Autonomic state in pain and correction

[Diane]

P 1303 Gray's:

Cervicothoracic (stellate) ganglion
This is irregular in shape and much larger that the middle cervical ganglion. It is probably formed by a fusion of the lower two cervical and first thoracic segmental ganglia, sometimes including the second and even third and fourth thoracic ganglia. The first thoracic ganglion may be separate, leaving an inferior cervical ganglion above it. The sympathetic trunk turns backwards at the junctions of the neck and thorax and so the long axis of the cervicothoracic ganglion becomes almost anteroposterior. The ganglion lies on or just lateral to the lateral border of the longus colli between the base of the seventh cervical transverse process and the neck of the first rib (which are posterior to it), the vertebral vessels being anterior. Below it is separated from the posterior aspect of the cervical pleura by the suprapleural membrane; the costocervical trunk branches near its lower pole. Lateral is the superior intercostal artery.

A small vertebral ganglion may be present on the sympathetic trunk anterior or anteromedial to the origin of the vertebral artery and directly above the subclavian. When present, it may provide the ansa subclavia and is joined to the cervicothoracic ganglion by fibres enclosing the vertebral artery. It is usually regarded as a detached part of the middle cervical or cervicothoracic ganglion. Like the middle cervical ganglion it may supply grey rami communicantes to the fourth and fifth cervical spinal nerves. The cervicothoracic ganglion sends grey rami communicantes to the seventh and eighth cervical and first thoracic spinal nerves and gives off a cardiac branch, branches to nearby vessels and sometimes a branch to the vagus nerve.

The grey rami communicantes to the seventh cervical spinal nerve vary from one to five; two, the usual number, are shown in 8.398, 399. A third often ascends medial to the vertebral artery in front of the seventh cervical transverse process, connects with the seventh cervical nerve and sends a filament upwards through the sixth cervical transverse foramen in company with the vertebral vessels to join the sixth cervical spinal nerve as it emerges from the intervertebral foramen. An inconstant ramus may traverse the seventh cervical transverse foramen. Grey rami to the the eighth cervical spinal nerve vary from three to six in number.

The cardiac branch descends behind the subclavian artery and along the front of the trachea to the deep cardiac plexus. Behind the artery it connects with the recurrent laryngeal nerve and the cardiac branch of the middle cervical ganglion, the latter often being replaced by fine branches of the cervicothoracic ganglion and ansa subclavia.

Branches to blood vessels form plexuses on the subclavian artery and its branches. The subclavian supply is derived from the cervicothoracic ganglion and ansa subclavia, extending to the first part of the axillary artery; a few fibres may extend further. According to Pearson and Sauter an extension of the subclavian plexus to the internal thoracic artery is joined by a branch of the phrenic nerve (p. 1265). The vertebral plexus is derived mainly from a large branch of the cervicothoracic ganglion which ascends behind the vertebral artery to the sixth transverse foramen, reinforced by branches of the vertebral ganglion or the cervical sympathetic trunk which pass cranially on the ventral aspect of the artery; from this plexus deep rami communicantes join the ventral rami of the upper five or six cervical spinal nerves. The plexus contains some neuronal cell bodies and continues into the skull along the vertebral and basilar arteries and their branches as far as the posterior cerebral artery, where it meets a plexus from the internal carotid. Some consider the vertebral plexus to be the main intracranial extension of the sympathetic system (Lazorthes 1949; Mitchell 1952). The plexus on the inferior thyroid artery reaches the thyroid gland, connecting with recurrent and external laryngeal nerves, the cardiac branch of the superior cervical ganglion, and the common carotid plexus.

The preganglionic fibres for the head and neck emerge from the spinal cord in the upper five thoracic spinal nerves (mainly the upper three), ascending in the sympathetic trunk to synapse in the cervical ganglia. The preganglionic fibres supplying the upper limb stem from upper thoracic segments, probably T2-6 (or 7), ascending via the sympathetic trunk to synapse mainly in its cervicothoracic ganglion, whence postganglionic fibres pass to the brachial plexus (mainly its lower trunk). Most of the vasoconstrictor fibres for the upper limb emerge in the second and third thoracic ventral roots; the arteries can thus be denervated by cutting the sympathetic trunk below the third thoracic ganglion, severing the rami communicantes connected with the second and third thoracic ganglia or by cutting the ventral roots of the second and third thoracic spinal nerves (intradurally). The white ramus to the cervicothoracic ganglion is not cut, partly because it does not convey many vasomotor or sudomotor fibres to the upper limb but mainly because it contains most of the preganglionic fibres for the head and neck; these ascend the trunk to the superior cervical ganglion, from which postganglionic branches supply vasoconstrictor and sudomotor nerves to the face and neck, secretory fibres to the salivary glands, dilator pupillae (and probably cilaris oculi), non-striated muscle in the eyelids and the orbitalis. Destruction of this nerve would thus lead to meiosis, ptosis, enopthalmos and loss of sweating on the face and neck (Horner's syndrome) and possibly some disturbance of accomodation. For a review consult Haxton (1954) and Bannister and Mathias (1992).

Blood vessels of the upper limb beyond the first part of the axillary artery receive their sympathetic supply via branches of the brachial plexus adjacent to them, e.g. the median nerve supplies branches to the brachial artery and palmar arches, the ulnar nerve supplies the ulnar arery and palmar arches and the radial nerve supplies the radial artery.

The first and second (and occasionally the third) intercostal nerves may be interconnected anterior to the necks of the ribs by filaments containing postganglionic fibres from their grey rami; these fibres provide another path by which postganglionic nerves can pass from the upper thoracic ganglia to the brachial plexus.

Why anyone would want to manipulate all this I have no idea. Wait a minute, I do... by pretending that none of it exists in that moment in time, in the neck within one's hands? Sorry, it doesn't all go away just because you close your mind to its existence. You can't wish it away. It's going to be there whatever you do to someone's neck, so start learning less violent ways of treating it.

