Sensitive innervation of the scalp: 1) the area of ​​the face above the incision of the eyes - the frontal and supraorbital nerves (from the 1st, ophthalmic, branch of the trigeminal nerve), the ear-temporal nerve (from the 3rd, mandibular, branch of the trigeminal nerve), temporo-zygomatic nerve (from the 2nd, maxillary, branch of the trigeminal nerve), a large ear nerve (from the cervical plexus);

2) the area of ​​the face between the incision of the eyes and the incision of the mouth - the infraorbital and zygomatic-facial nerves (from the 2nd, maxillary, branch of the trigeminal nerve);

3) the area of ​​the face below the incision of the mouth - the mental nerve (from the 3rd, mandibular, branch of the trigeminal nerve);

4) occipital region - large occipital nerve (posterior branch of the second cervical spinal nerve), small occipital nerve (from the cervical plexus).

Innervation of the muscles of the head: facial muscles - facial nerve (VII pair of cranial nerves); masticatory muscles - motor branches of the same name to the muscles (from the 3rd, mandibular, branch of the trigeminal nerve).

Language. Sensitive innervation: the general sensitivity of the anterior two-thirds is provided by the lingual nerve (from the 3rd, mandibular, branch of the trigeminal nerve), the taste sensitivity of the anterior two-thirds of the tongue is provided by the tympanic string (branch of the facial nerve). Posterior third of the tongue: general sensitivity - glossopharyngeal nerve (IX pair of cranial nerves) and vagus nerve (X pair of cranial nerves); taste sensitivity of the posterior third of the tongue - glossopharyngeal nerve.

The innervation of the muscles of the tongue is the hypoglossal nerve (XII pair of cranial nerves).

The mucous membrane of the cheeks. Sensitive innervation - buccal nerve (from the 3rd, mandibular, branch of the trigeminal nerve).

Sky. Sensitive innervation - anterior, middle and posterior palatine nerves (from the 2nd, maxillary, branch of the trigeminal nerve).

Innervation of the muscles: muscle that pulls the palatine curtain - 3rd, mandibular, branch of the trigeminal nerve; uvula muscle, palatine curtain lifter, lingo-palatine and pharyngo-palatine muscles - vagus nerve (X pair of cranial nerves).

Salivary glands. The parotid salivary gland receives sensory fibers from the ear-temporal nerve (3rd, mandibular, branch of the trigeminal nerve); parasympathetic fibers - from the glossopharyngeal nerve (IX pair of cranial nerves); sympathetic fibers - from the upper cervical node of the border sympathetic trunk (they reach the gland through the arteries that supply it with blood).

The submandibular and sublingual salivary glands receive sensory fibers from the 3rd branch of the trigeminal nerve, parasympathetic fibers from the tympanic string from the VII pair of cranial nerves, sympathetic fibers from the upper node of the cervical marginal sympathetic trunk (they reach the glands through the arteries that supply them with blood) .

Pharynx. Sensitive innervation - glossopharyngeal nerve (IX pair of cranial nerves) and vagus nerve (X pair of cranial nerves). Muscle innervation: vagus nerve (X pair of cranial nerves).

Contents of the eye socket. Sensitive innervation of all components of the orbit is carried out by the nerves of the 1st and 2nd branches of the trigeminal nerve.

Innervation of the external muscles of the eyeball: external rectus muscle of the eye - abducens nerve (VI pair of cranial nerves); superior oblique muscle of the eye - trochlear nerve (IV pair of cranial nerves); the remaining muscles are the oculomotor nerve (III pair of cranial nerves).

The internal muscles of the eyeball: the muscle that narrows the pupil, the ciliary muscle receives parasympathetic fibers from the nucleus of Yakubovich (the preganglionic fibers go as part of the oculomotor nerve to the ciliary node, from which the postganglionic fibers reach the named muscles). The muscle that dilates the pupil is innervated by sympathetic fibers coming from the cavernous plexus.

Lacrimal gland. Sensitive fibers come from the 1st branch of the trigeminal nerve; parasympathetic fibers originate from the superior salivary nucleus (preganglionic fibers as part of the facial nerve, more precisely, the intermediate nerve, reach the pterygopalatine ganglion, from which the postganglionic fibers penetrate the orbit through the infraorbital fissure and innervate the lacrimal gland). Sympathetic fibers come to the gland from the cavernous plexus.

nasal cavity. The general sensitive innervation of the mucous membrane of the nasal cavity is carried out by the 1st and 2nd branches of the trigeminal nerve; olfactory sensitivity is due to olfactory filaments (I pair of cranial nerves).

outer and middle ear. Sensitive innervation of the shell - a large ear nerve (cervical plexus), anterior ear nerves (3rd, mandibular, branch of the trigeminal nerve).

External auditory meatus and tympanic membrane. The sensitive innervation of the external auditory canal and the tympanic membrane is the ear-temporal nerve (from the 3rd, mandibular, branch of the trigeminal nerve).

Tympanic cavity and auditory tube. The sensitive innervation of the mucous membrane of the middle ear is the auricular-temporal nerve (from the 3rd mandibular, branch of the trigeminal nerve).

Middle ear muscles: stirrup muscle - facial nerve; muscle that stretches the eardrum, 3rd, mandibular, branch of the trigeminal nerve.

Neck

Neck skin: lesser occipital, greater auricular, transverse neck and supraclavicular nerves (branches of the cervical plexus).

Neck muscles. Superficial muscles of the neck. The subcutaneous muscle of the neck is the cervical branch of the facial nerve; sternocleidomastoid muscle - accessory nerve (XI pair of cranial nerves); neck muscles located below the hyoid bone - cervical loop; neck muscles located above the hyoid bone: anterior belly of the digastric muscle - 3rd, mandibular, branch of the trigeminal nerve, posterior belly - facial nerve, stylohyoid muscle - facial nerve, stylohyoid muscle - hyoid nerve: stylopharyngeal muscle - glossopharyngeal nerve; sublingual-maxillary muscle - 3rd, mandibular, branch of the trigeminal nerve; geniolingual, geniohyoid and hyoid-lingual muscles - hypoglossal nerve (XII pair of cranial nerves).

Deep neck muscles- muscular branches of the cervical and brachial plexuses.

Thyroid and parathyroid glands. These glands are innervated by the fibers of the vagus nerve and the border sympathetic trunk, sensory fibers are obtained from the cervical plexus.

Larynx. Innervation of the mucous membrane of the larynx: above the glottis - the superior laryngeal nerve (a branch of the vagus nerve), below the glottis - the inferior laryngeal nerve (a branch of the laryngeal age nerve).

Innervation of the muscles of the larynx: cricoid-thyroid muscle - superior laryngeal nerve; the remaining muscles of the larynx are the inferior laryngeal nerve (branches of the vagus nerve).

Breast

The intrinsic muscles of the chest are innervated by the intercostal nerves, the skin of the chest region receives sensory fibers mainly from the intercostal nerves, partly due to the branches of the cervical (subclavian region) and brachial (in the lateral sections) plexuses.

