Anatomical structures and function of nervous system

Anatomical structures and function of nervous system.

Conditioned and unconditioned reflexes. Active movements system (symptomatic and topical diagnostics of movement disturbances).

 

    Neuropathology (from greek neuro – nerve, pathos – disease, logos – science) – is a part of clinical medicine, which is involved iervous diseases and its role in pathology of other organs and systems of human body.

    The main structural functional genetic and anatomic unit of nervous system is neuron – nervous cell. Its main function is to accept and carry out impulse.

 

The main function of nervous system is unification and regulation of different physiological processes. That means that nervous system unites, integrates and subordinates all the parts of human body and provides its connection with environment.

     The base of nervous system activity is reflex principle. Reflex – is a reaction of our organism to various outside and inside effects. It is provided by nervous system.

      The reflex consists of afferent part (which accepts information), central part (that keeps information), and efferent part (that creates response). As a result we have a circle – like structure – receptor (primary information centre) – programme centre – executive apparatus.

       All the reflexes can be divided into different groups – simple and complex, inborn and trained, conditioned and unconditioned.

 

        Unconditioned reflexes.

 

1.      They are inborn ones.

2.      They are phylogenetically old, that means they were formed in course of phylogenesis.

3.      They are based on certain anatomic structures (segments of spinal cord or brain stem).

4.      They exist even without brain cortex influence.

5.      They are inherited.

6.      They can be regulated by brain cortex.

7.      They are basis for the conditioned reflexes.

 

Conditioned reflexes.

 

1.      They are the result of the individual experience and are formed during ontogenesis.

2.      They are unstable, that means they need constant support.

3.      They aren’t based on certain anatomic structures.

4.      They are fixed in brain cortex.

There are such conditioned reflexes as speaking, writing, reading, calculation, practice.

        Neurology studies unconditioned reflexes. That helps evaluate the state of nervous system. Conditioned reflexes are studied by psychiatrists.

        Unconditioned reflexes are divided into such groups:

·        Superficial and deep

·        Simple and complex

·        Proprioceptive (stretch, periosteal, articular)

·        Exteroceptive (dermal, from mucose membrane)

·        Interoceptive (from mucose membrane of internal organs – for example urination in case of internal sphincter irritation)

 

In clinical practice we evaluate the following reflexes:

 

Reflex	The group of reflex	Muscles	Nerves	Segments
Subeyesbrow	Deep, periostal reflex	M. orbicularis oculi	N. trigeminus  ( V ) – N.facialis (VII)	Medulla oblongata and pons
Corneal (lid)	Superficial, from mucose membrane	M. orbicularis oculi	N. trigeminus  ( V ) – N.facialis (VII)	Medulla oblongata and pons
Jaw Jerk (mandibular, chin, masseter) reflex (Bechterev’s)	Deep, periostal reflex	M.masseter	N. trigeminus  ( V ) – N.mandibularis (sensory and motor )	Medulla oblongata and pons
Pharyngeal	Superficial, from mucose membrane	Mm. constrictores pharyngis and others	N.glosso- pharyngeus, n.vagus (sensory and motor), 9th and 10th pair of CCN	Medulla oblongata
Palatal (palatine)	Superficial, from mucose membrane	Mm. levatores velli palatini	N.glosso- pharyngeus, n.vagus (sensory and motor)	Medulla oblongata
Biceps	Deep, stretch  reflex	M.biceps brachii	N.musculo- cutaneus	C5-C6
Triceps	Deep, stretch   reflex	M.triceps brachii	N.radialis	C7-C8
Radial (carporadial, brachioradial)	Deep, periostal reflex	Mm.pronatores flexores, digitorum, brachioradialis, biceps	N.medianus, N. radialis, N. musculo-cutaneus	C5-C8
Scapulo- humeral (scapuloperiosteal) reflex (Bechterev’s)	Deep, periostal reflex	Mm. teres major, subscapularis	N. subscapularis	C5-C6
Upper superficial abdominal	Superficial, dermal	Mm. transversus, obliquus, rectus abdominis	N.intercostales	D7-D8
Middle superficial abdominal	Superficial, dermal	Mm. transversus, obliquus, rectus abdominis	N.intercostales	D9-D10
Lower superficial abdominal	Superficial, dermal	Mm. transversus, obliquus, rectus abdominis	N.intercostales	D11-D12
Cremasteric	Superficial, dermal	M.cremaster	N.genito- femoralis	L1-L2
Knee jerk, or patellar reflex (quadriceps stretch reflex)	Deep, stretch  reflex	M.quadriceps femoris	N.femoralis	L3-L4
Achilles (ankle jerk)	Deep, stretch reflex	M.triceps surae	N.tibialis       (n.ischiadicus )	S1-S2
Plantar (sole)	Superficial, dermal	Mm. flexores digitorum pedis and others	N.ischiadicus	L5-S1
Anal	Superficial, dermal	M.sphinter ani externus	Nn. anococcygei	S4-S5