Next, the thoracic part of the sympathetic system.

[aléa]

Originally Posted by Diane

P 1303 Gray's:


Why anyone would want to manipulate all this I have no idea. Wait a minute, I do... by pretending that none of it exists in that moment in time, in the neck within one's hands? Sorry, it doesn't all go away just because you close your mind to its existence. You can't wish it away. It's going to be there whatever you do to someone's neck, so start learning less violent ways of treating it.

Next, the thoracic part of the sympathetic system.

Can you imagine that therapists do know that ? Can you imagine osteopathy, or chiro, as a reflex therapy ? How do you think manipulations work ?

Saying that, I'm not a manipulation fanatic.

[Diane]

Alea, let me be clear that when I used the term "manipulation" I was referring to HVLA thrust type cracking. I'm not at all opposed to "handling" of the neck. I understand reflexive treatment fairly well, I think. Thank you for your input.

[Barrett Dorko]

Diane,

I think the work you've done here should be required reading in every PT program.

In my experience, (years of that every day) manipulation doesn't result in much of anything - no increase in range, no change in symptoms. Every once in a great while people would be briefly better, sometimes worse. There was no predicting any of this.

There's a discussion on RE about the persistance of symtomotology after "whiplash." Various studies indicate that these aren't just driven by financial considerations. It seems that the anatomical reality of the region and its connection to the possibility of physiologic irritation is something that should always be considered.

It seems to me that the neck's typical lack of response to manipulation is a testament to its adaptability.

[Diane]

The neck is an interesting place
1. with all this essential wiring to vital food intake structures and airways and balance/equilibrium function;
2. vital tubing (vessels) and cord (to rest of body);
3. given the fact that embryologically the diaphragm and heart start out in there and that maybe part of the brain still thinks they are in there;
4. given the fact that even if it is strained, say in a whiplash accident, it still has to support the head? i.e., no way to rest it other than lay it down, or immobilize it in a collar (shown to be couterproductive for all sorts of reasons);
5. given the above, is it any wonder the brain may feel more greatly threatened when the neck is injured in, say, whiplash, in terms of a persistent pain state in the neck representation, than if, say, in a knee representation if a knee is dinged on the dashboard in the same accident?

Anyway, moving on to another interesting bit:
P. 1303, Gray's:

THORACIC PART OF THE SYMPATHETIC TRUNK
The thoracic sympathetic trunk contains ganglia almost equal in number to those of the thoracic spinal nerves (11 in more than 70%, occasionally 12, rarely 10 or 13). The first thoracic ganglion is usually fused with the inferior cervical, forming the cervicothoracic ganglion; Jit and Mukerjee (1960) found a fused ganglion in 80 out of 100 dissections. Rarely the middle cervical or second thoracic ganglion may be included. The succeeding ganglion is counted as the second in order to make the other ganglia correspond numerically with other segmental structures. Except for the lowest two or three the thoracic ganglia lie against the costal heads, posterior to the costal pleura; the lowest two or three are lateral to the bodies of the corresponding vertebrae. Caudally, the thoracic sympathetic trunk passes dorsal to the medial arcuate ligament (or through the crus of the diaphragm) to become the lumbar sympathetic trunk. The ganglia are small and interconnected by intervening segments of the trunk. Two or more rami communicantes, white and grey, connect each ganglion with its corresponding spinal nerve, white rami joining the nerve distal to the grey. Sometimes a grey and white ramus fuse to form a 'mixed' ramus (p. 1298).

The medial branches from the upper five ganglia are very small, supplying filaments to the thoracic aorta and its branches. On the aorta they form a fine thoracic aortic plexus with filaments from the greater splanchnic nerve. Rami of the second to fifth or sixth ganglia enter the posterior pulmonary plexus; others, from the second to fifth ganglia, pass to the deep (dorsal) part of the cardiac plexus. Small branches of these plumonary and cardiac nerves pass to the oesophagus and trachea. The medial branches from the lower seven ganglia are large, supplying the aorta and uniting to form the greater, lesser and lowest splanchnic nerves, the last not always being identifiable.

The greater splanchnic nerve consisting mainly of myelinated preganglionic efferent and visceral afferent fibres, is formed by branches from the fifth to ninth or tenth thoracic ganglia; but fibres in the upper branches may be traced to the first or second thoracic ganglion. Its roots vary from one to eight, four being the most usual number. It descends obliquely on the vertebral bodies, supplies branches to the descending thoracic aorta and perforates the ipsilateral crus of the diaphragm to end mainly in the coeliac ganglion but partly in the aortorenal ganglion and suprarenal gland. A splanchnic ganglion exists on the nerve opposite the eleventh or twelfth thoracic vertebra in 17-68% of dissections (Jit & Mukerjee 1960); but Mitchell (1953) reported microscopic evidence that it is always present.

The lesser splanchnic nerve formed by rami of the ninth and tenth (sometimes tenth and eleventh) thoracic ganglia and the trunk between them, pierces the diaphragm with the greater splanchnic to join the aorticorenal ganglion.

The lowest (least) splanchnic nerve (or renal nerve) from the lowest thoracic ganglion enters the abdomen with the sympathetic trunk to end in the renal plexus.

Jit and Mukerjee (1960) described in great detail dissections of the thoracic sympathetic nerves in 50 cadavers and surveyed the previous findings. The incidence of the splanchnic nerves, according to seven observers, is as follows: greater - always present, lesser - 94% (86-100%), least - 56% (16-98%). A fourth (accessory) splanchnic nerve has been described by deSousa (1955) but has not been confirmed.