A heart. Autonomic innervation: sympathetic - from the cervical border trunk (from its three nodes the upper, middle and lower cardiac nerves, respectively, depart to the heart), parasympathetic - sa due to the vagus nerve (the upper cardiac branch departs from the upper yurt nerve, the lower cardiac branches - from laryngeal recurrent nerve). Afferent fibers to the heart come as part of the same cardiac branches from the vagus nerve and from the cervical and upper thoracic spinal nerves through the border sympathetic trunk.

Thymus. Innervation is autonomic, carried out by branches of the vagus nerve and the border sympathetic trunk, sensory fibers come from the cervical spinal nodes along the branches of the border sympathetic trunk.

Esophagus. Sensitive innervation - vagus and glossopharyngeal nerves and afferent fibers of the thoracic spinal nerves. The striated muscles of its upper section receive motor somatic fibers from the vagus nerve, the smooth muscles of the lower section have autonomic innervation: from the border sympathetic trunk and the vagus nerve.

Lungs. Autonomic innervation: due to the branches of the border sympathetic trunk and the vagus nerve.

Stomach

The skin of the anterior and lateral surface of the abdomen receives innervation from the 6-12th intercostal nerves, the ilio-hypogastric and ilio-inguinal nerves. The lateral and anterior abdominal muscles are innervated by the same nerves as the skin. The posterior abdominal muscles and the iliopsoas receive motor fibers from the lumbar plexus.

The organs of the abdominal cavity have autonomic innervation: parasympathetic, sympathetic and afferent. All these fibers reach the organs through the plexus on the vessels that supply them with blood. The parasympathetic fibers of the abdominal organs are obtained from two sources: the vagus and pelvic nerves. The vagus nerves, having entered the abdominal cavity, form the anterior and posterior chords on the stomach and then enter the solar plexus, and from there through the vessels to the liver, pancreas, kidneys, adrenal glands, stomach and small intestine. Parasympathetic fibers come to the large intestine and pelvic organs from the sacral spinal cord, through the pelvic nerves and the hypogastric plexus.

Sympathetic fibers to the organs of the abdominal cavity and pelvis go as part of the visceral branches of the borderline sympathetic trunk (the largest of them are the celiac nerves), solar, lower mesenteric and hypogastric plexuses.

Afferent fibers (processes of cells of the spinal nodes) reach the organs in the same ways as sympathetic fibers (through the border sympathetic trunk and its branches).

Back

The skin of this area is innervated by the posterior branches of all spinal nerves, excluding the 2nd cervical. Innervation of the superficial muscles: latissimus dorsi - thoracic-spinal nerve (from the brachial plexus); trapezius muscle - accessory nerve (XI pair): levator scapula and rhomboid muscle - spinal nerve of the scapula (from the brachial plexus); the superior and inferior serratus muscles are the intercostal nerves. Innervation of the deep muscles: muscles of the occipital-vertebral group - along the occipital nerve (posterior branch of the 1st cervical spinal nerve); rib lifters - intercostal nerves; the rest of the deep muscles of the back are the posterior branches of the cervical, thoracic and lumbar spinal nerves.

Upper limb

Shoulder area. Skin innervation: Above the deltoid muscle, the skin is innervated by the supraclavicular nerves (from the cervical plexus) and the deltoid nerves (from the brachial plexus).

Innervation of the muscles: deltoid and small round muscles - deltoid nerve (from the posterior bundle of the brachial plexus), supraspinatus and infraspinatus muscles - suprascapular nerve (from the supraclavicular part of the brachial plexus), subscapularis muscle - subscapular nerves (from the supraclavicular part of the brachial plexus), large and small pectoral muscles - anterior pectoral nerves (from the supraclavicular part of the brachial plexus), latissimus dorsi and teres major - thoracic-spinal nerve (from the supraclavicular part of the brachial plexus), serratus anterior - long pectoral nerve (from the supraclavicular part of the brachial plexus), subclavian muscle - subclavian nerve (from the supraclavicular part of the brachial plexus).

Shoulder. Skin innervation: medial surface - medial cutaneous nerve of the shoulder (from the medial bundle of the brachial plexus), lateral surface - lateral cutaneous nerve of the shoulder (branch of the axillary nerve), posterior surface of the shoulder - posterior cutaneous nerve of the shoulder (branch of the radial nerve).

Muscle innervation: anterior group - musculocutaneous nerve (from the lateral bundle of the brachial plexus); posterior group - radial nerve (from the posterior bundle of the brachial plexus).

Forearm. Innervation of the skin: anterior surface - the medial cutaneous nerve of the forearm (from the medial bundle of the brachial plexus) and the lateral cutaneous nerve of the forearm (a branch of the musculocutaneous nerve); posterior surface - posterior cutaneous nerve of the forearm (branch of the radial nerve).

Muscle innervation: posterior group - deep branch of the radial nerve; anterior group: carpo-ulnar flexor and medial half of the deep flexor of the fingers - ulnar nerve; the remaining muscles of the anterior group of the forearm are the median nerve.

Brush. Innervation of the skin: the skin of the palm in the area of ​​3 1/2 fingers (starting with the thumb) - branches of the median nerve; the region of the remaining 1 1/2 fingers is the branches of the ulnar nerve; back of the hand: skin of 2 1/2 fingers (starting with the thumb) - radial nerve; the skin of the remaining 2 1/2 fingers is the ulnar nerve. Branches of the median nerve extend to the rear of the middle and nail phalanges of the II and III fingers.

Muscle innervation. The short abductor thumb muscle, which opposes the thumb, the superficial head of the short flexor thumb, the first and second worm-like muscles are innervated by branches of the median nerve; and the rest of the muscles of the hand - a deep branch of the ulnar nerve.

lower limb

Taz. Cutaneous innervation of the gluteal region. The upper floor of the skin of the gluteal region is innervated by the superior cutaneous gluteal nerves (posterior branches of the three upper lumbar spinal nerves), the middle floor by the middle cutaneous gluteal nerves (posterior branches of the three upper sacral spinal nerves) and the lower floor by the inferior cutaneous gluteal nerves ( branches of the posterior femoral cutaneous nerve).

Innervation of the pelvic muscles: gluteus maximus - inferior gluteal nerve (sacral plexus); tensor fascia lata, gluteus medius and minimus - superior gluteal nerve (sacral plexus); internal, obturator, twin and square muscles - muscular branches of the sacral plexus; external obturator muscle - obturator nerve (lumbar plexus).

Innervation of the skin of the thigh: anterior surface - the anterior cutaneous nerves of the thigh (femoral nerve); lateral surface - lateral cutaneous nerve of the thigh (lumbar plexus); medial surface - obturator nerve (lumbar plexus) and genitofemoral nerve (lumbar plexus); posterior surface - posterior cutaneous nerve of the thigh (sacral plexus).

Innervation of the thigh muscles: anterior group - femoral nerve (lumbar plexus); the medial group is the obturator nerve (lumbar plexus) (the large adductor muscle additionally receives motor fibers from the sciatic nerve); posterior group - sciatic nerve (sacral plexus).

