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Transcript of myotmes dermatomes
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Quiz for thosewho have not
taken it already
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Spinal
nerves – 31
pairs,
emerging ateach
vertebral
level
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Figure 13-10: The Cervical Plexus
Cranial nerves
Transverse cervical nerve
Great auricular nerve
Accessory
nerve (XI)
Hypoglossal
nerve (XII)
Lesser occipital nerve
Supraclavicular nerves
Clavic le
Sternothyroid muscle
Sternohyo id musc le
Phrenic nerve
Omohyoid musc le
Ansa cervicalis
C1
C2
C3
C4
C5
Thyrohyo id musc le
Geniohyo id musc le
Nerve roots of
cervical plexus
Cervical Plexus
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Brachial Plexus
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MYOTOMES & DERMATOMES
Myotomes
Each muscle in the
body is suppliedby a particular
level or segment
of the spinal cord
and by itscorresponding
spinal nerve.
Dermatomes
~Greek for"skin
cutting"~An area of the
skin supplied by
specific nerve
fibers.
Sensory
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Dermatomes and Myotomes
Dermatome- sensory region of skin
innervated by a nerve root
Myotome- muscles innervated by a single
nerve root
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Common Dermatomal Levels
C5- Shoulder
C6- Lateral Arm and Digits 1&2
C7- Middle Digit
C8- Digits 4 & 5
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Common Dermatomal Levels
L4- Anteromedial Shin
L5- Anterolateral Shin, dorsum of foot to
big toe
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Common Dermatomal Levels
S1- toe, lateral foot, sole and calf
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ASIA, 2006
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Neurologic Level C5
The muscles foundwithin this myotomalpattern are the deltoidand the biceps brachii.Because the latter isalso innervated by C6,the deltoid is the most"pure" C5 muscle.
One of the most
commonly used testsfor shoulder abductionis to instruct the patientto flex the elbow at 90degrees, then offer
gradual resistance toabduction
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Neurologic Level C6
the biceps brachii isinnervated by C5 andC6. C6 also innervates
the most powerful wristextensors, carpi radialislongus and brevis,which do radialextension. To test for
wrist extension,stabilize the patient’sforearm and wristextension
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Neurologic Level C7
The muscles foundwithin this myotomalpattern are the triceps,
wrist flexors. Thetriceps muscle primarilydoes elbow extension.
A common test for thisaction is to ask the
patient to fully flex thearm, offer firm, constantresistance untildiscerning themaximum resistance
h/she can overcome.
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Neurologic Level C8:
The muscles foundwithin this myotomalpattern are fingerflexors—flexordigitorum superficialis,flexor digitorumprofundis, and thelumbricals. To test forfinger flexion, the
patient fully flexes h/herfingers at all joints whileyou curl your fingersinto them. Ask thepatient to resist yourattempt to pull h/herfingers out of flexion.
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Neurologic level T1:
The muscles foundwithin this myotomalpattern are thoseinvolved in fingerabduction—dorsalinterossei and abductordigiti minimi, andadduction—palmarinterossei.
To test for finger
adduction, ask thepatient to extend h/herfingers and hold a pieceof paper (or a dollar bill)between two of h/her
fingers. Then you pull itout
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Neurologic Levels T12 to L3:
The muscles foundwithin this myotomalpattern are theiliopsoas, quadriceps,and the adductorsBecause this myotomalpattern includesmultiple muscle groupsan injury to this nerve
root level can be moreeasily evaluated bysensory testing of thedermatomal patterns.
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Neurologic Level L4:
The musclepredominantlyinnervated at this root
nerve level is the tibialisanterior, which doesdorsiflexion.
Instruct the patient todorsiflex and invert
h/her foot. With yourfree hand, hold thepatient’s foot and askh/her to resist yourattempt to move the
foot into plantarflexion
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Neurologic Level L5:
The muscles found
within this myotome
are the extensorhallucis longus (big
toe extensor) &
extensor digitorum
(heel walk)
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Neurologic Level S1:
The muscles found
within this myotome
are the peroneuslongus (eversion) &
peroneus brevis
(eversion)
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