With all this vital wiring piercing the diaphgram I would be inclined to predict that the "green light" types delineated on Nick's mechanical peripheral NS deformation thread lately, who can't abdominally breath and whose spines seem so rigid would maybe be nonconsciously guarding/defending their sympathetic chains. I wonder if the postural restoration people have looked into sympathetic nervous system anatomy, reflected on it, allowed it to inform their thinking to any extent?

"(Ooh! Uh! ooh! uh!)
Hey don't you know..
That's the sound of the men..
Working on the chain...
Ganglia.."

[Diane]

P 1304 Gray's:

LUMBAR PART OF THE SYMPATHETIC SYSTEM
The lumbar part of each sympathetic trunk usually containing four interconnected ganglia, runs in the extra-peritoneal connective tissue anterior to the verterbral column and along the medial trunk of the psoas major. Superiorly it is continuous with the thoracic trunk posterior to the medial arcuate ligament; inferiorly, passing posterior to the common iliac artery, it becomes the pelvic trunk. On the right side it is overlapped by the inferior vena cava and on the left by the lateral aortic lymph nodes. It is anterior to most of the lumbar vessels but may pass behind some lumbar veins.

The first, second and sometimes third lumbar ventral spinal rami send white rami communicantes to the corresponding ganglia. Grey rami communicantes passing from all ganglia to the lumbar spinal nerves, are long and accompany the lumbar arteries round the sides of the vertebral bodies, medial to the fibrous arches to which the psoas major is attached.

Usually four lumbar splanchnic nerves pass from the ganglia to join the coeliac, intermestenteric (abdominal aorta) and superior hypogastric plexuses. The first lumbar splanchnic nerve, from the first ganglion joins the coeliac, renal and intermestenteric plexuses. The second nerve, from the second and sometimes the third ganglion, joins the inferior part of the intermesenteric plexus; the third nerve issues from the third or fourth ganglion, passsing anterior to the common iliac vessels to join the superior hypogastric plexus. The fourth lumbar splanchnic, from the lowest ganglion, passes dorsal to the common iliac vessels to join the lower part of the superior hypogastric plexus or the hypogastric 'nerve'.

Vascular branches from all lumbar ganglia join the intermesenteric (aortic) plexus. Fibres of the lower lumbar splanchnic nerves pass to the common iliac arteries, forming a plexus continued along the internal and external iliac arteries as far as the proximal part of the femoral artery. Many postganglionic fibres in the grey rami, connecting the lumbar ganglia to the spinal nerves, travel in the femoral nerve to its muscular, cutaneous and saphenous branches, supplying vasoconstrictor nerves to the femoral artery and its branches in the thigh. Other postganglionic fibres travel via the obturator nerve to the obturator artery. Considerable uncertainties persist regarding sympathetic supplies to the lower limb (Wilde 1951; Wyburn 1956; Pick 1970).

Some of this bears repeating: Many postganglionic fibres in the grey rami, connecting the lumbar ganglia to the spinal nerves, travel in the femoral nerve to its muscular, cutaneous and saphenous branches, supplying vasoconstrictor nerves to the femoral artery and its branches in the thigh. Other postganglionic fibres travel via the obturator nerve to the obturator artery. Does anyone else see the possibilities here for eliciting positive reflex autonomic activity by handling skin on the front of the thigh? Up into the hip perhaps?

Next, pelvic part of the sympathetics.

[nari]

Yep, it certainly sounds likely that skin contact--> autonomic activity is logical. Could be hard to disprove...

Nari

[Diane]

P. 1305 Gray's:

PELVIC PART OF THE SYMPATHETIC SYSTEM
The pelvis sympathetic trunk lies in the extraperitoneal tissue anterior to the sacrum, medial or anterior to the anterior sacral foramina, and has four or five interconnected ganglia. Above, it continues into the lumbar trunk; below, the two trunks converge to unite in the small ganglion impar anterior to the coccyx. Grey rami communicantes pass from the ganglia to sacral and coccygeal spinal nerves but white rami communicantes are absent. Medial branches of distribution connect across the midline; twigs from the first two ganglia join the inferior hypogastric plexus (pelvic plexus) or the hypogastric 'nerve'; others form a plexus on the median sacral artery. The glomus coccygeum is supplied from the loop between the two trunks. The hypogastric 'nerve', which is usually plexiform, is a redundant term for the right and left connections, between the superior and inferior hypogastric plexuses (p. 1308).

Vascular branches
Through the grey rami many postganglionic fibres pass to the roots of the sacral plexus, especially those forming the tibial nerve, to be conveyed to the popliteal artery and its branches in the leg and foot. Others are carried in the poudendal and superior and inferior gluteal nerves to the accompanying arteries. Branches to the lymph nodes are also described (Wozniak 1966).

Preganglionic fibres for the lower limb are derived from the lower three thoracic and upper two or three lumbar spinal segments. They reach the lower thoracic and upper lumbar ganglia through white rami; some descend through the sympathetic trunk to synapse in the lumbar ganglia, whence postganglionic fibres join the femoral nerve to supply the femoral artery and its branches; other fibres descend to synapse in the upper two or three sacral ganglia, from which postganglionic axons join the tibial nerve to supply the popliteal artery and its branches in the leg and foot. Sympathetic denervation of vessels in the lower limb can thus be effected by removing the upper three lumbar ganglia and the intervening parts of the sympathtic trunk, all the preganglionic fibres to the lower limb thus being divided.

SEGMENTAL SYMPATHETIC SUPPLIES
Segmental sympathetic supplies are as follows:

(Note: I reorganized the list to have it make sense embryologically. Nothing has been excluded or added.)