Shin. Innervation of the skin: the posterior surface of the skin of the lower leg - lateral (branch of the common peroneal nerve) and medial (branch of the tibial) cutaneous nerves of the lower leg; lateral surface - lateral cutaneous nerve of the leg; the medial surface is the saphenous nerve (a branch of the femoral nerve).

Muscle innervation: anterior group - deep peroneal nerve (a branch of the common peroneal nerve); lateral group - superficial peroneal nerve (a branch of the common peroneal nerve); the posterior group is the tibial nerve (a branch of the sciatic nerve).

Foot. Skin innervation: most of the skin on the rear of the foot is a branch of the superficial peroneal nerve; area of ​​the 1st interdigital space - deep peroneal nerve; lateral edge of the foot - cutaneous nerve of the leg; the medial edge of the foot is the saphenous nerve.

On the sole, the skin in the area of ​​3 1/2 fingers (starting from the thumb) is innervated by the medial plantar nerve (a branch of the tibial nerve), the rest of the skin of the sole (the area of ​​the last 1 1/2 fingers) is innervated by the lateral plantar nerve (a branch of the tibial nerve).

Innervation of the muscles: the muscles of the rear of the foot - the deep peroneal nerve, the muscles of the sole - the medial and lateral plantar nerves.

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blood supply

The blood supply of the thoracic and lumbar spine is provided by the branches of the aorta, the cervical spine - by the vertebral artery. The corresponding radicular arteries enter the spinal canal through the intervertebral foramina. One or two large arterial trunks enter the body of each vertebra from behind. The latter are divided into four branches, which, heading forward, go up, down, right and left. The arterial trunks, approaching the surface of the vertebra, anastomose with the vessels of the long ligaments. Often one arterial source feeds two vertebrae. In the latter case, an infectious process, such as tuberculosis, can begin in the disk area. The blood supply to the lumbar part of the spine with all its organ-tissue components is carried out through the lumbar arteries - parietal branches of the abdominal aorta. These are four paired vessels extending from the posterior wall of the aorta and heading laterally at the level of I-IV lumbar vertebrae.

The two upper branches pass behind the crura of the diaphragm, the two lower branches behind the psoas major muscle. Connective tissue strands in the form of bridges are thrown over the lumbar arteries, and both vessels are located in peculiar bone-fibrous channels that protect the arteries from compression. Having reached the transverse processes of the vertebrae, each lumbar artery at the intervertebral foramen divides into anterior and posterior branches. The front, going behind the square muscle, goes to the front wall of the abdomen, and the back goes to the muscles and skin of the lower back. Throwing over the spinal nerve, each dorsal branch at the posterior edge of the intervertebral foramen divides into lateral and medial musculoskeletal branches. On the way to the muscles, the posterior branches give off the spinal branches.

According to VN Kravchuk (1975), they often come directly from the lumbar arteries. As a rule, the spinal branch splits into two arterial vessels, of which one goes to the anterior wall of the spinal canal, the other to the spinal cord. An arterial vessel or a dorsal branch of the lumbar artery departs independently to the posterior wall of the spinal canal at the level of the posterior edge of the intervertebral foramen. The anterior branches enter the intervertebral foramina and are directed, as already mentioned, to the anterior wall of the spinal canal. The blood supply to the disc undergoes significant changes during ontogeny. Up to 25-26 years of age, it is provided with branches of six vessels: two dorsal, two ventral, two axial. Arterial branches create bridge-like connections - "arcades". The vessels penetrate into the discs from the vertebral bodies (Obermuth H., 1930). The vascular plexus is thicker on the anterior surface of the discs (Radchenko E.I., 1958). With the completion of the period of body growth, by the age of 25-26, the vessels of the disc are already completely obliterated, nutrition is carried out by diffusion through the hyaline plates. This is the “ideal” (Obermuth H., 1930; Coventry M., 1945), i.e. avascular, the state of the disk is replaced in old age by a state of wear. At the site of tears, there is ingrowth of vessels, but this revascularization of the disc is already a pathological phenomenon.

Venous outflow from the vertebrae, dura mater and partly from the spinal cord is carried out by small veins that run next to the arterial trunks of the same name. These small veins carry blood to the venous lines located inside the spinal canal. The two anterior internal vertebral plexuses are called the longitudinal vertebral sinuses. They run between the dura mater and the posterior longitudinal ligament. The two posterior internal vertebral plexuses are in front of the arches. These longitudinal highways are interconnected by transverse veins. From the venous highways, blood flows through the branches that go in the intervertebral foramina towards the vertebral veins (Baacke H., 1957). Venospondylographic studies have shown that the veins of the spine, on the one hand, and the veins of the spinal cord and its membranes, on the other hand, are isolated, do not have pronounced anastomoses (Begg A., 1954; Rege O., 1956; Schobinger R., 1960).

Innervation of the spine

Until recently, it was generally accepted that the bone, epidural and sheath structures in the region of the spine are innervated mainly by the recurrent nerve (synonyms: sinuvertebral, meningeal, meningeal nerve - Luschka H., 1850)1. This is a sensitive nerve. Its fibers arise in the spinal cerebral ganglia and leave the funiculus somewhat distal to them. Just as the recurrent meningeal nerve of Arnold is sent from the Gasser ganglion posteriorly to the membranes, to the cerebellar tenon, also from the spinal ganglia, a similar nerve - sinuvertebral - returns to the spinal canal through its own intervertebral foramen. Entering the spinal canal and dividing into branches, it goes up and down (Tsukada K., 1938; Roof P., 1940). The branches of one side and the other meet in the region of the posterior longitudinal ligament. The innervation of the posterior wall of the spinal canal is provided by branches either from these nerves or from the white connecting branches.

There is "overlapping" of neighboring zones, which explains the widespread occurrence of lumbar pain with a hernia of only one disc. The term "meningeal branch" does not fully reflect the purpose of the nerve, because it innervates not only the dura mater, but also the periosteum of the bodies and arches of the vertebrae, including the venous epidural plexus (Tkach Z.A., Zyabloye A.I., 1964). It consists of soft afferents, through which impulses follow to the cell bodies of the spinal ganglia. Thus, pain and reflex manifestations in pathology in the area of ​​the spinal canal are primarily due to damage to the endings of the recurrent nerve of Luschka. Neuropeptide P, involved in sensory and conduction, was found in the posterior longitudinal ligament and was not found in the annulus fibrosus and yellow ligament (Korkala O. et ai, 1985). A number of features of the pain syndrome are explained by the fact that the Luschka nerve is not only somatic, but also autonomic. Departing with one thicker branch from the common trunk of the spinal nerve, it departs with the other two thin branches from the gray connecting branches of the nearest ganglia of the sympathetic trunk and from the lumbar plexus (Otelin A.A., 1965; Suseki K. et ai, 1996). At the cervical level, where there is a plexus of the vertebral artery, sympathetic fibers to the back wall come from it. All these nerves branch out in the bones, ligaments, vessels and membranes of the spinal cord.

