THE PERIPHERAL NERVOUS

SYSTEM
Chima Ijoma Anicho Nwosu, MA, MSc, MBBS, MD.
LEARNING OBJECTIVES
TO KNOW THAT
Structurally the nervous system is divided into CNS & PNS, and the PNS functions
to connect the central nervous system (CNS) to the trunk and limbs,
The peripheral nervous system (PNS) , made up of two parts (somatic &
autonomic), consists of the nerves and ganglia outside of the brain and spinal
cord,
Somatic component controls voluntary, whereas autonomic controls involuntary
functions of the body,
All sensory systems have the cell bodies of their first order neurons in the dorsal
root ganglia of the spinal nerves,
The spinal nerves form all the limb plexuses from their ventral primary rami,
Pattern of innervation is established in the embryo, and never changes;
innervation of body wall and limb structures is segmental/dermatome,
Distribution: the sympathetic division follows the spinal nerves to all parts of the
body, but the parasympathetic distribution is limited to viscera (not all),
Since the PNS is not protected by bones and blood-brain-barrier, it is exposed to
toxins and injuries,



SUBDIVISIONS OF THE
NERVOUS SYSTEM
STRUCTURALLY: Structurally : Central Nervous
System (CNS) & Peripheral Nervous System (PNS),
FUNCTIONALLY: somatic & autonomic parts,
Autonomic nervous system is distributed within the CNS &
PNS,
Somatic controls voluntary, whereas autonomic controls
involuntary functions of the body.

SOMATIC NERVOUS SYSTEM
SPINAL NERVES
There are 31 spinal nerves,
which are branches of the
spinal cord, distributed as 8
cervical, 12 thoracic, 5
lumbar, 5 sacral and 1
coccygeal nerves,
Every spinal nerve from C1 to
CX1 carries post-ganglionic
(unmyelinated/grey)
sympathetic fibers which
hitch hike along the spinal
nerve to their own
destination, to vessels for
vasoconstriction, to sweat
glands (sudomotor) and to
erector pilorum muscle of
hair follicle (pilomotor),
Limb plexuses come off
these.

PRINCIPLES OF INNERVATION
Nerve supply is established in the embryo and never
changes; a migrating structure always goes with its nerve(s),
no matter how far it goes. A clear example is the extrinsic
group of muscles of the back,
Skeletal muscles are innervated from motor neuron pools
groups of motor nerve cell bodies in certain cranial nerve
nuclei of the brainstem and anterior horn cells of the spinal
cord,
The body wall and its derivative (limbs) are innervated
segmentally by the spinal nerve branches (anterior/ventral
and posterior/dorsal).

THE NEUROVASCULAR PLANE
Layer 1
Layer 2
Layer 3
THE TRUNK NEUROVASCULAR PLANE IS BETWEEN LAYERS 2 & 3
MUSCLE, CUTANEOUS INNERVATION &
DERMATOMES
A dermatome is the area of skin
innervated by a single spinal
nerve,
On the trunk there is a
considerable overlap. In the
limbs there are similar overlaps,
except at the axial lines, where
dermatomes do not cross,
Most muscles are innervated by
two adjacent segments of the
spinal cord,
Examples are (a) flexors of the
arm are innervated by C5 & C6,
(b) the only extensor of the arm
is innervated by C7 & C8.

The following constitute an
approximate pattern of dermatomes:
C1 no skin
C4 from clavicle to angle of
Louis
C7 middle finger (thumb is by
C6, and pinky by C8)
T4 nipple
T7 epigastrium
T10 umbilicus
L1 groin/supra-
pubic/penis/anterior scrotum
Labium majus/upper buttock
S1 ankle/lateral side of
dorsum of foot
S3 sitting area of
buttock/posterior scrotum labium
majus
S4 perianal skin.

DERMATOME & HERPES ZOSTER
AUTONOMIC NERVOUS SYSTEM
WHAT IS AUTONOMIC NERVOUS SYSTEM?
This is the part of the nervous system
responsible for control of the body
functions that are not consciously directed,
such as breathing, the heartbeat, and
digestive processes,

It is made up of two divisions : Sympathetic
and Parasympathetic.
Bull
RUN
Hair raised.