 

 

Normally the reflexes are lively and the same on both sides. (D=S). Hyperreflexion, hyporeflexion or areflexion are abnormal signs. If the reflexes change on one side we can write down:

D > S;   S > D;    D = S;   D < S;  S < D.

Put the pathologic sign always on the first place.

 

There are quantity of unconditional reflexes is great enough for man. The greatest notice is deserved by that of them, which differ by appreciable persistence. Therefore we shall be limited to treating only of that small part of reflexes, which are permanently researched ieurological practice. In the presentation we shall adhere about research from above downwards, designating the name of a reflex, character of response, reflex arch and technique of calling.

 

Subeyesbrow reflex is caused by impact of a hammer on subeyesbrow arc territory. Concerns to deep, periosteal (bone) reflexes. Answer response is closering of blepharons (m. orbicularis oculi). Reflex arch: n. Ophthalmic (the first branch of a trigeminal nerve), sensitive nucleus of trigeminal nerve, motor neurons of facial nerve, movement fibbers of facial nerve, m. orbicularis oculi.

 

Corneal (lid) reflex turns out as a result of a cautious touch by cotton or soft paper to a cornea above the iridescent shell (but not above a pupil); a reflex superficial, from a mucous. The movement response consists in same closering of blepharons; reflex arch same, as of subeyesbrow reflex.

 

Conjunctival reflex, as frequently absent iorm, large value in research of the nervous system have no. It has such reflex arch as a corneal reflex.

 

Mandibular (chin, masseter, jaw) reflex (Bechterev’s) jaw relaxed and about half-opened. Finger, pressing downward on chin, is percussed. It is a deep, periosteal (bone) reflex. Answer response is abbreviation (cutting) masseter (m. masseter), causing closering of a jaw (rising of a mandible). Reflex arch: sensitive fibbers of n. Mandibular (the third branch of a trigeminal nerve), sensitive nucleus of trigeminal nerve, its motor neurons in the pons, movement fibbers same third branch of trigeminal nerve. The reflex does not differ by the large persistence iorm and is sharply boosted in pathological cases (at a pseudobulbar paralysis).

 

      Pharyngeal reflex is caused by applicator stick touch to a back wall of pharynx’s; occur swallowing, sometimes cough and gagging. Reflex arch: sensitive fibbers and nucleus of IX and Х nerves (n. glosso-pharyngeal and n. Vagus), motor neurons and fibbers of IX and Х nerves.

 

Pharyngeal and palatal (palatine) reflexes do not differ by the large persistence and can be absent for the healthy persons.  The one-sided lowering or absence of reflexes is the diagnostic valuable. Therefore it is necessary to concern separately right and left sides of a mucous soft palate and fauces. Both reflexes concern to number superficial, from mucous.

 

Biceps reflex from a tendon of m. biceps is caused by impact of a hammer on a tendon of the two-chapter muscle in an Ulnar fold. Answer response is abbreviation (cutting) the called muscle and inflection in an Ulnar joint. Reflex arch: n. Musculocutaneous, V and VI cervical segments of a spinal cord. It is a tendon (deep) reflex. 

 

Triceps reflex from a tendon m. triceps, it turns out as a result of impact by a hammer on a tendon of the three-chapter muscle, that causes its abbreviation (cutting) and extension of a forearm in an Ulnar joint. The impact is put on 1,5 — 2 sm above olecranon. Reflex arch: n. radial, VII and VIII cervical segments of a spinal cord. It is a tendon (deep) reflex.

 

Radial (carporadial, brachioradial) reflex is caused by impact of a hammer on ргос. stiloideus a beam and consists in bending in Ulnar joint, pronation and bending of fingers. Not all named reactions turn out constantly: it is most clearly usually expressed pronation. Reflex arch: mm. Pronatores, flexores digitorum, brachioradial and biceps: nn. Median, Radial and Musculocutaneous; V, VI, VII and VIII cervical segments of a spinal cord. It is a deep (periosteal) reflex.