Thanks to macro- and microscopic examination under a binocular magnifying glass, it was possible to obtain updated information about the innervation of the spine (Otelin A.A., 1965; Bogduk N., 1988). It turned out that each vertebra receives up to 30 nerve trunks, of which a part goes deeper than the periosteum on its own or accompanying the vessels. Sources of stems are: 1) cord; 2) its posterior branch; 3) anterior branch; 4) Luschka's nerve; 5) sympathetic nodes of the border trunk; 6) gray connecting branches. The largest number of branches in the region of the cervical vertebrae is separated from the sympathetic trunk and Luschka's nerve. Fibers from the sympathetic trunk create plexuses on the lateral surface of a pair of vertebrae. There are no encapsulated receptors here, but there are free nerve endings in the form of points, buttons, loops, which explains the high pain sensitivity of the periosteum. In other parts of the vertebrae, the periosteum also contains few encapsulated receptors. From the cord, three or four branches go to the arch and root of the transverse process, into the thickness of the yellow ligaments. From the posterior branch of the cord, the fibers go to the joint capsule and the spinous process. In this case, the periosteal fibers branch off from the trunks that innervate the deep muscles of the back. The most abundantly supplied with free and encapsulated receptors is the periosteum in the region of the intervertebral foramina.

At the cervical level, the branches of the sinuvertebral nerve go up, innervate the capsule of the corresponding disc, its superficial and deep layers (Bogduk N., 1988). Sensory fibers of the ligaments of the spine and dura mater are part of the Luschka nerve. The subdural fibers of these nerves are especially pronounced in the cervical region.
Unmyelinated nerve fibers were found in the anterior and posterior longitudinal ligaments and in the fibrous ring (Jung A., Brunschwig A., 1932; Malkov G.F., 1946; Lindeman K., Kuhlendahl N., 1953; Sturm A., 1958; Fernstrom U ., 1960, etc.). P.Roofe (1940) established that the annulus fibrosus is innervated by exposed ends of thin non-myelinated fibers. A.A. Otelin (1965) found encysted Vaterpachinian bodies in its lateral sections. In the posterior longitudinal ligament, the fibers terminate in the form of glomeruli. Some fibers are associated with blood vessels. All anatomists and physiologists agree that there is a commonality in the sensory innervation of the capsules of the vertebral joints, ligaments and muscles, the similarity of the same receptor bodies of Ruffini and Pacini. At the same time, however, some features of the receptors of joint capsules are also noted.

V.D. Wyke (1967, 1979), in accordance with the data of other authors, distinguishes 4 types of receptors in the joint capsules: 1,11 and III - mechanoreceptors, IV - nociceptors.

Type I is formed by encapsulated bodies, the fibers are slightly myelinated. These are receptors that adapt the outer layers of the capsule for stretching for a long time, have
reflex effects through the motor neurons of the muscles of the whole body, including even the muscles of the eyes, cause parasympathetic inhibition of type IV nociceptive afferents.
Type II is formed by encapsulated conical and oblong bodies, the fibers are well myelinated. These receptors, which quickly adapt the deep layers of the capsule to stretching, have reflex-phasic effects on the muscles of the spine and extremities and cause short-term presynaptic inhibition of nociceptive impulses.
Type III - typical receptors for ligaments and places of attachment of the tendon to the bone. In shape, these are long-term adaptive Golgi organs. They are not present in joint capsules. Formed by single fusiform wide bodies, the fibers are abundantly myelinated, possibly also inhibiting nociceptive impulses.
Type IV - non-encapsulated, naked (free), finely myelinated nociceptors, ubiquitous in fibrous tissues of ligaments, capsules and quickly responding to mechanical and chemical irritations. They cause pain and reflex responses of striated and smooth muscles.

However, it should be pointed out that the question of the innervation of the fibrous ring remains controversial. A.Jung and A.Brunschwig (1932), G.Wiberg (1949), C.Hirsch and Schajowich (1953), D.Stellwell (1956) did not find nerve endings in it.

The autonomic nerves take a significant part in the innervation of the disc and other formations of the spine (see 6.1.5.2). As for the lower lumbar roots, they are devoid of sympathetic fibers. It is known that the Jacobson spinal sympathetic center and the corresponding efferent sympathetic fibers in the composition of the anterior roots, as well as the white connecting branches, are absent below the II lumbar spinal segment. The source of autonomic disorders in the pathology of the lower lumbar level should be sought not in the compressed root, but in other structures.

The anterior branches of the spinal nerves form plexuses. The innervation is segmental. The posterior branches of the same nerves innervate the deep muscles, the skin of the neck, back and sacral region. Coming out of the posterior intervertebral foramina, they form connectives below the thoracic SMS and sacroiliac ligaments - the posterior lumbosacral-coccygeal plexus (Trolard R., 1882; Sokolov V.V., 1947). A particularly abundant accumulation of connections, loops was noted in the posterior long sacroiliac ligament outward from the two upper sacral foramens. The branches of the lower sacral and coccygeal branches unite in the posterior sacro-lumbar ligaments.

Ya.Yu.Popelyansky
Orthopedic neurology (vertebroneurology)

SURFACE MUSCLES OF THE BACK

The superficial muscles of the back are attached to the skeleton of the shoulder girdle and to the humerus and are arranged in two layers (Fig. 116, 117). The first layer is made up of the trapezius muscle a and the latissimus dorsi muscle, the second is the large and small rhomboid muscles and the muscle that lifts the scapula.

trapezius muscle,T.trapezius, flat, triangular in shape, with a wide base facing the posterior median line, occupies the upper back and back of the neck. It begins with short tendon bundles from the external occipital protrusion, the medial third of the superior nuchal line of the occipital bone, from the nuchal ligament, spinous processes of the VII cervical vertebra and all thoracic vertebrae, and from the supraspinous ligament. From the places where the muscle bundles begin, they are directed, noticeably converging, in the lateral direction and are attached to the bones of the shoulder girdle. The upper bundles and muscles pass downward and laterally, ending on the posterior surface of the outer third of the clavicle. The middle bundles are oriented horizontally, pass from the spinous processes of the vertebrae outwards and attach to the acromion and scapular spine. The lower muscle bundles follow upward and laterally, pass into the tendon plate, which is attached to the scapular spine.The tendon origin of the trapezius muscle is more pronounced at the level of the lower border of the neck, where the muscle has the greatest width.At the level of the spinous process of the VII cervical vertebra, the muscles of both sides form a well-defined tendon area, which is found in the form of an impression in a living

person.

The trapezius muscle is located superficially throughout its entire length, its upper lateral edge forms the back side of the lateral triangle of the neck. The lower lateral edge of the trapezius muscle crosses the latissimus dorsi muscle and the medial edge of the scapula from the outside, forming the medial border of the so-called auscultatory triangle. The lower border of the latter runs along the upper edge of the latissimus dorsi muscle, and the lateral one - along the lower edge of the rhomboid muscle (the size of the triangle increases with the arm bent forward at the shoulder joint, when the scapula is displaced laterally and anteriorly).