Head, neck, heart: T1-5
Bronchi and lung T2-4
Upper limb: T2-5
Oesophagus (caudal part) T5-6
Stomach, spleen, pancreas T6-10
Liver and gallbladder T7-9
Suprarenal T8-L1
Small intestine T9-10
Kidney T10-L1
Tests and ovary T10-11
Large intestine to splenic flexure, prostate, prostatic urethra T11-L1
Ureter, epididymis, ductus deferens, seminal vesicles, bladder T11-L2
Uterus T12-L1
Large intestine splenic flexure to rectum L1-2
Uterine tube T10-L1
Lower limb T10-L2

There. I'm sure the nervous system would rather have the list in the order I have put it in. The previous order was according to tissue systems; musculoskeletal, thoracic organs, GI tract etc..

Yeah, Gray's really did use the word "whence." Even in 1995. That is not a typo.

The big takeaway point for me is all the sympathetic fibres in the regular nerves. It has got to feel good (everywhere) to get them liberated from the surrounding mesoderm within the leg..

Next, plexuses in the thoracic, abdominal and pelvic cavities.

[Diane]

P 1306, Gray's

PLEXUSES IN THE THORACIC, ABDOMINAL, AND PELVIC CAVITIES
The larger autonomic plexuses are aggregations of nerves and ganglia situated in the thoracic, abdominal and pelvic cavities. They are the cardiac, plumonary, coeliac and hypogastric plexuses, supplying the thoracic, abdominal, and pelvic viscera, respectively. Extensions of these major plexuses pass along most branches of the large vessels which they surround and are usually named after the artery along which they are distributed. This leads to a plethora of named plexuses, often separately described in detail which may overshadow their essential unity.

CARDIAC PLEXUSES
The cardiac plexus at the base of the heart is divided into superficial (ventral) and deep (dorsal) parts which are closely connected. Several small ganglia lie within it, the most constant being the cardiac ganglion described below. Mizeres (1963) has emphasized the unity of the cardiac plexus, considering its division into two parts as an artefact of dissection; he was, however, prepared to allow regional names for its coronary, pulmonary, atrial and aortic extensions. Since major concentrations of the plexus are situated as described here, the terms superficial and deep have been retained.

More on the cardiac plexus next time.

[Diane]

P 1306 Gray's

Superficial (ventral) part of the cardiac plexus
This lies below the aortic arch and anterior to theright pulmonary artery. It is formed by the cardiac branch of the left superior cervical sympahetic ganglion and the lower of the two cervical cardiac branches of the left vagus. A small cardiac ganglion is usually present in this plexus immediately below the aortic arch, to the right of the ligamentum arteriosum. This part of the cardiac plexus connects with (1) the deep part, (2) the right coronary plexus, (3) the left anterior pulmonary plexus.

Deep (dorsal) part of the cardiac plexus
This is anterior to the tracheal bifurcation, above the point of division of the pulmonary trunk and posterior to the aortic arch. It is formed by the cardiac branches of the cervical and upper thoracic sympathetic ganglia and of the vagus and recurrent laryngeal nerves. The only cardiac nerves which do not join it are those joining the superficial part of the plexus.

Branches from the right half of the deep part of the cardiac plexus pass in front of and behind the right pulmonary artery; those anterior to it, the more numerous, supply a few filaments to the right anterior pulmonary plexus and continue on to form part of the right coronary plexus; those behind the pulmonary artery supply a few filaments to the right atrium and then continue into the left coronary plexus. Ther left half of the deep part of the cardiac plexus is connected with the superficial, supplying filaments to the left atrium and left anterior pulmonary plexus and then continuing to form much of the left coronary plexus.

Left coronary plexus
This is larger than the right, and is formed chiefly by the prolongation of the left half of the deep part of the cardiac plexus and a few fibres from the right; it accompanies the left coronary artery to supply the left atrium and ventricle.

Right coronary plexus
This is formed from both superficial and deep parts of the cardiac plexus, and accompanies the right coronary artery to supply the right atrium and ventricle.

Atrial plexuses
Described by Mizeres (1963), these are derivatives of the right and left continuations of the cardiac plexus along the coronary arteries. Their fibres are distributed to the corresponding atria, overlapping those from the coronary plexuses.

All the cardiac branches of the vagus and sympathetic contain both afferent and efferent fibres, except the cardiac branch of the superior cervical sympathetic ganglion, which is purely efferent. The efferent preganglionic cardiac sympathetic fibres arise in the upper four or five thoracic spinal segments; they pass by white rami communicantes to synapse in trhe upper thoracic sympathetic ganglia, though many ascend to synapse in the cervical ganglia. Post-ganglionic fibres from the thoracic and cervical ganglia form the sympathetic cardiac nerves, which accelerate the heart and dilate the coronary arteries. Of the sympathetic fibres from the first four or five thoracic spinal segments, the upper pass to the ascending aorta, pulmonary trunk and ventricles, the lower to the atria.

The efferent cardiac parasympathetic fibres from the dorsal vagal nucleus and neurons near the nucleus ambiguus run in vagal cardiac branches to synapse in the cardiac plexuses and atrial walls. These vagal fibres slow the heart and cause constriction of the coronary arteries (p. 1500). In man (like most mammals) intrinsic cardiac neurons are limited to the atria and interatrial septum (Davies et al 1952; King & Coakley 1958); they are most numerous in the subepicardial connective tissue near the SA and AV nodes. There is now evidence that these intrinsic ganglia are not simple nicotinic relays but may also act as sites for integration of extrinsic nervous inputs and form complex circuits for the local neuronal control of the heart and perhaps even local reflexes (consult Saffrey et al 1992).

Thus does the CNS remain aware of its own heart beating. The segmental sympathetic supplies to head neck AND heart, are T1-5. The heart started out in the neck and then the head and neck grew away from it.

Something I'd like to accomplish one fine day is to learn to (confidently) visualize the difference between white and grey rami communicantes without all that complex wiring and function blurring together in my mind.

