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2 Structure and Function of the Nervous System
N. E. Cameron and C. J. Mathias
The Somatic Nervous System
N. E. Cameron
The somatic nervous system is subdivided into motor and sensory components. The motor division is concerned with control of skeletal muscle contraction, and hence of voluntary movement and of posture and reflexes. The somatosensory division is a collection of receptors, tracts, and nuclei that convey the sensations of light touch, vibration, temperature, and pain (nociception) to the consciousness. It also conveys information about movements and position of the body (proprioception and kinesthesia). Somatosensory receptors are found in the skin, muscles, joints, and viscera. In addition to providing sensation, the somatosensory division has a critical role in motor control, through feedback about muscle length and tension, joint position, velocity of muscle and limb movement, and contact with external surfaces. The basic structure and function of the somatic nervous system has been described in numerous physiology, neurology, and neuroscience texts: the reader is referred to two recent books for further information [1,2]. Diabetes affects both the peripheral and the central nervous system (for discussion of the latter see Chapter 5, page 205-208), although most clinical and scientific interest has focused on the periphery because of the devastating effect on nerve fiber integrity. This section provides an overview of the substrate of the somatic nervous system, with a greater emphasis on peripheral than on central structures.
Fig. 2.1 General organization of the somatosensory system, showing the dorsal column-lemniscal system which mediates touch sensation and proprioception, and the spinothalamic system, which deals with temperature and fast pain information
Somatosensory System
There are two major somatosensory pathways running from the spinal cord to the primary sensory area (area 3 or S1) on the postcentral gyrus of the cerebral cortex (Fig. 2.1). Information about touch and proprioception is carried in the dorsal column medial lemniscus system, whereas temperature and pain information traverses the spinothalamic pathway [3].
In the touch system, fibers from first-order neurons with cell bodies in the dorsal root ganglia traverse the dorsal columns of the spinal cord (Fig. 2.1)