Function: simultaneous contraction of all parts of the trapezius muscle with a fixed spine brings the scapula closer to the spine; upper bundles of muscle raise the scapula; upper and lower beams with simultaneous reduction,. forming a pair of forces, rotate the scapula around the sagittal axis: the lower angle of the scapula is displaced forward and in the lateral direction, and the lateral angle - upward and medially. With a strengthened shoulder blade and contraction on both sides, the muscle unbends the cervical spine and tilts the head back; with unilateral contraction, it slightly turns the face in the opposite direction.

Innervation: n. accessorius, plexus cervicalis (C m - C, v) -

Blood supply: a. transversa cervicis, a. occipitalis, a. suprascapularis, aa. intercostales posteriores.

latissimus dorsi muscle,T.latissimus dorsi, flat, triangular in shape, occupies the lower half of the back on the corresponding side.

The muscle lies superficially, with the exception of the upper edge, which is hidden under the lower part of the trapezius muscle. Below, the lateral edge of the latissimus dorsi muscle forms the medial side of the lumbar triangle (the lateral side of this triangle forms the edge of the external oblique muscle of the abdomen, the lower one - the iliac crest, see Fig. 117). It begins with an aponeurosis from the spinous processes of the lower six thoracic and all lumbar vertebrae (together with the superficial plate of the lumbothoracic fascia), from the iliac crest and the median sacral crest. The muscle bundles follow upward and laterally, converging towards the lower border of the axillary fossa. At the top, muscle bundles are attached to the muscle, which start from the lower three to four ribs (they go between the teeth of the external oblique muscle of the abdomen) and ° t of the lower angle of the scapula. Covering the lower angle of the scapula from behind with its lower bundles, the latissimus dorsi muscle sharply bends, spirally bends around the large round muscle, the posterior edge of the axillary fossa passes into a flat thick shoulder, which is attached to the crest of the small tubercle of the humerus. Near the point of attachment, the muscle covers behind the vessels and nerves located in the axillary fossa. It is separated from the large round muscle by the synovial bag.

Function: brings the arm to the body and turns it inward (pronation), unbends the shoulder; lowers the raised hand; if the arms are fixed (on the crossbar - the horizontal bar), pulls the torso to them (when climbing, swimming).

Innervation: n. thoracodorsalis (Civ- Soup).

Blood supply: a. thoracodorsalis, a. circumflexa humeri posterior, aa. intercostales posteriores.

Muscle that lifts the scapulaT.levdior scapulae, begins with tendon bundles from the posterior tubercles of the transverse processes of the upper three or four cervical vertebrae (between the attachment points of the middle scalene muscle - in front and the belt muscle of the neck - behind). Heading down, the muscle attaches to the medial edge of the scapula, between its upper angle and the spine of the scapula. In its upper third, the muscle is covered by the sternocleidomastoid muscle, and in the lower third by the trapezius muscle. Directly anterior to the levator scapula muscle, the nerve to the rhomboid muscle and the deep branch of the transverse artery of the neck pass.

Function: raises the scapula, at the same time bringing it closer to the spine; with a strengthened scapula, it tilts the cervical part of the spine in its direction.

Blood supply: a. transversa cervicis, a. cervicalis ascendens.

Small and large rhomboid muscles,tt.rhomboidei minor et major, often grow together and form one muscle. The small rhomboid muscle starts from the lower part of the nuchal ligament, the spinous processes of the VII cervical and I thoracic vertebrae and from the supraspinous ligament. Its bundles pass obliquely - from top to bottom and laterally and are attached to the medial edge of the scapula, above the level of the spine of the scapula.

The rhomboid muscle originates from the spinous processes of the II-V thoracic vertebrae; attached to the medial edge of the scapula - from the level of the spine of the scapula to its lower angle.

The rhomboid muscles, located deeper than the trapezius muscle, themselves cover the back of the superior serratus posterior muscle and partly the muscle that straightens the spine.

Function: brings the scapula closer to the spine, while simultaneously moving it upward.

Innervation: n. dorsalis scapulae (Civ-Cv).

Blood supply: a. transversa cervicis, a. suprasca-pularis, aa. intercostales posteriores.

Two thin flat muscles are attached to the ribs - the upper and lower posterior dentate muscles (Fig. 118).

Serratus superior posterior,T.serratus posterior superior, located in front of the rhomboid muscles, begins in the form of a flat tendon plate from the lower part of the nuchal ligament and the spinous processes of the VI-VII cervical and I-II thoracic vertebrae. Going obliquely from top to bottom and laterally, it is attached with separate teeth to the back surface of the II-V ribs, outward from their corners.

Function: raises the ribs.

Innervation: nn. intercostales (Thi-Thiv).

Blood supply: a. intercostales posteriores, a. cervicalis profunda.

Serratus posterior inferior,T.serratus posterior inferior, lies in front of the latissimus dorsi, begins with a tendon plate from the spinous processes of the XI-XII thoracic and I-II lumbar vertebrae; closely fused with the superficial plate of the lumbar-thoracic fascia and the beginning of the latissimus dorsi. It is attached by separate muscular teeth to the four lower ribs.

Function: lowers the ribs.

Innervation: pp. intercostales (Thix-Thxn).

Blood supply: a. intercostales posteriores.

DEEPMUSCLESBACKS

The deep muscles of the back form three layers: superficial, medium and deep. The superficial layer is represented by the belt muscle of the head, the belt muscle of the neck and the muscle that straightens the spine; middle layer - transverse spinous muscle; the deep layer is formed by the interspinous, intertransverse and suboccipital muscles.

The greatest development is achieved by the muscles of the surface layer, which belong to the type of strong muscles that perform predominantly static work. They extend all over the back and back of the neck from the sacrum to the occipital bone. The places of origin and attachment of these muscles occupy vast surfaces and therefore, during contraction, the muscles develop great strength, holding the spine in an upright position, which serves as a support for the head, ribs, viscera and upper limbs.

The muscles of the middle layer are oriented obliquely, they are thrown from the transverse processes to the spinous processes of the vertebrae. They form several layers, and in the deepest layer, the muscle bundles are the shortest and are attached to adjacent vertebrae; the more superficially the muscle bundles lie, the longer they are and through a greater number of vertebrae they are thrown (from 5 to 6).

In the deepest (third) layer, short muscles are located between the spinous and transverse processes of the vertebrae. They are not present at all levels of the spine, they are well developed in the most mobile parts of the spinal column: cervical, lumbar and lower thoracic. This - deep - layer should include the muscles located in the back of the neck and acting on the atlanto-occipital joint. They are called the suboccipital muscles.

The deep muscles of the back become visible after the superficial muscles are cut in layers and crossed: the latissimus dorsi and the trapezius muscle - in the middle between the points of their origin and attachment (Fig. 119).

belt head muscle, T.splenius capitalism, located directly anterior to the upper parts of the sternocleidomastoid and trapezius muscles. It starts from the lower half of the ligament (below the level of the IV cervical vertebra), from the spinous processes of the VII cervical and upper three to four thoracic vertebrae. 1 The bundles of this muscle pass upward and laterally and are attached to the mastoid process of the temporal bone and the rough area under the lateral segment of the superior nuchal line of the occipital bone.

