal nerve To paralyze a muscle completely, it would be necessary to section several spinal nerves or destroy several segments of the spinal cord
1. Face dermatomes- divisions of trigeminal nerve supply a precise area of skin Little or no overlap to the cutaneous area of another divisio
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Biceps brachii tendon reflex y C5-C6 y Elbow joint Flexion by tapping the biceps tendon Triceps tendon reflex y C6, C7 & C8 y Elbow joint Extension by tapping the triceps tendon Brachioradialis tendon reflex y C5, C6 & C7 y Supination of Radioulnar joints by tapping insertion of brachioradialis tendon Abdominal superficial reflexes y Upper: T6 -7 y Middle : T8 -9 y Lower : T10 -12 y Contraction of underlying abdominal muscles by stroking the skin Patellar tendon reflex (Knee Jerk) y L2, L3 & L4 y Knee joint Extension by tapping patellar tendon
VAKALS (Vanir, Anj, Kim, Abi, Lyka, Suni)
6.
Achilles tendon reflex y S1 & S2 y Plantar Flexion of ankle joint by tapping Achilles tendon- tendo calcaneus
MUSCLE FATIGUE It is the progressive loss of strength of a muscle with prolonged strong contraction due to reduction in amounts of ATP within muscle fibers. POSTURE It is the position adopted by an individual within his/her environment. Line of gravity in Standing Position: 1. Odontoid process of the axis 2. Behind the centers of the hip joints 3. In front of Knee joints 4. In front of Ankle joints Since greater part of body weight lies anterior to vertebral column, the deep muscles of the back are important in maintaining normal postural curves of the vertebral column in standing position. Posture depends on: y Integrity of the reflex arc y Summation of the nervous impulses received by the motor anterior gray column cells from neurons of nervous system
MUSCLE TONE & MUSCLE ACTION Motor unit- consists of a motor neuron in the anterior gray column of the spinal cord and all the muscle fibers it supplies Muscle tone- Partial state of contraction in a skeletal muscle during rest Accomplished by asynchronous discharge of nervous impulses in the motor neurons in anterior gray horn of spinal cord Dependent on a monosynaptic reflex arc composed of 2 neurons (Afferent neuron: arising from neuromuscular and neurotendinous spindles and Efferent neuron: cell body lies in the anterior gray column of spinal cord) y Muscle spindles- sensitive sensory endings that detects lengthening and shortening in a muscle - Response regulated by small Gamma efferent fibers y Tendon spindles- detects tension NOTE! Neurotendinous receptor- inhibitory; reduces tone Neuromuscular spindle- excitatory; increases tone Degree of muscle tone depends on Summation of nerve impulses received: Cutting of Afferent or Efferent Pathways Loss of muscle tone Flaccid Quick atrophy and reduced volume SUMMATION OF MOTOR UNITS At beginning of muscular contraction, smaller motor units are recruited first Smaller motor units are innervated by smaller neurons in spinal cord and brainstem Lower threshold of excitability
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The desire to take medicine is perhaps the greatest feature which distinguishes man from animals. ~ William Osler :P The hardest thing you can do is smile when you are ill, in pain, or depressed. But this no-cost remedy is a necessary first half-step if you are to start on the road to recovery. ~Allen Klein HAKUNA MATATA!- means NO WORRIES! ~Lion King
Root Injury C5 C6 C7 C8 L1 L2 L3 L4 L5 S1 S2
Dermatome Pain Lateral side of the upper part of arm Lateral side of forearm Middle finger Medial side of forearm Groin Anterior part of thigh Medial side of knee Medial side of calf Lateral side of lower leg and dorsum of foot Lateral edge of foot Posterior part of thigh
Muscles Supplied Deltoid and biceps brachii Extensor carpi radialis longus and brevis Triceps and flexor carpi radialis Flexor digitorum superficialis and profundus Iliopsoas Iliopsosas, Sartorius, hip adductors Iliopsosas, Sartorius, quadriceps, hip adductors Tibialis anterior, quadriceps Extensor hallucis longus, extensor digitorum longus Gastrocnemius, soleus Flexor digitorum longus, flexor hallucis longus
Movement Weakness Shoulder abduction, elbow flexion Wrist extensors Extension of elbow and flexion of wrist Finger flexion Hip flexion Hip flexion, hip adduction Hip flexion, knee extension, hip adduction Foot inversion, knee extension Toe extension, ankle dorsiflexion Ankle plantar flexion Ankle plantar flexion, toe flexion
Reflex Involved Biceps Brachioradialis Triceps None Cremaster Cremaster Patellar Patellar None Ankle jerk None
VAKALS (Vanir, Anj, Kim, Abi, Lyka, Suni)