[Diane]

P 1307 Gray's:

PULMONARY PLEXUSES
These are anterior and posterior to the other hilar structures of the lungs, the anterior plexus being much smaller. According to Mizeres (1963) they are extensions from the cardiac plexus along the right and left pulmonary arteries. They are formed by vagal and sympathetic branches. Efferent parasympathetic fibres arise from the dorsal vagal nucleus; efferent sympathetic fibres are postganglionic branches of the second to fifth thoracic sympathetic ganglia.

The anterior plumonary plexus is formed by rami from vagal and cervical sympathetic cardiac nerves as well as direct branches from both sources; the posterior plumonary plexus is formed by the rami of vagal cardiac branches from the second to fifth or sixth thoracic sympathetic ganglia, the left plexus also receiving branches from the left recurrent laryngeal nerve. The two plexuses are interconnected; from them nerves enter the lung as networks along branches of the bronchi and pulmonary and bronchial vessels extending as far as the visceral pleura. There are small ganglia within the tracheobronchial tree of the airways with which efferent vagal preganglionic fibres synapse (Coburn 1987). They may act as sites of integration and/or modulation of the input from extrinsic nerves or permit some local control of aspects of airway function by local reflex mechanisms (Allen & Burnstock 1990). In the small intestine interstitial cells have been described in terminal autonomic networks, but have not been seen in thoracic organs, apart perhaps from the oesophagus (Dijkstra 1969). Efferent vagal fibres are bronchoconstrictor, secretomotor to bronchial glands and vasodilator. Efferent sympathetic fibres are bronchodilator and vasomotor.

Lest we forget, the lungs bud off the foregut in the embryo. The esophagus and the trachea are originally one tube, that separates into two.

[Diane]

COELIAC PLEXUS
The coeliac, the largest major autonomic plexus, sited at the level of the last thoracic and first lumbar vertebrae, is a dense network uniting two large coeliac ganglia. It surrounds the coeliac artery and the root of the superior mesenteric artery. It is posterior to the stomach and omental bursa, anterior to the crura of the diaphragm and the commencement of the abdominal aorta and between the suprarenal glands. The plexus and ganglia are joined by the greater and lesser splanchnic nerves of both sides and branches from both the vagus and phrenic nerves. They extend as numerous secondary plexuses along adjacent arteries.

The coeliac ganglia are irregular masses, one on each side, between the suprarenal gland and the coeliac trunk and in front of the crura; the right one is behind the inferior vena cava, the left behind the splenic vessels. The upper part of each is joined by a greater splanchnic nerve; the lower part, more or less detached as the [i]aroticorenal ganglion, receives the lesser splanchnic nerve and forms most of the renal plexus; its position is variable but near the origin of the renal artery from the aorta. (For details consult Norvell 1968). Secondary plexuses from or connected with the coeliac are: the phenic, splenic, hepatic, left gastric, intermesenteric, suprarenal, renal, testicular or ovarian, superior mesenteric and inferior mesenteric.

Phrenic plexus
This accompanies the inferior phrenic artery to the diaphragm, with branches to the suprenal gland. It arises near the upper end of the coeliac ganglion and is larger on the right. It receives one or two phrenic branches. At the junction of the right phrenic plexus with the phrenic nerve is a small phrenic ganglion, distributing branches to the inferior vena cava, suprarenal and hepatic plexuses.

Hepatic plexus
The largest coeliac derivative, this also receives filaments from the left and right vagi and right phrenic nerve. It accompanies the hepatic artery and portal vein and their branches into the liver, where its fibres are confined to the vicinity of the blood vessels. It follows all branches of the hepatic artery. Branches to the gallbladder form a thin cystic plexus; bile ducts are also supplied. Branches accompanying the right gastric artery supply the pylorus. From the gastroduodenal extension of the plexus branches reach the pylorus and the first part of the duodenum. Many follow the right gastro-epiploic artery to supply the right side of the stomach and the greater curvature. The superior pancreaticoduodenal extension of the plexus supplies the descending part of the duodenum, the pancreatic head and the lower part of the bile duct. The hepatic plexus contains afferent and efferent sympathetic and parasympathetic fibres; the vagal constituents are said to be motor to the musculature of the gallbladder and bile ducts and inhibitory to the sphincter of the bile duct. Petkov (1968) identified a distinct nerve to the sphincter in 23 out of 25 human dissections.

Left gastric plexus
This accompanies its artery along the lesser curvature of the stomach, joining with the vagal gastric branches. Gastric sympathetic nerves are motor to the pyloric sphincter but inhibitory to the gastric mural musculature.

Splenic plexus
This is formed by branches of the coeliac plexus, left coeliac ganglion and right vagus, and accompanies its artery to the spleen, giving off subsidiary plexuses along arterial branches. The fibres are mainly, perhaps wholly, sympathetic and terminate in blood vessels and non-striatred muscle of the splenic capsule and trabeculae.

Suprarenal plexus
This is formed by branches from the coeliac ganglion and plexus and greater splanchnic nerve. Relative to its size, the suprarenal gland has a larger autonomic supply than any other organ. Its fibres are commonly described as myelinated and preganglionic. In rats, however, non-myelinated fibres are ten times as numerous and are considered preganglionic; they end in synapses, often deeply invaginated, with large chromaffin cells, the phaeochromocytes, which are thus homologous with the postganglionic sympathetic neurons (p.1905). A space of 150-200 nm separates the synaptic membranes, which often have electron-dense zones. Small and large vesicles with electron-dense granular contents occur in these endings. Only non-myelinated fibres appear to innervate chomaffin cells, all of which are related to one or more such terminals. Multi-polar neurons also occur in the adrenal medulla; some preganglionic non-myelinated fibres form axodendritic synapses with them. The destination of their axons is not known (Coupland 1965a). A preponderance of non-myelinated fibres has also been described in the human suprarenal plexus (Coupland 1965a, b; Grottel 1968).