Pupils dilated.
Heart rate .
Blood pressure .
Bronchodilatation

Adrenal : ADR + NADR .
Liver: Glycogenolysis energy.
Skeletal muscle : blood flow.

Sphincters
closed.

SYMPATHETIC SYSTEM
FRIGHT FLIGHT FIGHT

Heart rate & blood
pressure
Gastric & intestinal
glands: secretions
Peristalsis
PARASYMPATHETIC ACTION:
Conserving & restoring energy!!
AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC :
THORACOLUMBAR
OUTFLOW: T1 T0 L2
PARASYMPATHETIC :
CRANIOSACRAL
OUTFLOW
III, VII, IX,
AND X HAVE
PARASYMPAT
HETIC FIBERS
S 2, 3, 4
SEGMENTS
OF SPINAL
CORD
SYMPATHETIC
NERVOUS
SYSTEM
THE
COMPONENTS
OF
SYMPATHETIC
SYSTEM
THE SYMPATHETIC
TRUNKS/CHAINS
THE VISCERAL BRANCHES OF
SYMPATHETIC TRUNKS (the
sympathetic splanchnic &
cardiac nerves),
THE VASCULAR BRANCHES OF
SYMPATHETIC TRUNKS
THE
SYSMPATHETIC
TRUNKS
THE WHITE & GRAY RAMI
COMMUNICANTES
THE VISCERAL BRANCHES OF SYMPATHETIC NERVES
The visceral
branches of
sympathetic
nerves are
cardiac nerves
& Splanchnic
nerves
THE CARDIAC NERVES
THE GREATER, LESSER, LEAST & LUMBAR
Greater
Lesser
Aortico-
renal
Least
lumbar
SUPERIOR & INFERIOR HYPOGASTRIC
PLEXUSES
AFFERENT VISCERAL FIBERS hitch hickers
SYMPATHECTOMY
DEFINITION: In the neck and trunk are located the sympathetic chain runs up
and down along your spine. During a sympathectomy, a surgeon cuts or
clamps this nerve chain. This keeps nerve signals from passing through it,
PROCEDURE : This may be done surgically or chemically, i.e. injection of
phenol. In the cervical region, the sympathetic outflow to the upper limb may be
performed at the root of the neck or through the third intercostal space via
axillary or trans-thoracic approach, by a minimal access procedure through a
thoracoscope. In the lumbar region, an extra-peritoneal approach through the
appropriate flank to reach the vertebral column, and avoiding related structures
such as the ureters, gonadal vessels, abdominal aorta and lumbar branches,
inferior vena cava and genitofemoral nerve overlying the Psoas muscle.
INDICATIONS: This procedure is used to treat a condition called hyperhidrosis
or heavy sweating in the palms of the hands, the face, the underarms, and
sometimes the feet. It's also used for facial blushing, some chronic pain
conditions and Raynaud phenomenona condition that leads to profound
sensitivity to cold temperatures and color changes of the skin.

THE PARASYMPATHETIC
COMPONENT OF
AUTONOMIC NERVOUS
SYSTEM
Parasympathetic : Cranial outflow

Parasympathetic ; sacral outflow
SUMMARY
WE HAVE EXAMINED:
The somatic two components of the PNS,
Somatic nerve/DRG/limb plexuses,
Pattern of innervation by somatic nerves;
embryology/sensory/motor/segmental,
Autonomic nervous system (ANS) exerts involuntary
control,
Distribution of the sympathetic and parasympathetic.
THANK YOU
DISORDERS OF PERIPHERAL NERVOUS
SYSTEM
Peripheral nerve disorders may be congenital
or acquired . Examples are some metabolic
disorders such as diabetes mellitus, Guillain
Barre syndrome, which happens after a virus
infection. Others are nerve compression
syndromes such as carpal tunnel syndrome,
thoracic outlet syndrome.