Limbs Foot Pathway Notes

1. Pathways to the Foot 
1. Blood Supply 
1. Aorta  descending aorta  common iliac  external iliac  through femoral sheath  femoral artery  popliteal  
1. Anterior tibial artery  dorsalis pedis artery  dorsum of foot 
2. Posterior tibial artery  plantar arteries  plantar aspect of foot 
2. Blood Drainage 
1. Medial foot  great saphenous vein  femoral vein  external iliac  common iliac  IVC 
2. Lateral foot  lesser saphenous vein  popliteal  femoral  external iliac  common iliac  IVC
3. Nerve supply 
1. Afferent 
1. Somatic 
1. Dorsum of foot skin and muscles  superficial and deep peroneal nerves  common peroneal  sciatic nerve  over piriformis muscle  through greater sciatic foramen lumbosacrial plexus  L4-S3  posterior division  dorsal roots  spinal cord
2. Autonomic 
1. N/A
2. Efferent 
1. Somatic 
1. Spinal cord  ventral roots of lumbar/sacral plexus  sciatic nerve  
2. Anterior division  tibial nerve  plantar nerves (flex toes)
3. Posterior division  peroneal nerve   
1. Superficial peroneal  dorsum of foot 
2. Deep Peroneal nerve  dorsum of foot 
2. Autonomic 
1. Sympathetic 
1. IML  ventral roots  ventral rami of lumbar/sacral plexus  white rami  Lumbar/sacral plexus of sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  lumbar sacral plexus  
1. Sciatic nerve posterior division  common peroneal nerve  dorsum of foot 
2. Sciatic nerve anterior division  tibial nerve  plantar nerves  plantar of foot  

Limbs Lower Leg Pathways Notes

1. Pathways of the Lower Leg 
1. Blood Supply 
1. Aorta  Descending aorta  common iliac  external iliac  femoral sheath  femoral  popliteal
1. Superior and inferior geniculate branches 
2. Anterior tibial  anterior muscles 
3. Posterior tibial  posterior muscles and skin 
2. Blood Drainage 
1. Anterior tibial  popliteal  femoral 
2. Great saphenous  femoral 
3. Posterior vein  popliteal  femoral 
4. Lesser saphenous  popliteal  femoral 
5. Femoral  femoral sheath  external iliac  common iliac  IVC  RA
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Medial skin  saphenous nerve  around medial epicondyle of femur  under sartorius muscle  femoral nerve  behind inguinal ligament lateral to psoas major an medial to lateral cutaneous nerve  lumbar plexus  L2,3,4  dorsal roots  spinal cord 
2. Lateral skin and muscles of anterior and posterior  sciatic nerve  lumbar/sacral plexus  L4-S3  dorsal roots  spinal cord
2. Autonomic 
1. N/A 
2. Efferent 
1. Somatic 
1. Spinal cord  ventral roots  lumbar/sacral plexus  L4-S3  
1. Anterior division  tibial nerve  posterior muscles of the leg 
2. Posterior division  common peroneal nerve  superficial and deep peroneal nerves  muscles of anterior leg 
2. Autonomic 
1. Sympathetic
1. IML  ventral root  ventral rami of LS plexus  white rami  LS plexus of sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  LS plexus  
1. Femoral nerve  saphenous  skin of medial leg 
2. Sciatic nerve  
1. Anterior division  tibial nerve  posterior skin of leg 
2. Posterior division  common peroneal  superficial peroneal and lateral sural  anterior muscles and lateral skin 