Renal plexus
This is dense and formed by rami from the coeliac ganglion and plexus, aorticaorenal ganglion, lowest thoracic splanchnic nerve, first lumbar splanchnic nerve and aortic plexus. Small ganglia occur in the renal plexus, the largest usually behind the start of the renal artery. The plexus continues into the kidney around the arterial branches to supply the vessels, renal glomeruli, and tubules, especially the cortical tubules (Norvell 1968). Renal nerves are mostly vasomotor. From the renal plexus branches supply ureteric and tesicular (or ovarian) plexuses. The ureteric plexus receives, in its upper part, branches from the renal and aortic plexuses, in its intermediate part from the superior hypogastric plexus and hypogastric nerve and in its lower part from the hypogastric nerve and inferior hypogastric plexus. This supply influences the inherent motility of the ureter.

Testicular plexus
This accompanies the testicular artery to the testis. Its upper part receives branches from the renal and aortic plexuses. Distally it is reinforced from the superior and inferior hypogastric plexuses. Its rami pass to the epididymis and ductus deferens.

Ovarian plexus
This accompanies the ovarian artery to the ovary and uterine tube. The upper part is formed by branches from the renal and aortic plexuses; its lower part is reinforced from the superior and inferior hypogastric plexuses.

The nerves in the testicular and ovarian plexuses contain efferent and afferent sympathetic fibres; the efferents are vasomotor and derived from the tenth and eleventh thoracic spinal segments; the parasympathtic fibres, from the inferior hypogastric plexuses, are probably vasodilator.

Superior mesenteric plexus
This is a downward continuation of the coeliac, which receives a branch from the junction of the right vagus and coeliac plexus. It accompanies the superor mestenteric artery into the mesentery, dividiung into secondary plexuses distributed to parts supplied by the artery: pancreatic, jejunal and ileal, ileocolic, right colic, and middle colic. The [i]superior mesenteric ganglion lies superior in the plexus, usually above the superior mesenteric artery's origin. Intestinal sympathetic nerves are motor to the ileocaecal sphincter but inhibitory to the mural musculature; some are vasoconstrictor.

Abdominal aortic plexus (intermesenteric plexus)
This is formed by branches from the coelic plexus and ganglia and receives rami from the first and second lumbar splanchnic nerves. It is on the sides and front of the aorta, between the origins of the superior and inferior mesenteric arteries. It consists of four to 12 intermesenteric nerves, connected by oblique branches. It is continuous above with the coeliac plexus and coeliac and aorticorenal ganglia, below with the superior hypogastric plexus. From it parts of testicular, inferior mesenteric, iliac, and superior hypogastric plexuses arise; it also supplies the inferior vena cava.

Inferior mesenteric plexus
This is chiefly from the aortic plexus but also from the second and lumbar splanchnic nerves. It surrounds the inferior mesenteric artery and is distributed along its branches; thus a left colic plexus supplies the left part of the transverse colon, the descending and the sigmoid colon; a superior rectal plexus supplies the rectum. Near the origin of the inferior mesenteric artery an inferior mesenteric ganglion may occur but more often small ganglia are scattered around the origin of the artery in the proximal part of the plexus. In one study (Southam 12959) an inferior mesenteric ganglion occurred in all of 22 human stillborn infants. The colic sympathetic nerves are inhibitory to mural muscle in the colon and rectum. Branches from parasympathetic pelvic splanchnic nerves ascend occasionally through but usually near the superior hypogastric and inferior mesenteric plexuses to supply the large intestine from the left half of the transverse colon to the rectum (p. 1786); they are motor to the colic musculature. It is to be emphasized that the parasympathetic supply to the distal colon is largely by these direct branches of the pelvic splanchnic nerves, not via the hypogastric and inferior mesenteric plexuses (Mitchell 1935; Woodburne 1956).

Next, superior and inferior hypogastric plexuses.

[Diane]

P. 1308 Gray's

SUPERIOR HYPOGASTRIC PLEXUS
The superior hypogastric plexus is anterior to the aortic bifurcation, the left common iliac vein, medial sacral vessels, fifth lumbar vertebral body and sacral promontory and between the common iliac arteries. Often termed the presacral nerve it is seldom a single nerve, and is prelumbar rather than presacral. It lies in extraperitoneal connective tissue; the parietal peritoneum can easily be stripped off its anterior aspect. It varies in breadth and condensation of its constituent nerves and is often a little to one side of the midline (more often to the left); the attachment of the sigmoid mesocolon, containing superior rectal vessels, is to the left of the lower part of the plexus. Scattered neurons occur in it. The plexus is formed by branches from the aortic plexus and third and fourth lumbar splanchnic nerves. It divides into right and left hypogastric 'nerves' which descend to the two inferior hypogastric plexuses. The superior plexus supplies branches to the ureteric, testicular, ovarian and common iliac plexuses. In addition to sympathetic fibres, it may also contain parasympathetic fibres (from pelvic splanchnic nerves) which descend from the inferior hypogastric plexus; but these fibres usually ascend to the left of the superior hypogastric plexus and across the sigmoid branches of left colic vesssels. These parasympathetic fibres are distributed partly along the inferior mesenteric arterial branches and also as independent retroperitoneal nerves to supply the left part of the transverse colon, left colic flexure, descending and sigmoid colon.

I found a nice visual for the autonomics. There is a click in the upper right to change views, but it only works in reverse, so start of page 12 and work backwards.

Enjoy.

I'm back in this post to announce that I found a small author error in the link I've placed here. On page 2 of 12, the author says (about visceral afferents) "These fibres, originating within the spinal cord, accompany visceral efferent fibres throughout their pathways." I'm here to say, that visceral afferent fibres do NOT originate within the spinal cord; rather they are from neural crest and therefore are more likely to "originate" as part of DRGs, same as all the rest of the sensory system. Only motor fibres originate in the cord. At least that's how I understand origins based on embryology.

