Pain Referral, Reflex According to Spinal Cord (Dermatomes)
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Verteb ral space Affecte d root Pain referral Weakness Reflex changes Additional features C5 Shoulder, trapezius Supra & infraspinatus, deltoid, slight biceps weakness Slight decrease of biceps jerk C6 Trapezius, tip of shoulder, radiation to anterior upper arm, thumbs, index finger (1,2) Biceps, brachioradialis, extensor carpii radialis Decrease biceps jerk supinator Tenderness over spine of scapula in suprascapular region paraesthesia in I,II fingers Cervic al C7 Shoulder, axilla, posterior arm, elbow, 2 and 3 fingers Triceps, wrist extensors, 2 & 3 finger extensors Decrease / absent triceps jerk Tenderness over medial scapula & suprascapular region of triceps paraesthesia in most fingers. T1 (C8) Medial forearm, 4&5 fingers, hypoesthesia Insintric hand muscle (m.interosseus & plexus of fingers) wrist flexors May have carporadial reflex decrease Mimic ulnar palsy L3 Anterior thigh, over knee Thigh adductor, quadriceps Absent / decrease knee jerk - L4 Anterior thigh, medial foreleg muscles, Anterior tibial and partial foot, deep Decrease / absent knee jerk Can’t extend knee, have sensation of medial knee and anterior calf.
Transcript of Pain Referral, Reflex According to Spinal Cord (Dermatomes)
Vertebral space
Affected root
Pain referral Weakness Reflex changes Additional features
C5Shoulder, trapezius Supra & infraspinatus,
deltoid, slight biceps weakness
Slight decrease of biceps jerk
C6
Trapezius, tip of shoulder, radiation to anterior upper arm, thumbs, index finger (1,2)
Biceps, brachioradialis, extensor carpii radialis
Decrease biceps jerk supinator
Tenderness over spine of scapula in suprascapular region paraesthesia in I,II fingers
CervicalC7
Shoulder, axilla, posterior arm, elbow, 2 and 3 fingers
Triceps, wrist extensors, 2 & 3 finger extensors
Decrease / absent triceps jerk
Tenderness over medial scapula & suprascapular region of triceps paraesthesia in most fingers.
T1 (C8)Medial forearm, 4&5 fingers, hypoesthesia
Insintric hand muscle (m.interosseus & plexus of fingers) wrist flexors
May have carporadial reflex decrease
Mimic ulnar palsy
L3 Anterior thigh, over knee Thigh adductor, quadriceps
Absent / decrease knee jerk
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L4Anterior thigh, medial foreleg muscles, quadriceps muscle
Anterior tibial and partial foot, deep (sometimes)
Decrease / absent knee jerk
Can’t extend knee, have sensation of medial knee and anterior calf.
Lumbar
L5
Posterogluteal lateral thigh, anterolateral foreleg, dorsal root, lateral maleolus, I, II, II toes
Extensor hallucis longus, extensor digiti brevis, some weakness of anterior tibialis, sometimes with foot drop
Unaffected (except posterior tibial)
Cannot extend feet (cannot walk on heel) pain with straight leg, raised, variant test tenderness over 4th lumbar lateral process and lateral gluteal region
Sacral S1
Midgluteal, posterior thigh, posterior of leg, lateral foot, heel, lateral toes
Plantar – flexes hamstring muscles (m. gastrocnemius)
Absent / decrease knee jerk
Patient cannot flex toes. Pain with straight legs rising and tenderness over lumbosacral (L5 – S1) joint & sciatic notch discomfort, hypoesthesia on lateral part of foot and 5th toe.