 

   Scapulohumeral (scapuloperiosteal) reflex (Bechterev’s) turns out at impact of a hammer on internal edge of scapular: reduction and rotation a shoulder which freely should hang down thus is marked. It is a deep (periosteal) reflex. Reflex arch: mm. Teres major and Subscapular: n. Subscapular, V, VI cervical segments of spinal cord.

 

Superficial abdominal reflexes are caused by shaped irritation of a stomach skin: below the costal arch – epigastric reflex, at a level an umbilicus – midlamdominal reflex, above pupart sheaf – hypogastric reflex. Shaped irritations should be fast render a little bit pointed subject (a goose feather). A direction of strokes and places of their drawing are represented on fig. 2. Reflex arches: the top belly reflex – VII and VIII chest segments; on the average – IX and X; bottom – XI and XII. Response is reduction of muscles belly press. Reflexes are dermal, superficial.

There reflexes usually cannot be elicited if the abdomen is obese, distended, or overly flaccid, or if the patient is unable to relax. Proper relaxation seems best obtained when the patient lies supine with knees comfortably drawn up and supported, arms hanging loosely at the sides, and eyes closed.

 

Cremasteric reflex causes shaped irritation of a hip internal surface skin. Reflex contraction of the cremasteric muscle with elevation of the testicle is observed. Reflex is constant, but sometimes and in norm non-uniform (apparently, because of unequal smartness testis). Reflex arch: n. Genitofemoral, I-II lumbar segments. It is a superficial, cutaneous reflex (see fig. 2).

 

Knee jerk, or patellar reflex (quadriceps stretch reflex), turns out at hammer impact on patellar tendon lower than patella. As a result of that there is a reduction of m. quadriceps femor and extension of shins. Reflex arch: n. femoral, II and IV lumbar segments. It is deep, tendon reflex.

 

  Achilles (ankle) reflex is caused by impact of hammer on Achilles tendon; there is a reduction of m. triceps sure and extension of stops. Reflex arch: n. Tibial (a branch of n. Sciatic), I and II sacral segments. It is a deep, tendon reflex.

 

Plantar (sole) reflex is the normal flexion of the toes that result from stimulation of the sole of the foot. The direction of a stroke may be from below upwards or from the top downward (fig. 3); it is better to carry spend a stroke with some pressing, with his strengthening by the end of irritation. Response is bending fingers stops. Reflex arch: n. Sciatic, V lumbar and I sacral segments of a spinal cord. A superficial reflex.

Plantar reflex is inherent in the intact nervous system of the person who has reached age of 1-3 years. At small children exists, and at patients with damaged of pyramidal system (dissociation with a brain) arises Babinski phenomenon (great-toe reflex).

 

Anal reflex is caused by an injection of a skin about back pass; his circular muscle (m. sphincter ani externus). A reflex arch: nn. anococcygei, IV and V sacral segments. It is a superficial, dermal reflex.

 

 

Motor system

    This system provides conduction of nervous impulse from brain cortex to muscles. The way of this impulse is known as motor way or tractus corticomuscularis. It consists of two neurons:

1.      central

2.      peripheral

 

Upper and lower extremities, neck, trunk and perineum muscles’ innervation

 

The first (central) neuron is called tractus corticospinalis.

The second (peripheral) neuron is called tractus spinomuscularis.

 

The fibers of tr.corticospinalis are of Betz cells origin. Most of its fibers originate from anterior central gyrus, posterior parts of upper and middle frontal gyri and paracentral lobe (area 2,4,6). The Betz cells in central anterior gyrus are presented vice versa to the parts of the body:

in upper part the muscles of lower extremities are presented;

in middle part  – the muscles of upper extremities are presented;

in lower part – the face muscles are presented.

    There is crossed innervation of muscles .The axons of Betz cells that create tr. corticospinalis go through corona radiata to internal capsula via its anterior 2/3 of posterior crus. Then the axons of motor way go through the peduncles, pons to medulla oblongata to form pyramides.

   80 % of all fibers make decussationon the border between medulla oblongata and spinal cord. The crossed fibers go to the lateral foniculus of spinal cord on the opposite side and create tr. corticospinalis lateralis. The last provides lower and upper extremities muscles innervation.

