H1 Deep Radial

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This is the most important ARP because its sensitivity is evident in more than 99% of the population. The deep radial nerve (arising from C5 to C8 and from T1) is one of the terminal branches from the posterior cord of the brachial nerve plexus

(Fig. 8-20). This nerve provides the major nerve supply to the extensor muscles of the upper limb: triceps, anconeus, brachioradialis, and all the extensor muscles of the forearm. It also supplies cutaneous sensation to the skin of the extensor region, including the hand.

The radial nerve leaves the axilla and runs posteriorly, inferiorly, and laterally between the long and medial heads of the triceps muscle. It enters the radial groove in the humerus. The radial nerve penetrates the lateral intermuscular septum of the arm and divides into two terminal branches: the deep and the superficial radial nerves. The primary homeostatic ARP of the body is located at the branching spot, which is about 4 cm distal to the lateral epicondyle between the brachioradialis muscle and the extensor carpi radialis longus muscle.

Radial collateral artery

Triceps brachii Ulnar nerve Ulnar recurrent artery Olecranon Cubital anastomosis Anconeus Extensor carpi radialis brevis Extensor carpi ulnaris Radial nerve, deep branch Posterior interosseous artery Extensor carpi ulnaris, tendon Extensor digiti minimi, tendon Dorsal branch (ulnar nerve) Dorsal carpal arch

Brachioradialis Extensor carpi radialis longus Lateral epicondyle

Inferior ulnar collateral artery

Brachioradialis Extensor carpi radialis longus Lateral epicondyle

Extensor / digitorum

Abductor pollicis longus

Extensor pollicis brevis Radial nerve superficial branch Anterior interosseous artery Extensor retinaculum

Posterior interosseous artery Extensor digitorum Deep branch of radial nerve, posterior interosseous nerve Extensor pollicis longus Extensor carpi ulnaris, tendon Dorsal branch (ulnar nerve) Extensor retinaculum

Inferior ulnar collateral artery

Anconeus

Recurrent interosseous artery

Supinator Radial nerve, deep branch Extensor carpi radialis brevis

Muscular branches

Abductor pollicis longus Interosseous membrane Radial nerve, superficial branch Extensor pollicis brevis

Extensor pollicis longus, tendon

Figure 8-20 Deep branches from the radial nerve. An acu-reflex point is formed at the branching site.

There, the deep radial nerve is accompanied by the radial artery and vein and their tributaries. As the deep radial nerve runs distally to the wrist from this point, it sequentially gives off branches to nine muscles.

The H1 deep radial point is the first ARP to become sensitive in the human body. However, its clinical value is more in diagnosis. As discussed, the efficacy and prognosis of acupuncture therapy depends on the self-healing capability of the body. As homeostasis declines, the self-healing potential drops, and more points gradually become sensitive along the deep radial nerve distally from the H1 deep radial point. Thus the number of sensitive points appearing on the deep radial nerve provides quantitative information about the body's homeo-stasis and self-healing potential.

The H1 deep radial ARP can be needled all the way down to the bone below.

H12 Superficial Radial (Cutaneous)

After branching from the deep radial nerve just below the elbow, the superficial radial nerve runs under the brachioradialis muscle and emerges to the surface at the distal portion of the radius. This nerve starts branching first at the anatomic snuffbox and then on the web between the thumb and the index finger. The H12 superficial radial ARP is located on the second branching spot (Fig. 8-21).

HOMEOSTATIC ACU-REFLEX POINTS ON THE LOWER LIMB

The primary function of the lower limbs is locomotion, bearing weight, and maintaining equilibrium. The lower limb consists of four major parts: the hip, the thigh, the leg, and the foot. The lower limb has eight primary homeostatic ARPs: one on the hip, one on the thigh, five on the leg, and one on the foot.

Radial nerve, posterior cutaneous nerve of forearm

Cephalic vei

Basilic vein Ulnar nerve, dorsal branch

Dorsal venous network of hand

Intercapitular veins

Radial nerve, posterior cutaneous nerve of forearm

Cephalic vei

Intercapitular veins

Homeostatic Points Lower Leg

Radial nerve, superficial branch

Dorsal digital branches

Figure 8-21 The superficial radial nerve runs under the brachioradialis muscle and emerges to the surface at the distal portion of the radius. This nerve branches first at the anatomic snuffbox and then on the web between the thumb and the index finger. The second branching spot is the site of the H12 superficial radial point.

Radial nerve, superficial branch

Dorsal digital branches

Figure 8-21 The superficial radial nerve runs under the brachioradialis muscle and emerges to the surface at the distal portion of the radius. This nerve branches first at the anatomic snuffbox and then on the web between the thumb and the index finger. The second branching spot is the site of the H12 superficial radial point.

The lower limb, including its bone, joints, muscles, and skin, is innervated by the nerves from both the lumbar nerve plexus and the sacral nerve plexus. All the spinal nerves have dorsal and ventral rami, as described previously, but only the ventral rami of the lumbar and sacral spinal nerves are interconnected to form the lumbar plexus and the sacral plexus. Collectively, they are called the lumbosacral nerve plexus (Fig. 8-22). Like the brachial nerve plexus, the lumbosacral plexus branches into anterior and posterior divisions. The posterior division has two major nerves: the femoral and the common fibular nerves. The anterior division likewise has two major nerves: the obturator and the tibial nerves. The tibial nerve has two terminal branches: the medial plantar and the lateral plantar nerves.

In the leg region, the saphenous nerve is the longest branch of the femoral nerve. Branches from the tibial nerve (medial) and the common fibular nerve unite to form the sural nerve.

The lumbosacral nerve plexus supplies the lower limb. The lumbar part is located in the abdomen, and the sacral part in the pelvis. The major nerves that supply the lower limb are derived from the anterior rami of L2 to S3 spinal nerves. L1 and S4 usually supply only a limited area of skin in the inguinal (L1) and perianal (S4) region (see Fig. 8-8).

Iliohypogastric nerve . Ilio-inguinal nerve

Lateral cutaneous nerve of thigh Genitofemoral nerve -Femoral nerve ■ Obturator nerve ■

■ Superior gluteal nerve

■ Inferior gluteal nerve Pudendal nerve Posterior cutaneous nerve of thigh

Sciatic nerve

Saphenous nerve ■

Common fibular nerve -Deep fibular nerve -Superficial fibular nerve ■

Saphenous nerve -

Intermediate dorsal cutaneous nerve' Medial dorsal cutaneous nerve'

Dorsal digital nerves of foot

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