Function: with bilateral contraction, the muscles unbend the cervical spine and head; with unilateral contraction, the muscle turns its head in its direction.

Innervation: posterior branches of the cervical spinal nerves (Ssh - Cvin).

Belt muscle of the neck,T.splenius cervicis, starts from the spinous processes of III-IV thoracic vertebrae. It is attached to the posterior tubercles of the transverse processes of the two or three upper cervical vertebrae, covering the beginning of the bundles of the muscle that lifts the scapula from behind. It is located in front of the trapezius muscle.

Function: with simultaneous contraction, the muscles unbend the cervical part of the spine, with unilateral contraction, the muscle turns the cervical part of the spine in its direction.

Innervation: posterior branches of the cervical spinal nerves (Ciii-Cviii).

Blood supply: a. occipitalis, a. cervicalis profunda.

Muscle, straightening the spine T.erector spinae. This is the strongest of the autochthonous muscles of the back, extending along the entire length of the spine - from the sacrum to the base of the skull. Lies anterior to the trapezius, rhomboid, serratus posterior, latissimus dorsi muscles. Behind it is covered with a superficial sheet of the lumbar-thoracic fascia. It begins with thick and strong tendon bundles from the dorsal surface of the sacrum, spinous processes, supraspinous ligaments, lumbar, XII and XI thoracic vertebrae, posterior segment of the iliac crest and lumbar-thoracic fascia. Part of the tendon bundles, starting in the sacrum, merges with the bundles of the sacrotuberous and dorsal sacroiliac ligaments.

At the level of the upper lumbar vertebrae, the muscle is divided into three paths: lateral, intermediate and medial. Each tract gets its name: the lateral one becomes the iliocostal muscle, the intermediate one becomes the spinous muscle. Each of these muscles, in turn, is divided into parts.

Structural features of the muscle that straightens the spine have developed in the course of anthropogenesis in connection with upright posture. The fact that the muscle is strongly developed and has a common origin on the pelvic bones, and above is divided into separate tracts, attached widely on the vertebrae, ribs and on the base of the skull, can be explained by the fact that it performs the most important function - it holds the body in an upright position. At the same time, the division of the muscle into separate tracts, the division of the latter at different levels of the dorsal side of the body into shorter muscles that have a shorter length between the points of origin and attachment, allows the muscle to act selectively. So, for example, when the iliocostal muscle of the lower back contracts, the corresponding ribs are pulled downward and thereby a support is created for the manifestation of the force of the action of the diaphragm during its contraction, etc.

iliocostalis muscle,T.iliocostalis (see Fig. 119), is the most lateral part of the muscle that straightens the spine. It starts from the iliac crest, the inner surface of the superficial plate of the lumbothoracic fascia. Passes upward along the posterior surface of the ribs laterally from the corners of the latter to the transverse processes of the lower (VII- IV) cervical vertebrae. According to the location of individual parts of the muscle in different areas, it is divided into the iliocostal muscle of the lower back, the iliocostal muscle of the chest and the iliocostal muscle of the neck.

The iliocostal muscle of the lumbar, m.iliocostalis lumbo-git, starts from the iliac crest, the inner surface of the superficial plate of the lumbar-thoracic fascia, is attached by separate flat tendons to the corners of the lower six ribs.

The iliocostal muscle of the chest, m.iliocostalis thoracis, starts from the six lower ribs, medially from the places of attachment of the iliocostal muscle of the lower back. Attaches to the upper six ribs in the area of ​​the corners and to the posterior surface of the transverse process VII cervical vertebra.

The iliocostal muscle of the neck, m.iliocostalis cervicis, starts from corners III, IV, V and VI ribs (inward from the places of attachment of the iliocostal muscle of the chest). It is attached to the posterior tubercles of the transverse processes of the VI-IV cervical vertebrae.

Function: together with the rest of the erector spinae muscle, it extends the spine; with unilateral contraction, tilts the spine to its side, lowers

ribs. The lower bundles of this muscle, pulling and strengthening the ribs, create support for the diaphragm.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves (Civ-Lin).

/ tx. longissimus muscle,T.longissimus, - the largest of the three muscles that form the muscle that straightens the spine. It is located medially to the iliocostal muscle, between it and the spinous muscle. It contains the longest muscles of the chest, neck and head.

Longissimus pectoralis muscle, m.longissimus thoracis (see Fig. 119), has the greatest extent. The muscle originates from the posterior surface of the sacrum, the transverse processes of the lumbar and lower thoracic vertebrae. It is attached to the back surface of the lower nine ribs, between their tubercles and corners, and to the tops of the transverse processes of all thoracic vertebrae (muscle bundles).

The longissimus muscle of the neck, m.longissimus cervicis, begins with long tendons from the tops of the transverse processes of the upper five thoracic vertebrae. Attaches to the posterior tubercles of the transverse processes VI-II cervical vertebrae.

The longissimus muscle of the head, m.longissimus capitalism, begins with tendon bundles from the transverse processes of I- III breast and III-VII cervical vertebrae. It is attached to the posterior surface of the mastoid process of the temporal bone under the tendons of the sternocleidomastoid muscle and the splenius muscle of the head.

Function: the longest muscles of the chest and neck unbend the spine and tilt it to the side; the longest muscle of the head unbends the latter, turns the face in its direction.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves (Ci - Lv).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores, aa. lumbales.

spinous muscle,T.spindlis (see Fig. 119), - the most medial of the three parts of the muscle that straightens the spine. Adjacent directly to the spinous processes of the thoracic and cervical vertebrae. In it, respectively, the spinous muscle of the chest, the spinous muscle of the neck and the spinous muscle of the head are distinguished.

spinous muscle of the chest,m. spindlis thoracis, begins with 3-4 tendons from the spinous processes II and I lumbar, XII and XI thoracic vertebrae. It is attached to the spinous processes of the upper eight thoracic vertebrae. The muscle is fused with the underlying semispinalis muscle of the chest.

spinous muscle of the neck,m. spinalis cervicis, starts from the spinous process I and II chest VII cervical vertebra and lower segment of the ligament. Attaches to the spinous process II(sometimes III and IV) the cervical vertebra.

spinous muscle of the head,m. spinalis capitalism, begins in thin bundles from the spinous processes of the upper thoracic and lower cervical vertebrae, rises up and attaches to the occipital bone near the external occipital protrusion. Often this muscle is missing.

Function: unbends the spine

Innervation: posterior branches of the cervical, thoracic and upper lumbar spinal nerves (Csh-Ln).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores.

function throughout muscles that straighten the spineT.erector spinae, accurately reflects its name. Since the component parts of the muscle originate on the vertebrae, it can act as an extensor of the spine and head, being an antagonist of the anterior muscles of the trunk. Contracting in separate parts on both sides, this muscle can lower the ribs, unbend the spine, and tilt the head back. With unilateral contraction, it tilts the spine in the same direction. The muscle also shows great strength when bending the torso, when it performs inferior work and prevents the body from falling forward under the action of the ventrally located muscles, which have a greater leverage on the spinal column than the dorsally located muscles.

transverse spinous muscle,T. transversospindlis . This muscle is represented by many layered muscle bundles that run obliquely upward from the lateral to the medial side from the transverse to the spinous processes of the vertebrae. The muscle bundles of the transverse spinous muscle are of unequal length and, spreading through a different number of vertebrae, form separate muscles: semispinous, multifid and rotator muscles.