    The rest – 20 % of all fibers aren’t crossed. They go to foniculus anterior and create tr. corticospinalis anterior ( fasciculus Turka ). This one provides neck, trunk, perineum muscles innervation.

    The fibers of tr. corticospinalis are finished in motorneurons of spinal cord anterior horns.

 

The second neuron – peripheral – tractus spinomuscularis.

 

Neurons of C1-C4 anterior horns innervate neck muscles, C5-Th1-2 – muscles of upper extremities, Th2-Th12 – trunk muscles, L1-S2 – muscles of lower extremities, S3-S5 – muscles of pelvic organs.

 

The second neuron originates from anterior horns alphamotorneurons of spinal cord. Axons of these neurons go within anterior roots and then join with posterior ones to form the spinal nerve. Each spinal nerve gives 4 branches:

1. ramus anterior ( together they form plexus – cervical, brachial, lumbar and sacral)

2. ramus posterior (it is spinal nerve, which innervates posterior trunk muscles)

3. ramus meningeus

4. ramus comunicante albi.

 

     Thus, the motor impulse goes from anterior horns through anterior roots, spinal nerve, plexus and peripheral nerves to muscles.

      

      That’s the reason to make following conclusions:

 

1. The muscles of upper and lower extremities have unilateral cortical innervation from contralateral hemisphere

2. The muscles of neck, trunk and pelvic organs have bilateral innervation from both hemispheres. In case of unilateral pathologic focus these structures do not suffer.

 

Face, tongue and pharynx muscles innervation.

 

This way is called tractus corticomuscularis.

The first central neuron is called tractus corticonuclearis.

The second peripheral one is called tractus nucleomusculares.

 

     The first neuron cells are situated in the lower part of anterior central gyrus. The axons go through corona radiata, the knee of internal capsula to brain stem (that means peduncles, pons and medulla oblongata). There are nuclei of CCNs in brain stem.

     And one more peculiarity – the fibers of tractus corticonuclearis make decussation above all the nuclei. This decussation is incomplete.  The only exception is lower nucleus of VII CCN and nuclei of XII CCN. In this case decussation is complete.

     The second neuron is situated in motor nucleus of CCNs. This way to face muscles is called tractus nucleomuscularis.

 

Thus we can make the following conclusions:

1.   The face muscles have bilateral cortex innervation except the mimic muscles and tongue muscles that have unilateral innervation from the opposite hemisphere.

2.    The muscles of upper and lower extremities, lower mimic muscles and tongue muscles have unilateral cortical innervation.

3.    All the other muscles (the muscles of neck, trunk, perineum, m. oculomotorial, m. masseter, pharyngeal and palatal muscles) have bilateral cortical innervation.

 

Movements disturbances.

     In case of complete lesion of motor way (tractus corticomuscularis) paralysis (plegia) occurs. That means the absence of active movements

    In case of incomplete lesion of motor way paresis occurs. That means active movements disorders – hemi-, tetra-, mono-, tri- and paraparesis.

 

Paralysis is divided into

·        Central ( spastic )

·        Peripheral ( flaccid )

 

Central or spastic paralysis is caused by the lesion of central neuron and its fibers (tr. corticospinalis or tr. corticonuclearis).

 

Peripheral or flaccid paralysis is caused by the lesion of peripheral neuron (tractus spinomuscularis or tractus nucleomuscularis).

 

The main features of central or spastic paralysis are:

1. It is a diffuse paralysis.

2. There is spastic hypertonus of muscles

That means

·        Tonus is increased in the group of flexors in upper extremities and in the group of extensors in lower extremities

·        “ clasp – knife “ symptom

·        in course of evaluation tonus decreases

3.  Hyperreflexion of stretch and periostal reflexes.

4.   There are pathologic reflexes.They are considered to be reliable signs of central paralysis.

 

All the pathologic reflexes on lower extremities are divided into flexing and extensing.

    To flexing ones belong Rossolimo,  Jukovski, Bechterev’s, Mendel – Bechterev’s reflexes. The response is reflex flexing of II -V fingers.

 

    To extensing reflexes belong Babinski, Oppenheim’s, Gordon’s, Shtrumpel, Grossman, Sheffer,  Chaddock’s, Pusep’s and Redlich reflexes. The abnormal response is dorsiflexion of the great toe and fanning of the.

         

There are following pathologic reflexes on upper extremities:

 

1. Bechterev’s sign This is simply a muscle-stretch reflex of bending of fingers obtained by tapping the back of hand with a reflex hammer.

