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Dermatomes and Myotomes
Dermatomes are areas on the surface of the skin that are control by specific nerve roots from the spinal cord
Myotomes correspond to muscles that are controlled by specific nerve roots from the spinal cord
• Cranial Nerves branch out off the brain (12)
• Nerve Roots branch out off the spinal cord (31)
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info.med.yale.edu/ caim/cnerves/ options/ lowback/dclmlama.htm
These nerve roots branch out to form a plexus which is a network of intersecting nerves which travel to different parts of the body, they are both motor and sensory
• Cervical Plexus1 C1-C4 nerve roots innervate the diaphragm, shoulder and neck.
• Brachial Plexus2 C5-T1 nerve roots innervate the upper limbs
• Lumbosacral Plexus3 L1- L5, S2 nerve roots innervate the lower extremity
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2. .../Brachial_Plexus.jpg
3. "LifeART (and/or) MediClip image copyright (2005) Lippincott Williams & Wilkins. All rights reserv
• Skin (sensation) is innervated by a single nerve roots called the dermatomes
• Muscles (movement) are innervated by singe nerve roots called myotomes
• Nerves and nerve roots are typically injured by compression or stretching forces
• When a nerve root is damaged a deficit may occur in the corresponding limb
• The evaluation of nerve root damage can be done by testing dermatomes and myotomes
• Nerve root trauma should always be inspected by a physician
Dermatomes
• Test for abnormalities in sensitivity by using a pinwheel, paper clip or finger nail
• The athlete should close his/her eyes and give the therapist feedback with regards to various stimuli
• All tests should be compared bilaterally
Nerve Root Dermatome Patterns
Upper Extremity
C1 Top of head
C2 Temporal & occipital regions of head
C3 Neck and posterior cheek
C4 Superior shoulder and clavicle
C5 Deltoid patch & lateral arm
C6 Lateral forearm, thumb and index finger
C7 Posterior lateral forearm & middle finger
C8 Medial forearm, ulna border & ring/little fingers
T1 Medial side of forearm & upper arm
Lower Extremity
L1 Back, hip and groin
L2 Anterior superior thigh, medial thigh above knee
L3 Back, anterior thigh and medial knee
L4 Lateral thigh/knee, anterior medial lower leg to medial aspect of big toe
L5 Lateral knee and lateral lower leg and top of foot
S1 Buttocks, posterior lateral thigh and lateral plantar surface of foot
S2 Buttocks, posterior medial thigh and medial plantar surface of foot
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Figure 24-4 Dermatome distribution of the spinal nerves.From Thibodeau GA, Patton KT: Anatomy and Physiology,ed 6, St. Louis, 2006, Mosby.
(Cameron, Michelle H.. Physical Rehabilitation: Evidence-Based Examination, Evaluation, and Intervention. W.B. Saunders Company, 032007.).
Myotomes
• Test with resistive exercises
• The clinician will check for weakness in strength
• All tests should be compared bilaterally
Upper Extremity
Nerve Root Muscle Test
C4 Upper traps tested with resisted shoulder shrugs/elevation
C5 Deltoids, Biceps tested with resisted shoulder abduction
C6 Biceps, Wrist Ext tested with resisted elbow flexion, wrist extension
C7 Wrist Flexors, Elbow Ext tested with resisted wrist flexion, elbow extension
C8 Thumb Ext, Flexors tested with resisted thumb extension
T1 Hand Intrinsics fingers abduction & adduction
Lower Extremity
Nerve Routes Muscle Test
L1-L2 Iliopsoas, hip adductors tested with resisted hip flexion
L3 Quadriceps tested with resisted knee extension
L4 Anterior Tibialis, tested with resisted foot dorsiflexion
L5 Extensor Hallucis, Glut Medius tested with resisted great toe extension
S1/S2 Gastrocnenius tested with plantar flexion
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