Dermatome Patterns

Dermatome Patterns

Dermatome Patterns

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Dermatomal Patterns help physicians define nerve radiculopathy patterns.  Most neurologists/spine specialists  accept certain associated sensation, muscle strength, and reflex changes patterns to specific nerve roots.

L5 radiculopathy is typically associated with weakness of the extensor hallucis longus muscle.  That is the muscle that allows the great toe to point upwards.  L5 radiculopathy also follows a dermatomal pattern associated with the front of the foot.  There are no reflexes associated with L5.

SI radiculopathy is associated with weakness of the gastrocnemius muscle.  That is the muscle that allows a person to step on their tip toes.  S1 radiculopathy follows a dermatomal pattern  associated with the outer heel, and back of the calf.

But, as physicians,  we know that there can be considerable overlap in the sensation changes associated with each of these dermatomes.

In the above study published in  SPINE,  the authors mapped out the distribution of pain and pins and needles patterns in patients with known disk herniations causing specific entrapment of either the L5, or the S1 nerve.

 

After mapping the sensation patterns of these patients,  the authors came to the conclusion that patient report is an unreliable method of identifying the anatomic source of pain or paresthesia by nerve root compression.

The results read “There is a substantial overlap of the dermatomes with most patients indicating pain or pins or needles in more than the dermatomal area.  In addition, the distribution of pain and pins and needles did not correspond well with dermatomal patterns.”

Clinicians know this statement to be true.  As I explain to patients,  “I guess your S1 nerve did not read the anatomy book”,  as the pattern was not consistent.

In my opinion,  dermatomal patterns are helpful to establish  the presence of a radiculopathy.  But, as the author concludes,  these dermatome patterns do not always exactly follow the pattern.  But,  while I appreciate the fact that there is deviations of the dermatome patterns,  what I do look for is a pattern.  For patients that have global pain to one extremity,  it is likely that that global loss of sensation,  or  pain, is secondary to non-dermatomal issues such as neuropathy,  cord compression,  or non-physical matters.

 

 

 

Citations

  • Taylor CS, Coxon AJ, Watson PC, Greenough CG. Do L5 and s1 nerve root compressions produce radicular pain in a dermatomal pattern? Spine (Phila Pa 1976). 2013 May 20;38(12):995-8. PubMed PMID: 23324941

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Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

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Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

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The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

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February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

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May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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