Limbs Thigh Pathways Notes

1. Pathways to the Thigh 
1. Blood Supply 
1. Aorta  descending aorta  common iliac  external iliac  femoral sheath  femoral  deep femoral  thigh muscles 
2. Blood Drainage 
1. Femoral vein and Great saphenous vein  femoral sheath  external iliac  common iliac  IVC 
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Upper anterior thigh  femoral branch of genitofemoral nerve  genitofemoral nerve  lateral to femoral sheath and behind the inguinal ligament  lumbar plexus  L12  dorsal roots  spinal cord 
2. Anterior thigh  femoral nerve  L234  dorsal roots  spinal cord 
3. Medial thigh  obturator nerve L234  dorsal root  spinal cord 
4. Lateral thigh  lateral femoral cutaneous  L23 dorsal root  spinal cord 
5. Posterior thigh  posterior cutaneous nerve of the thigh  S123  dorsal root  spinal cord 
2. Autonomic 
1. N/A
2. Efferent
1. Somatic 
1. Lumbar spinal cord  ventral roots  LS plexus  
1. Sciatic nerve  posterior muscles 
2. Obturator nerve  skin of the medial thigh and adductor muscles 
3. Femoral nerve  muscles of the anterior thigh 
2. Autonomic 
1. Sympathetic 
1. IML  ventral roots  ventral ramus of LS plexus  white rami  LS plexus of sympathetic ganglion  Ach synapse  gray rami  LS plexus  same divisions as afferent except reversed and to the vasomotor of skin and muscles of thigh 

Limbs Forearm Pathways Notes

1. Pathways to the Forearm 
1. Blood Supply 
1. Aorta  L subclavian or brachiocephalic to R subclavian  axillary  below teres major  brachial artery  
1. Ulnar  posterior arm, medial wrist and hand 
2. Radial  anterior arm, lateral wrist  over styloid process to anatomical snuff box between extensor palmaris longus and brevis  hand 
2. Blood Drainage 
1. Cephalic from lateral wrist 
2. Basilic from medial wrist 
3. Cephalic and basilic merge with intermediate antebrachial  axillary  subclavian  brachiocephalic  SVC
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Musculocutaneous nerve from lateral skin and anterior muscles  lateral cord  superior and middle trunks  C4-C7  dorsal roots  spinal cord 
2. Medial cutaneous of the forearm  lateral cord  superior and middle trunks  C4 – C7  dorsal roots  spinal cord 
3. Radial nerve from the posterior muscles and skin  Posterior cord  superior, middle, and inferior trunks  C4- T1  dorsal roots  spinal cord 
4. Ulnar nerve to flexors  medial cord  inferior trunk  C8-T1  dorsal roots  spinal cord 
5. Median nerve to flexors  
1. Medial cord  inferior trunk 
2. Lateral cord  superior and medial trunks 
3. Trunks  C4-T1  dorsal roots  spinal cord 
2. Autonomic 
1. N/A
2. Efferent 
1. Somatic 
1. Spinal cord  C4-T1  ventral roots  brachial plexus  
1. Superior and middle trunks  lateral cord  
1. Musculocutaneous nerve  medial skin and muscles of forearm 
2. Median nerve  flexors of the forearm 
2. Superior, Middle, and Inferior Trunks  posterior cord  
1. Radial nerve  extensors of the posterior fore arm 
3. Inferior trunk  medial cord  
1. Median nerve  flexors of the forearm 
2. Ulnar nerve  flexors in the forearm 
2. Autonomic
1. Sympathetic  
1. IML  ventral roots  ventral rami of cervical spinal nerves  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  cervical spinal nerves  brachial plexus  
1. Musculocutaneous to lateral skin and anterior muscles (lateral cord)
2. Medial cutaneous of the forearm (medial cord)
3. Radial nerve to posterior skin and extensors (posterior cod)
4. Ulnar nerve to flexors (medial cord)
5. Median nerve to flexors (medial cord or lateral cord)
6. All of the above  dorsal roots  spinal cord