2. Jukovski sign. This is caused by hammer impact on a palm under fingers; response is reflex flexing of II-V fingers.

3. Rossolimo ( Venderovych ) reflex: This is simply a muscle-stretch reflex obtained by tapping the palmar surfaces of the fingers with a reflex hammer; the response is reflex flexing of II-V fingers.

4.  Tremner reflex . This is simply a muscle-stretch reflex obtained by tapping the palmar surfaces of the nail-phalax of II – V fingers. The response is fingers flexing.

5. Jakobson – Laske reflex. This is caused by hammer impact on processus styloideus ; the response is reflex flexing of II-V fingers.

6. Klipel – Veil reflex. This is caused by passive bending of II – V fingers. The response is thumb flexing.

5.      Protective reflexes (the reflexes of spinal automatism).

They also are one of signs of lesion of motor way. They are especially clearly expressed at cross lesion of a spinal cord (dissociation of underlaying segments of the last from a brain). The result is squeezing of foot, and also an injection or sharp plantar flexion of toes (V.M.Bechterev). The response reflex flexion of paralyzed extremities, flexion in femoral, knee and talocrural joints (shortly reaction); opposite extremities thus straightens, being unbent in joints (long reaction). Serial putting irritations  on one and the other leg, can result in  imitation of automatisms of walking.

6.      Pathologic synkinesis

are involuntary movements in paralysed extremity . They are observed while moving by healthy extremity. Synkinesis are divided into

·        Global

·        Coordinatory

·        Imitating

 

Peripheral (flaccid, atonic) paralysis.

 

     It occurs at lesion of tractus spinomuscularis or tractus nucleomuscularis.

 The main features of peripheral paralysis are:

 

1. Areflexion or hyporeflexion

2. Atonia or hypotonia

3. Muscular atrophy

4. Fasciculation of muscles

5. It is limited paralysis

6. There is reaction of degeneration.

        

 

The main symptoms of motor way lesion on different levels

1.  The lesion of anterior central gyrus

usually cause monoplegia  (or monoparesis ) on the opposite side . If the focus is situated in upper part of anterior central gyrus, paralysis of lower extremity occurs.

If it is in middle part of anterior central gyrus, we can observe paralysis of upper extremity. If it is in lower one, face suffers. In case of anterior central gyrus irritation  Motar Jackson takes place. Motor Jackson is a set of local seizures that can cause generalized seizures.

 

2.The lesion of corona radiata

usually cause central hemiplegia on the opposite side (that means that arm, leg, lower mimic muscles and tongue muscles are involved). By the way, if the process is much more expressed in upper part of corona radiata, paralysis in lower extremity dominates. If the process is much more expressed in middle part of corona radiata , paralysis in upper  extremity prevales. If the process is much more expressed in lower part of corona radiata, paralysis in face muscles dominates.

Besides hemianesthesia can join hemiplegia.

 

3. The lesion of internal capsula part of motor way

can cause hemiplegia on the opposite side, central paresis of tongue muscles and lower mimic muscles . Hemihypesthesia often joins all the other symptoms. Vernike – Mann posture is typical for this lesion.

 

4. The lesion of brain stem

cause central paralysis  on the opposite side and peripheral paralysis of face muscles on the side of lesion. It is known as alternating syndrome. The last are divided into peduncle, pontine and bulbar ones.

 

5. The lesion of pyramidal decussation part of motor way

usually cause central paralysis of upper extremity on the side of lesion and paralysis of lower extremity on the opposite side . Sometimes tetraplegia or triplegia is observed.

 

6. The lesion of motor way in lateral foniculus of spinal cord

cause central paralysis below the level C1-C4, C5-Th1, Th1- Th12, L1-S2.

 

7. The lesion of anterior horns or motor nucleus of CCNs

cause peripheral paralysis of certain muscles . At chronic process we can observe fasciculation of muscles. Also there are early atrophy and degenerative reaction.

 

8. Anterior roots lesion

cause also peripheral paralysis . In most of cases it is observed only when several roots are damaged.

 

9.      The lesion of nerve plexus

cause peripheral paralysis , pain, sensory and autonomic disturbances.

 

10. The lesion of peripheral nerve

cause peripheral paralysis of the muscle , innervated by this nerve. There is also pain, sensory and autonomic disturbances.