At the same time, according to the area occupied throughout the spinal column, each of these muscles, in turn, is subdivided into separate muscles, named after their location on the dorsal side of the trunk, neck and occipital region. In this sequence, individual parts of the transverse spinous muscle are considered.

semispinalis muscle,T.semispinalis, has the form of long muscle bundles, starts from the transverse processes of the underlying vertebrae, spreads through four to six vertebrae and attaches to the spinous processes. It is divided into semispinalis muscles of the chest, neck and head.

semispinalis muscle of the chest,m. semispinalis thoracis, starts from the transverse processes of the lower six thoracic vertebrae; attached to the spinous processes of the four upper thoracic and two lower cervical vertebrae.

Semispinous muscle of the neck, m.semispinalis cervicis, originates from the transverse processes of the six upper thoracic vertebrae and the articular processes of the four lower cervical vertebrae; attached to the spinous processes of the V-II cervical vertebrae.

semispinalis muscle of the head,m. semispinalis capitalism, wide, thick, starts from the transverse processes of the six upper thoracic and articular processes of the four lower cervical vertebrae (outward from the long muscles of the head and neck); attached to the occipital bone between the upper and lower nuchal lines. The muscle behind is covered by the belt and longest muscles of the head; deeper and anterior to it lies the semispinalis muscle of the neck.

Function: semispinalis muscles of the chest and neck unbend the thoracic and cervical sections of the spinal column; with unilateral contraction, these departments are rotated in the opposite direction. The semispinous muscle of the head throws the head back, turning (with one-sided contraction) the face in the opposite direction.

Innervation: posterior branches of the cervical and thoracic spinal nerves (Csh-Thxii).

Blood supply: a. cervicalis profunda, aa. intercos-tales posteriores.

multifidus muscles,mm. multifidi, are muscular-tendon bundles that start from the transverse processes of the underlying vertebrae and attach to the spinous processes of the overlying ones. These muscles, spreading over two to four vertebrae, occupy grooves on the sides of the spinous processes of the vertebrae along the entire length of the spinal column, starting from the sacrum to the II cervical vertebra. They lie directly in front of the semispinalis and longissimus muscles.

Function: rotate the spinal column around its longitudinal axis, participate in extension and tilt it to the side.

Innervation: posterior branches of the spinal nerves (С„, -Si).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores, aa. lumbales.

Muscles - rotators of the neck, chest and lower back,tt.rotators cervicis, thoracis et lumborum, make up the deepest layer of the muscles of the back, occupying the groove between the spinous and transverse processes. The rotator muscles are better expressed within the thoracic spine. According to the length of the bundles, the rotator muscles are divided into long and short. The long rotator muscles start from the transverse processes and attach to the bases of the spinous processes of the overlying vertebrae, spreading over one vertebra. Short rotator muscles are located between adjacent vertebrae.

Function: rotate the spinal column around its longitudinal axis.

Blood supply: a. cervicalis profunda, aa. intercos-tales posteriores, aa. lumbales.

Interspinous muscles of the neck, chest and lower back,tt.interspi- nales cervicis, thordcis et lumborum, connect the spinous processes of the vertebrae with each other starting from the II cervical and below. They are better developed in the cervical and lumbar sections of the spinal column, which are characterized by the greatest mobility. In the thoracic part of the spine, these muscles are weakly expressed (may be absent).

Function: participate in the extension of the corresponding parts of the spine.

Innervation: posterior branches of the spinal nerves.

Blood supply: a cervicalis profunda, aa. intercos-tales posteriores, aa. lumbales.

Intertransversemuscleslower back, chestAndneck, mm, intertransversarii lumborum, thordcis et cervicis, are represented by short bundles that are thrown between the transverse processes of adjacent vertebrae. Better expressed at the level of the lumbar and cervical spine.

The transverse muscles of the lower back are divided into lateral and medial, tt.intertransversarii laterdles et media­ tes lumborum. In the neck area, the anterior (thrown between the anterior tubercles of the transverse processes) and the posterior transverse muscles of the neck are distinguished, tt.intertransversarii anteriores et posteriores cervicis. The latter have a medial part, pars medialis, and the lateral part pars lateralis.

Function: tilt the corresponding sections of the spinal column in their direction.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

Blood supply: a. cervicalis profunda, aa. intercosta-les posteriores, aa. lumbales.

BACK FACIA

The superficial fascia covering the trapezius and latissimus dorsi muscles is weakly expressed. Well-developed lumbar-thoracic fascia fascia thoracolumbalis, which covers the deep muscles of the back.

At different levels, this fascia is expressed differently. It is most developed in the lumbar region, where it is represented by superficial and deep plates that form a fascial sheath for the muscle that straightens the spine.

The superficial plate of the lumbothoracic fascia is attached to the spinous processes of the lumbar vertebrae, to the supraspinous ligaments and to the median sacral crest. The deep plate of this fascia is attached on the medial side to the transverse processes of the lumbar vertebrae and intertransverse ligaments, below - to the iliac crest, above - to the lower edge of the XII rib and the lumbocostal ligament.

At the lateral edge of the muscle that straightens the spine, the superficial and deep plates of the lumbar-thoracic fascia are combined into one. The deep plate of the lumbothoracic fascia separates the erector spinae muscle from the quadratus lumborum. Within the chest wall, the lumbar-thoracic fascia is represented by a thin plate that separates the erector spinae muscle from the more superficially located muscles. Medially, this fascia is attached to the spinous processes of the thoracic vertebrae, laterally, to the corners of the ribs. In the posterior (exudate) region of the neck, between the muscles located here, there is exudate fascia, fascia nuchae

Innervation is the communication of body structures with the central nervous system. Every part of our body is equipped with sensitive nerve endings. They perceive information about ongoing processes and the state of the organ and transmit it through centripetal fibers to the brain. The information received is processed - response signals are sent along the centrifugal nerves. So the central nervous system responds to the needs of the body and regulates its work.

The main link in the system of transmission of nerve impulses is the spinal cord with roots. And it is hidden in the spine. If there is an infringement of the roots or the spinal cord itself, then the conductive connection is broken. As a result, pain appears in various organs, the functionality of individual structures worsens, and even complete immobilization occurs below the affected area. According to the innervation of the spine, a number of functional deviations can be diagnosed.

Scheme of innervation of the spine

Nerve impulses are transmitted back and forth. Depending on the direction of transmission, the following types of innervation are distinguished:

• afferent (centripetal) - transmission of signals from organs and tissues to the central nervous system;
• efferent (centrifugal) - the transmission of signals from the central nervous system to the structures of the body.