Limbs Arm Pathways Notes

1. Pathways of the Arm 
1. Blood Supply 
1. Aorta  aortic arch  L subclavian or brachiocephalic to R subclavian  axillary  brachial 
1. Ulnar collaterals 
2. Deep brachial 
1. Middle collateral 
2. Radial collateral 
2. Blood Drainage 
1. Basilic or cephalic  axillary  subclavian  brachiocephalic  SVC  RA
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Posterior and lateral arm via the radial nerve  posterior cord  superior, middle, and inferior trunks  C4-T1  dorsal roots  spinal cord
2. Anterior arm via medial cutaneous of the fore arm  medial cord  inferior trunk  C8-T1
3. Medial arm via medial cutaneous of arm  medial cord  inferior trunk  C8-T1
2. Autonomic 
1. N/A
2. Efferent 
1. Somatic 
1. Spinal cord C4-T1  ventral roots  brachial plexus  
1. Superior and middle trunks  lateral cord  musculocutaneous  muscles of anterior arm 
2. Autonomic 
1. Sympathetic 
1. IML of spinal cord  ventral roots  ventral rami of cervical plexus  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fiber  gray rami  ventral rami of brachial plexus  
1. Superior and middle trunks  lateral cord 
1. Musculocutaneous  anterior muscles 
2. Superior, middle and inferior trunks  posterior cord  radial nerve  posterior and lateral muscles, skin 
3. Inferior trunk  medial cord 
1. Medial cutaneous of forearm  anterior skin 
2. Medial cutaneous of arm  medial skin 

Limbs Posterior Shoulder Pathways Notes

1. Pathways to Posterior Shoulder
1. Blood Supply 
1. Aorta  aortic arch  L subclavian or brachiocephalic to R subclavian  
1. Dorsal scapular  medial scapula 
2. Thyrocervical trunk  suprascapular  supra and infraspinatus fossa 
3. Axillary third part  
1. Posterior circumflex humoral  upper arm 
2. Subscapular  circumflex scapular  infraspinatus fossa 
2. Blood Drainage 
1. Posterior circumflex humoral  basilic  axillary  subclavian  brachiocephalic  SVC
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Supra and infraspinatus fossa  suprascapular nerve  superior trunk  C5-6  dorsal roots  spinal cord 
2. Deltoid muscle  axillary nerve posterior cord  superior, middle, and inferior trunks  C4-T1  dorsal roots  spinal cord
2. Autonomic 
1. N/A
2. Efferent 
1. Somatic 
1. Same as afferent except reverse order 
2. Autonomic 
1. Sympathetic 
1. IML  ventral root  
1. Ventral rami of cervical spinal nerves  cervical sympathetic ganglion  gray rami  brachial plexus  
1. Axillary nerve 
2. Suprascapular nerve (superior trunk)
2. Ventral rami of cervical spinal  cervical sympathetic ganglion  gray rami  dorsal rami  dermatomes C6-T1 

Limbs Anterior Shoulder Pathway Notes

1. Pathways to Anterior Shoulder 
1. Blood Supply 
1. Aorta  aortic Arch  L subclavian or brachiocephalic to R subclavian  
1. Axillary first part 
1. Superior thoracic 
2. Axillary second part 
1. Thoracoacromial 
1. Deltoid 
2. Pectoral 
3. Acromial 
4. Clavicular 
2. Lateral thoracic 
3. Axillary third part 
1. Subscapular  thoracodorsal 
2. Anterior circumflex humoral 
3. Brachial after teres major 
2. Blood Drainage 
1. Cephalic vein or basilic vein  axillary  subclavian  brachiocephalic  SVC
3. Nerve Supply 
1. Afferent 
1. Somatic 
1. Reversal of efferent somatic except through dorsal root 
2. Autonomic 
1. N/A
2. Efferent 
1. Somatic 
1. Spinal cord  ventral roots  brachial plexus 
1. Pectoral nerve  pectoralis muscle 
2. Axillary nerve  deltoid muscle
2. Autonomic 
1. Sympathetic 
1. IML  ventral roots  ventral rami of brachial plexus  white rami  cervical sympathetic ganglion  Ach synapse to postganglionic fibers  gray rami  
1. Cervical plexus  supraclavicular nerve  skin of upper shoulder 
2. Brachial plexus  
1. Pectoral nerves 
2. Axillary nerve