[Diane]

P 1309, Gray's

INFERIOR HYPOGASTRIC PLEXUSES
The superior hypogastric plexus divides caudally into right asnd left hypogastric 'nerves', each descending in extraperitoneal connective tissue into the pelvis, medial to each internal iliac artery and its branches to become the inferior hypogastric plexus. Each nerve may be single or an elongated plexus of anastomosing filaments. (Hypogastric nerves can scarcely be distinguished from their continuations, the inferior hypogastric plexuses. The latter are joined by pelvic splanchnic nerves, a distinction minimized by the fact that both nerves and plexuses contain sympathetic and parasympathetic fibres. Some authorities prefer to describe a superior hypogastric plexus dividing into two inferior plexuses.) From each hypogastric nerve branches may pass to the testicular, ovarian and ureteric plexus or to the internal iliac plexuses and to the sigmoid colon; each nerve may be joined initially by the lowest lumbar splanchnic nerve from last lumbar sympathetic ganglion.

Inferior hypogastric (pelvic) plexus
This is in the extraperitoneal connective tissue. In males it is lateral to: the rectum, seminal vesicle, prostate and the posterior part of the urinary bladder. In females each plexus is lateral to: the rectum, uterine cervix, vaginal fornix and the posterior party of the urinary bladder, extending into the broad uterine ligament. Lateral to it are the internal iliac vessels and their branches and tributaries, the levator ani, coccygeus and obturator internus. Posterior are the sacral and coccygeal plexuses and above are the superior vesical and obliterated umbilical arteries. The plexuses contain numerous small ganglia. Each is formed by a hypogastric nerve, conveying most of the sympathetic fibres of the plexus, the remaining few arriving via branches from the ganglia. Parasympathetic fibres are derived from pelvic splanchic nerves. Preganglionic efferent sympathetic fibres originate in the lower three thoracic and upper two lumbar spinal segments, some relaying in ganglia of the lumbar and sacral parts of the sympathetic trunk, others synapsing in the lower part of the aortic plexus and in the superior and inferior hypogastric plexuses. Preganglionic parasympathetic fibres originate in the second to fourth sacral spinal segments, reach the plexus in the pelvic splanchic nerves and synapse in it or in walls of viscera supplied by its branches. Numerous branches are distributed to the pelvic and some abdominal viscera, either directly or along their arteries.

Parasympathetic fibres ascend in the hypogastric plexuses or as separate filaments to reach the inferior mesenteric plexus by way of the aortic plexus. By this route the descending and sigmoid parts of the colon recieve parasympathetic innervation.

Middle rectal plexus
This is formed by fibres from the upper part of the inferior hypogastric plexus to the rectum passing directly or along the middle rectal artery. It connects above with the superior rectal plexus and extends below to the internal anal sphincter. The rectal and anal nerve supply is from:

• The superior rectal plexus

• the middle rectal plexus

• the inferior rectal (haemorrhoidal) nerves, branches of the pudendal nerve.

The parasympathetic preganglionic fibres from the rectal plexuses synapse with postganglionic neurons in the well-developed myenteric plexus, while sympathetic afferents pass through it without interruption. Efferent sympathetic fibres in the rectal plexuses inhibit the explusive musculature and stimulate the sphincter. Pain impulses traverse the sympathetic and parasympathetic fibres but the parasympathetic afferent and efferent fibres are more active in normal defaecation. Inferior rectal nerves supply motor fibres to the striated external anal sphincter and sensory (somatic) fibres to the lower (ectodermal) part of the anal canal (p. 194).

Vesical plexus
Coming from the anterior part of the inferior hypogastric plexus, this comprises many filaments which pass along vesical arteries to the bladder. Branches supply the seminal vesicles and deferent ducts. Many small groups of neurons exist among the nerve fibres in the vesical muscular wall. Sympathetic preganglionic fibres in the plexus are from the lower two thoracic and upper two lumbar spinal segments, synapsing with neurons scattered in the superior and inferior hypogastric plexuses and vesical wall. The parasympathetic preganglionic efferent fibres come from the second to fourth sacral spinal segments and synapse near or in the vesical wall with postganglionic neurons which stimulate its detrusor muscle and inhibit its sphincter. Efferent sympathetic nerves are motor to the sphincter and inhibitor to the detrusor muscle; but some maintain that they are mainly vasomotor and that vesical filling and emptying are controlled by parasympathetic nerves.

Prostatic plexus
Continued from the lower part of the inferior hypogastric plexus, this is composed of large nerves entering the base and sides of the prostate and contains neurons. It supplies: the prostate, seminal vesicles, prostatic urethra, ejaculatory ducts, corpora cavernosa, corpus spongiosum, membranous and penile urethra and bulbo-urethral glands. The nerves to the corporea cavernosa form two sets, the greater and lesser cavernous nerves, arising from the front of the plexus to join branches from the pudendal nerve and then passing below the pubic arch. The precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa has been described by Lepor et al (1985) in the adult male pelvis. Lesser cavernous nerves pierce the fibrous penile sheath proximally to supply the erectile tissue of the corpus spongiosum and penile urethra. Greater cavernous nerves proceed on the dorsum penis, connect with the dorsal nerve and supply the erectile tissue, some filaments reaching the erectile tissue of the corpus spongiosum. Sympathetic supplies to the male genital organs produce vasoconstriction, the parasympathetic being vasodilator. Seminal vesicles are supplied from the vesical and prostatic plexuses and inferior hypogastric nerves; extensions pass to the ejaculatory and deferent ducts. Contraction of the seminal vesicles and ejaculation are considered to be due to the sympathetic supply, which also inhibits the vesical musculature and stimulates the sphincter during ejaculation, preventing reflux into the bladder. Others have suggested that contraction of the seminal vesicles is under parasympathetic control (Matthews & Raisman 1969).