Behind each vertebra are spinal nerves. They consist of nerve fibers of the anterior and posterior roots that emerge from the spinal cord. A person has 31 pairs of them. Therefore, the spinal cord includes 31 pairs of segments:

• eight cervical;
• twelve chest;
• five lumbar;
• as many sacral;
• one coccygeal.

What organs and systems do they innervate?

• Cervical vertebrae: pituitary gland and sympathetic nerves, visual and auditory systems, temporal regions; facial nerves and teeth, nasolabial areas, mouth, throat ligaments, cervical muscles, forearm, shoulder and elbow joints.
• Thoracic vertebrae: arms, trachea, bronchi, lungs, solar plexus and sternum; esophagus, gallbladder and ducts, liver, duodenum and spleen; kidneys, adrenal glands and ureters; large and small intestine; fallopian tubes, groin.
• Lumbar vertebrae: Abdomen, pelvic organs, upper thigh, knees, shins and feet (including fingers).
• Sacral vertebrae: gluteal muscles and femurs.
• Coccyx: anus and rectum.

Diagnosis of the spinal column

The incorrect position of the vertebrae leads to various disorders in the body. No wonder they say that the well-being of the whole body depends on the state of the spinal axis. Pinching in a particular area prevents the organs from fully functioning. Transmission of signals to the CNS occurs with a delay. The brain is not able to respond in a timely manner to the needs of the body. Hence the various failures.

Let's carry out diagnostics taking into account the innervation of the spine.

cervical

Thoracic

Problems in this section of the spinal column lead to functional disorders of the main internal organs. If the distance between the vertebrae is less than normal, then the function of the organ decreases. The intervertebral gap is more than normal - the function is overestimated.

• 1 and 2 vertebrae of the thoracic region - hands, little fingers go numb, elbows hurt, pneumonia.
• 3 and 4 - mastopathy, bronchitis, pneumonia.
• 5, 6, 7 - heart and chest hurts.
• 8 - problems with the pancreas, impaired insulin secretion, appetite, failure in carbohydrate metabolism.
• 9 - fat metabolism suffers.
• 10 - proteins are poorly broken down.
• 11 - pathology of the small intestine and kidneys.
• 12 - dysfunction of the large intestine.

Lumbar

This zone takes on the heaviest load. Accordingly, the lower back makes itself felt faster. The lumbar spine is practically devoid of additional support. There are no cartilaginous rings, as in the cervical region. The ribs do not help, as the thoracic region.

Nature has provided support for the lower back with strong abdominal muscles. What if they are stretched? The spine will have to hold the stomach on its own.

• With a decrease in the distance between the 1st and 2nd lumbar vertebrae, enuresis, painful periods, obstruction of the fallopian tubes, and cysts are observed. The sexual sphere weakens, miscarriages are frequent. This position of the vertebrae is fraught with infertility.
• When pinching 3 vertebrae, the knee joints hurt.
• 4th - back of the thigh.
• 5th - lateral femoral and gluteal muscles, lower leg, foot.

When the intervertebral discs wear out, a herniated disc forms. It presses on the nerve roots and provokes severe pain.

trapezius muscle, t. Trapezius. It begins with short tendon bundles from the external occipital protrusion, the medial third of the superior nuchal line of the occipital bone, from the nuchal ligament, spinous processes of the VII cervical vertebra and all thoracic vertebrae, and from the supraspinous ligament. From the places where the muscle bundles begin, they are directed, noticeably converging, in the lateral direction and are attached to the bones of the shoulder girdle.

Function: brings the scapula closer to the spine; upper bundles of muscle raise the scapula; the upper and lower bundles rotate the scapula around the sagittal axis. innervation:n. accessorius, plexus cervicelis blood supply: a. transversa cervicis, a. occipitalis, a. suprascapularis, aa. intercostales posteriores.

Latissimus dorsi muscle, m. latissimus dorsi. Start: Spinous processes of six lower thoracic and all lumbar vertebrae, dorsal surface of the sacrum, iliac crest labrum, ribs IX-XII. attachment: Ridge of the lesser tubercle of the humerus. Function: Leads the shoulder, pulls it backwards, turns inwards. With fixed arms, pulls the torso towards them. innervation:n. thoracodorsalis blood supply: a. thoracodorsalis, a. circumflexa humeri posterior. a.a. Intercostals posterior

Muscle that lifts the scapula, m. levator scapulae. Start: Transverse processes of the four upper cervical vertebrae. attachment: Upper angle of the scapula. Function: Raises the superior angle of the scapula and pulls it medially. innervation: n.dorsalis scapulae. blood supply: fu transversa cervicis, a.cervicalis ascendes

Minor and major rhomboid muscles, mm. rhomboidei minor et major. Start: Spinous processes of thoracic and cervical vertebrae. attachment: Medial edge of the scapula below and above its spine. Function: Pulls the scapula to the spinal column upwards, presses the scapula to the chest (together with the serratus anterior muscle). innervation:n. dorsalis scapulae. blood supply: a. transversa cervicis, a. suprascapularis, aa. Intercostals posteriores.

Serratus posterior superior, m.

serratus posterior superior. Start: Spinous processes of VI-VII cervical and I-II thoracic vertebrae. attachment: II-V ribs, outward from the corners. Function: Raises II-V ribs, participates in the act of inhalation. innervation:n. dorsalis scapulae. blood supply: a. transversa cervicis, a. suprascapularis, aa. Intercostals posteriores.

Serratus posterior inferior, m. serratus posterior inferior. Start: Spinous processes of XI-XII thoracic and I-II lumbar vertebrae. attachment: Lower edges of ribs IX-XII. Function: Lowers the IX-XII ribs, participates in the act of exhalation. innervation: nn. Intercostals. blood supply: a.a. Intercostal posters.

Belt muscle of the head, m. splenius capitis. Start: lower part of the nuchal ligament, spinous processes of the VII cervical and upper 3-4 thoracic vertebrae. attachment: Superior nuchal line, mastoid process of the temporal bone. Function: Turns and tilts his head to his side. innervation blood supply

Belt muscle of the neck, m. splenius cervicis. Start: Spinous processes of III-IV thoracic vertebrae. attachment: transverse processes of 2-3 upper cervical vertebrae. Function: turns the cervical part of the spine in its direction, with bilateral contraction, it unbends the cervical part of the spine. innervation: posterior branches of the spinal nerves. blood supply: a. occipitalis, a. cervicalis profunda.

superficial fascia, covering the trapezius and latissimus dorsi, is weakly expressed. Well developed thoracic fascia fascia thoracolumbalis, which covers the deep muscles of the back.

Vaginal fascia, fascia nuchae, is located in the back of the neck, between the superficial and deep layers of muscles. Medially, it grows together with the nuchal ligament, laterally passes into the superficial sheet of the fascia of the neck, and is attached to the upper nuchal line at the top.

Lumbar-thoracic fascia, fascia thoracolumbalis forms a dense fibrous sheath in which the deep muscles of the back lie. This fascia consists of two sheets - deep (anterior) and superficial (rear).