Skip to main content
SpringerLink
Log in

The Peripheral Nervous System: Gross Anatomy

  • Chapter
  • First Online:
Book cover Surgical Disorders of the Peripheral Nerves

Abstract

The nervous system is the mechanism through which the organism is kept in touch with its internal structures and external environments and reacts to changes in them. The central nervous system – the brain and its caudal prolongation the spinal cord – is connected to the periphery by the peripheral nervous system. The latter includes the cranial nerves, the spinal nerves with their roots and rami, the peripheral nerves and the peripheral components of the autonomic nervous system, the sympathetic, parasympathetic and enteric divisions (Gardner and Bunge 2005). The peripheral nerves contain motor fibres (to end plates in skeletal muscle), sensory fibres (from organs and endings in skin, muscle, tendon, periosteum, and bone and joint), efferent autonomic fibres (to blood vessels, sweat glands and arrectores pilarum muscle), and visceral afferent fibres. In no other system is so much functional and relay capacity concentrated in so small a volume of tissue. The cervical spinal cord, with a width of about 2 cm and a depth of about 1.5 cm, contains all the apparatus transmitting control of somatic function from the neck down, together with that of control of much visceral function. Because of their greater content of connective tissue, the peripheral nerves have proportionately a lesser functional content, yet severance in an adult’s arm of the median nerve of 5 mm diameter effectively ruins the function of the hand and forearm (Fig. 1.1).

Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election Professor in Neurological Orthopaedic Surgery, University College, London

Visiting Professor, Department of Academic Neurology, Imperial College, London

Honorary Orthopaedic Consultant, Hospital for Sick Children Great Ormond Street, London

The National Hospital for Nervous Diseases, Queen Square, London

Raigmore Hospital, Inverness

Honorary Orthopaedic Surgeon to the Royal Navy

Consultant in Charge, War Nerve Injuries Clinic at the Defence Medical Rehabilitation Centre, Headley Court, Leatherhead, Surrey

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Beldner S, Zlotolow DA, Melone CP, Agnes AM, Jones MH (2005) Anatomy of the lateral antebrachial cutaneous and superficial radial nerves in the forearm: a cadaveric and clinical study. J Hand Surg 30A:1226–1230

    Google Scholar 

  • Bhadra N, Keith MW, Peckham PH (1999) Variation of innervation of flexor digitorum profundus muscle. J Hand Surg 24A:700–703

    Article  Google Scholar 

  • Branovovacki G, Hanson M, Cash R, Gonzalez M (1998) The innervation pattern of the radial nerve at the elbow and in the forearm. J Hand Surg 23B:167–169

    Google Scholar 

  • Bremner-Smith AT, Unwin AJ, Williams WW (1999) Sensory pathways in the spinal accessory nerve. J Bone Joint Surg 81B:226–228

    Article  Google Scholar 

  • Brodal A (1981) The spinal accessory nerve. In: Neurological anatomy. Oxford University Press, New York/Oxford, p 458

    Google Scholar 

  • Brown H (2002) Anatomy of spinal accessory nerve plexus: relevance to head and neck cancer and atherosclerosis. Exp Biol Med 227:570–578

    CAS  Google Scholar 

  • Bucknill AT, Coward K, Plumpton C, Tate S, Bountra C, Birch R, Sandison A, Hughes SP, Anand P (2002) Nerve fibres in lumbar spine structures and injured spinal roots express the sensory neurones specific sodium channels SNS/PN3 NaN/SNS2. Spine 27:135–140

    Article  PubMed  Google Scholar 

  • Coene LNJEM (1985) Axillary nerve lesions and associated injuries. Thesis, University of Leiden

    Google Scholar 

  • Cooper S (1953) Muscle spindles in the intrinsic muscles of the human tongue. J Physiol 67:1–13

    Google Scholar 

  • Donaghy M (2005) Lumbosacral plexus lesions. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy. 4th edn. Philadelphia, Elsevier, Chapter 56. pp 1375–1390

    Chapter  Google Scholar 

  • Edgar MA (2007) The nerve supply of the lumbar intervertebral disc. J Bone Joint Surg 89B:1135–1139

    Google Scholar 

  • Fleming P, Lenehan B, Sankar J, Folan-Curran P, Curtin W (2004) One third, two thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat 17:26–29

    Article  PubMed  CAS  Google Scholar 

  • Furness JB (2006) Novel gut afferents: intrinsic afferent neurones and intestinofugal neurones. Auton Neurosci 125:81–85

    Article  PubMed  Google Scholar 

  • Furness JB, Costa M (1980) Types of nerves in the enteric nervous system. Neuroscience 5:1–20

    Article  PubMed  CAS  Google Scholar 

  • Gardner E, Bunge RP (2005) Gross anatomy of the peripheral nervous system. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy, 4th edn. Saunders Elsevier, Philadelphia, pp 11–34