Uterovaginal plexus
Uterine nerves arise from the inferior hypogastric plexus, mainly the part in the broad ligament, the utrovaginal plexus, from which branches descend with the vaginal arteries, while others pass directly to the cervix uteri or ascend with or near uterine arteries in the broad ligament. Nerves to the cervix form a plexus in which are small paracervical ganglia, one ganglion sometimes being larger and termed the utrerine cervical ganglion. Nerves ascending with the uterine arteries supply the uterine body and tube, connecting with tubal nerves from the inferior hypogastric plexus and with the ovarian plexus. The uterine nerves ramify in the myometrium and endometrium, generally accompanying the vessels. Efferent preganglionic sympathetic fibres are from the last thoracic and first lumbar spinal segments; the sites of their postganglionic neurons are unknown.Preganglionic parasympathetic fibres arise in the second to fourth sacral segments and relay in the paracervical ganglia. Sympathetic activity may produce uterine contraction and vasoconstriction and parasympathetic activity may produce uterine inhibition and vasodilation, but these activities are complicated by hormonal control of uterine functions.

Vaginal nerves from the lower parts of the inferior hypogastric and uterovaginal plexuses follow the vaginal arteries to supply the vaginal walls, the erectile tissue of the vestibular bulbs and clitoris (canvernous nerves of the clitoris), the urethra and the greater vestibular glands. The nerves contain many parsympathetic fibres which are vasodilator to the erectile tissue.

That's all there is in this section from Gray's. There is a section on enterics which I'm omitting.

I'll slowly bring more here from Burnstock's books, etc. Plese feel free to add material or links you might find on autonomics to this thread.

[Diane]

My copy of The Integrative Action of the Autonomic Nervous System: Neurobiology of Homeostasis by Wilfred Jänig, arrived yesterday. It's nearly brand new, only published this past June. Also quite reasonable as textbooks go, well under $200.

Chapter 4 alone is worth the price. It is titled The Peripheral Sympathetic and Parasympathetic Pathways, and contains 8 "sub"chapters, listed here:

• 4.1 Sympathetic vasoconstrictor pathways
• 4.2 Sympathetic non-vasoconstrictor pathways innervating somatic tissues
• 4.3 Sympathetic non-vasoconstrictor neurons innervating pelvic viscera and colon
• 4.4 Other types of sympathetic neuron
• 4.5 Adrenal medulla
• 4.6 Sympathetic neurons innervating the immune tissue
• 4.7 Proportions of preganglionic neurons in major sympathetic nerves
• 4.8 Parasympathetic systems

I have only browsed so far, but already I'm liking this book more than the Burnstock series on the ANS.. Burnstock simply provided within the covers of each of his books a bunch of already published studies. As an editor he did no editing at all, just collecting and re-publishing. And each book in the series (about a dozen books) cost as least as much as this one.

Janig takes the time to actually sit and synthesize everything. He does not predigest it at all but puts it through his mental blender a bit first, at least. And he's very careful to keep his own speculations separate from what's "known", plus at the end he has a very comprehensive list of what is not yet known.

I think I can trust this book. And as a humble human primate social groomer I very much appreciate that he's done some of the mental map making for me.

[Diane]

Here is a short excerpt from Jänig's book, based on this article:

Type 1 allostatic overload occurs when energy demand exceeds supply, resulting in activation of the emergency life history stage. This serves to direct the animal away from normal life history stages into a survival mode that decreases allostatic load and regains positive energy balance. The normal life cycle can be resumed when the perturbation passes. Type 2 allostatic overload begins when there is sufficient or even excess energy consumption accompanied by social conflict and other types of social dysfunction. The latter is the case in human society and certain situations affecting animals in captivity. In all cases, secretion of glucocorticosteroids and activity of other mediators of allostasis such as the autonomic nervous system, CNS neurotransmitters, and inflammatory cytokines wax and wane with allostatic load. If allostatic load is chronically high, then pathologies develop. Type 2 allostatic overload does not trigger an escape response, and can only be counteracted through learning and changes in the social structure.

Not the distinction made between types of allostatic load.
1. Type one is stress induced by forces supplied directly from the environment. The creature is fully capable of pressing back as a living organism - responding powerfully, integrally, with the fullest of uninhibited responses.
2. Type two is stress induced by an environment that includes not only a metaphoric "rock" but also a "hard place". The creature has to be politically wise - it can't just rush to meet adversity with all its might, or run from it, instead it has to consider the "cost/benefit" of its response, and respond in some manner that costs personally/physiologically but won't rock the social fabric.

As a human primate social groomer, I think one of the biggest services I can provide is (a) a safe place in which patients can experience their own interoception and subsequent autonomic correction; and (b) some exteroceptively provided manual input to get (a) started.

Much more about this book can be read here.

[Raulan2]

Diane,

With all this vital wiring piercing the diaphgram I would be inclined to predict that the "green light" types delineated on Nick's mechanical peripheral NS deformation thread lately, who can't abdominally breath and whose spines seem so rigid would maybe be nonconsciously guarding/defending their sympathetic chains. I wonder if the postural restoration people have looked into sympathetic nervous system anatomy, reflected on it, allowed it to inform their thinking to any extent?

Yes, we have!!!
Gee what a surprise, This is the main topic of the postural respiration course. Yes we do consider and express mesurements in terms of mesoderm, but I have been trying to tell you all that we are considering the importance of respiration and its effects on "mesodermal posture (function)", but more importantly on the autonomic nervous system and how it influences all systems, including ganglia etc..

[Mary C]

Raulan2

I found your comment today as I was going through the old threads on ANS.

Some French posters keep mentioning Janig but never bring any quotes from his writings. Now I can see why he is so important. This is probably what was missing from the theory in Souchard's RPG. I have not found any mention of autonomics on the RP (Mezieres) site so far.

Mary