 

 

 Table

Muscle innervation—action

Muscle                                     Nerve root level		Action
Rhomboids	Dorsal scapular N C4-C5	Adduction—scapula
Supraspinatus	Suprascapular N C4-C5	Abduction—arm
Infraspinatus	Suprascapular N C4-C6	Lateral rotation—arm
Serratus anterior	Long thoracic N C5-C7	Draws scapula forward during pushing
Subscapularis	Subscapular NC5-C6	Medial rotation—arm
Latissimus dorsi	Thoracodorsal N C6-C8	Adduction, medial rotation—arm
Teres major	Lateral subscapular N C5-C7	Adduction, extension, medial rotation—arm
Deltoid	Axillary NC5-C6	Abduction—arm
Biceps brachii	Musculocutaneous N C5-C6	Flexion—forearm
		Supination—hand
Triceps	Radial NC6-C8	Extension—forearm
Brachioradialis	Radial NC5-C6	Flexion—forearm
Extensor carpi radialis	Radial NC5-C7	Extension, abduction—hand
Supinator	Radial NC5-C7	Supination—hand
Extensor digitorum	Radial NC6-C8	Extension—wrist, phalanges
Extensor carpi ulnaris	Radial N C6-C8	Extension adduction—hand
Abductor pollicis longus	Radial N C6-C8	Abduction—thumb
Extensor pollicis longus	Radial N C6-C8	Extension—second phalanx thumb
Extensor pollicis brevis	Radial NC7-T1	Extension—first phalanx thumb
Pronator teres	Median N C6-C7	Pronation —hand
Flexor carpi radialis	Median NC6-C7	Flexion, abduction—hand
Flexor digitorum sublimis	Median NC7-T1	Flexion—second phalanx—fingers
Flexor digitorum profundus	Median NC7-T1	Flexion—terminal phalanx—fingers
Flexor pollicis longus	Median NC6-C8	Flexion—second phalanx thumb
Abductor pollicis brevis	Median NC7-T1	Abduction—thumb
Opponens pollicis	Median NC7-T1	Abduction, flexion—thumb
Flexor pollicis brevis	Median NC7-T1	Adduction, flexion—thumb
Flexor carpi ulnaris	Ulnar N C7-T1	Flexion, adduction—hand
Abductor digiti quinti brevis	Ulnar NC8-T1	Abduction—little finger
Flexor digiti quinti brevis	Ulnar NC8-T1	Flexion—little finger
Opponens digiti quinti	Ulnar NC8-T1	Abduction, flexion—little finger
Abductor pollicis	Ulnar NC8-T1	Adduction—thumb
Interossei	Ulnar NC8-T1	Dorsal — abduction fingers from middle finger
Lumbricals	1,2-median	Palmar—adduction fingers toward middle finger
	3,4-ulnarC8-Tl
Neck flexors	C1-C6	Flexion—neck
Neck extensors	Cl-Tl	Extension—neck
Diaphragm	Phrenic NC3-C5	Diaphragmatic breathing
Abdominal muscles
upper	T5-T9
lower	T10-L3
Iliopsoas	Femoral N L2-L4	Flexion—thigh at hip
Adductor magnus, longus, brevis	Obturator NL2-L4	Adduction—thigh
Gluteus medius minimus	Superior gluteal N L4-S1	Abduction, medial rotation—thigh
Gluteus maximus	Inferior gluteal N L4-S2	Extension, lateral rotation—thigh
Quadriceps femoris	Femoral NL4-S1	Extension—leg at knee
Hamstrings	Sciatic NL4-SI	Flexion—leg at knee
Tibialis anterior	Deep peroneal N L4-L5	Dorsiflexion, inversion—foot
Extensor hallucis longus	Deep peroneal N L4-S1	Extension—great toe dorsiflexion—foot
Extensor dig. longus	Deep peroneal N L4-S1	Extension—lat. 4 toes dorsiflexion—foot
Extensor dig. brevis	Deep peroneal N L4-S1	Extension—all toes except little toe
Peroneus longus brevis	Sup. peroneal N L5-S1	Eversion—foot
Gastrocnemius soleus	Tibial NL5-S2	Plantar flexion—foot
Tibialis posterior	Posterior tibial N L5 – S1	Inversion—foot
Flexor dig. longus	Posterior tibial L5-S2	Plantar flexion—toes
Flexor hallucis longus	Posterior tibial L5-S2	Plantar flexion—great toe
Foot intrinsics	Posterior tibial L5-S2