    Chapter  Google Scholar 

  • Gruber W (1870) Über die Verbindung des Nervus medianus mit dem Nervus ulnaris am Unterarme der Menschen und der Säugethiere. Archive Anatomie Physiologie Medizin (Leipzig) 37:501–522

    Google Scholar 

  • Hughes RAC (2005) Disease of the fifth cranial nerve. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy, 4th edn. Elsevier Saunders, Philadelphia, pp 1207–1218, Chapter 49

    Chapter  Google Scholar 

  • Kampa RJ, Prasthofer A, Lawrence-Watt DJ, Pattison RM (2007) The internervous safe zone for incision of the capsule of the hip. J Bone Joint Surg 89B:971–976

    Google Scholar 

  • Kierner AC, Zelenka I, Burian M (2001) How do the cervical plexus and the spinal accessory nerve contribute to the innervation of the trapezius muscle? Arch Otolaryngol Head Neck Surg 127:1230–1232

    PubMed  CAS  Google Scholar 

  • Lambert SM (2005) Further opinion: radial nerve palsy associated with fractures of the shaft of the humerus. Doi: 10.1302/0301-620X.87B12.17720

  • Langley JN (1903) The autonomic nervous system. Brain 26:1–26

    Article  Google Scholar 

  • Langley JN (1926) The autonomic nervous system. Part 1. Heffer, Cambridge

    Google Scholar 

  • Last RJ (1949) Innervation of the limbs. J Bone Joint Surg 31B:452–464

    CAS  Google Scholar 

  • MacAvoy MC, Rust SS, Green DP (2006) Anatomy of the posterior antebrachial cutaneous nerve: practical information for the surgeon operating on the lateral aspect of the elbow. J Hand Surg 31A:908–911

    Google Scholar 

  • MacNicol MF, Kelly M (2002) Identification of the saphenous nerve at arthroscopy. Arthroscopy 14:312–314

    Google Scholar 

  • Mahakkanukrauh P, Somsarp V (2002) Dual innervation of the brachialis muscle. Clin Anat 15:206–209

    Article  PubMed  Google Scholar 

  • Mok D, Nikolis A, Harris PG (2006) The cutaneous innervation of the dorsal hand: detailed anatomy with clinical implications. J Hand Surg 31A:563–574

    Google Scholar 

  • Nathan PW, Smith MC (1987) The location of descending fibres to sympathetic pre-ganglionic vasomotor and sudomotor neurones in man. J Neurol Neurosurg Psychiatry 50:1257–1262

    Article  Google Scholar 

  • Pereira MT, Williams WW (1999) The spinal accessory nerve distal to the posterior triangle. J Hand Surg 24B(3):368–369

    Google Scholar 

  • Schott GD (1994) Visceral afferents: their contribution to “sympathetic-dependent” pain. Brain 117:397–413

    Article  PubMed  Google Scholar 

  • Solan MC, Lemon M, Bendall SP (2001) The surgical anatomy of the dorsomedial cutaneous nerve at the hallux. J Bone Joint Surg 83B:250–252

    Article  Google Scholar 

  • Srinivasan R, Rhodes J (1981) The median-ulnar anastomosis (Martin Gruber) in normal and congenitally abnormal fetuses. Arch Neurol 38:418–419

    Article  PubMed  CAS  Google Scholar 

  • Standring SM, Bunting S (2000) The fibre content of the spinal accessory nerve. Personal Communication

    Google Scholar 

  • Suseki K, Takahishi Y, Takahishi K, Chiba T, Yamagata M, Moriya H (1998) Sensory nerve fibres from lumbar intervertebral discs pass through rami communicates. J Bone Joint Surg 80B:737–742

    Article  Google Scholar 

  • Tennent TD, Birch NC, Holmes MJ, Birch R, Goddard NJ (1998) Knee pain and the infrapatellar branch of the saphenous nerve. J R Soc Med 91:573–575

    PubMed  CAS  Google Scholar 

  • Tindall MA, Patel M, Frost A, Parkin I, Shetty A, Compson J (2006) The anatomy of the dorsal cutaneous branch of the ulnar nerve – a safe zone for positioning of the 6R portal in wrist arthroscopy. J Hand Surg 31B:203–205

    Google Scholar 

  • Weddell G, Harpman JA, Lambley DG, Young L (1940) The innervation of the musculature of the tongue. J Anat 74:255–267

    PubMed  CAS  Google Scholar 

  • Wilbourn AJ (2005) Brachial plexus injuries. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy, 4th edn. Elsevier Saunders, Philadelphia, Chapter 55. pp 1339–1373

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University College, London, UK

    Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election (Professor in Neurological Orthopaedic Surgery)

Authors
  1. Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer London

About this chapter

Cite this chapter

Birch, R. (2010). The Peripheral Nervous System: Gross Anatomy. In: Surgical Disorders of the Peripheral Nerves. Springer, London. https://doi.org/10.1007/978-1-84882-108-8_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-108-8_1

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-107-1

  • Online ISBN: 978-1-84882-108-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation