Spinal nerve & dermatome

& myotome
Khwanthana Grataitong (อาจารย์ขวัญ)

Department of Basic Medical Sciences, Faculty of Medicine Vajira Hospital, Navamindradhiraj University

khwanthana@nmu.ac.th Khwanthana Grataitong @khwanthana

Outline
vSpinal nerve & Spinal ganglion
vSpinal nerve plexuses
vDermatome & Clinical correlation
vMyotome & Clinical correlation
Spinal nerves

v Spinal nerves (31 pairs):

Ø Cervical nerves 8 pairs
Ø Thoracic nerves 12 pairs
Ø Lumbar nerves 5 pairs
Ø Sacrum nerves 5 pairs
Ø Coccygeal nerve 1 pairs 3
 Spinal nerves & Branches
Anterior (ventral) nerve root
Posterior (dorsal) nerve root
Posterior (dorsal) ramus
Motor/Sym supplies deep back muscles,
and skin areas of back.
Spinal nerves Anterior (ventral) ramus
supplies anterior trunk muscles,neck, limb
Sensory 2 rami muscles and skin areas of neck, trunk and limbs.
(L., branches) Gray/White rami comunicans
Typical thoracic spinal nerve
Principles of Dermatome and Plexus Formation

Lower tetrapods Mammals

The trunk is located between the limbs The limbs are also rotated

Posterior Rotated forward

( lower) limbs

Anterior
(upper) limbs
Rotated backward
 Plexus formation
Adjacent anterior rami merge to form plexuses in which
their fibers are exchanged and redistributed, forming a
new set of multisegmental peripheral nerves
Segmental nerves

The segmental (dermatomal)

pattern of nerve fiber distribution

Segmental nerves

Plexus formation

The segmental (dermatomal)

pattern of nerve fiber distribution remains
Plexus formation

v Cervical plexus (C1-5)

v Brachial plexus (C5-T1)
v Intercostal nerve(T1-T12)
v Lumbar plexus (L1-4)
v Sacral plexus
Cervical plexus

v Root: Ventral rami of C1-4 spinal nerves

v Motor branches
-Ansa cervicalis , nerve to thyrohyoid, phrenic nerves
v Cutaneous branches
-Lesser occipital nerve (C2)
-Great auricular nerve (C2 and C3)
-Transverse cervical nerve (C2 and C3)
-Supraclavicular nerves (C3 and C4)
Brachial Plexus
v Root: Ventral rami of C5-T1 spinal nerves
v 5 Terminal branches
-Muculocutaneous nerve
-Median nerve
-Ulnar nerve
-Radial nerve
-Axillary nerve
 Lumbosacral and
Coccygeal Plexuses
v Lumbar plexus (L1-4)
-Femoral nerve (L2–L4)
-Obturator nerve (L2–L4)
-Lumbosacral trunk (L4, L5)
-Ilio-inguinal and iliohypogastric nerves (L1)
-Genitofemoral nerve (L1, L2)
-Lateral cutaneous nerve of the thigh
v Sacral plexus
-Sciatic nerve (L4-5,S1-3)
-Pudendal nerve(S2,3,4)
-Superior gluteal nerve
-Inferior gluteal nerve
v Coccygeal plexus- coccygeal nerves
 Dermatome & Myotome

A dermatome is an area of skin that is mainly supplied by afferent nerve

fibres from the dorsal root of any given spinal nerve.

A myotome is the group of muscles that a single spinal nerve innervates.

Dermatomes
A dermatome is defined as ‘a strip of skin that is innervated by a single
spinal nerve‘. They are of great diagnostic importance, as they allow the
clinician to determine whether there is damage to the spinal cord, and to
estimate the extent of a spinal injury if there is one present.
Origin of Dermatome

Somites
Dermis and Subcutaneus
Dermatome tissue of Skin
Mapping : Dermatome distribution via Peripheral nerves

Dermatome distribution Peripheral nerves distribution

Clinical Relevance: Assessing Spinal Cord Lesions
Dermatomes to determine the presence and the extent of a spinal cord lesion.

Cotton wool

To test
light touch sensation

Small pin

To test
pain sensation
vLight touch and pain are tested
separately as their fibers travel in
different parts of the spinal cord
Clinical Relevance: Herpes Zoster
Herpes zoster, or shingles, is the most common infection of the peripheral nervous system. It is an acute
neuralgia confined to the dermatome distribution of a specific spinal or cranial sensory nerve root.
Clinical Relevance: Referred pain
Referred pain is pain perceived at a location other than the site of the painful stimulus/ origin. It is the result of
a network of interconnecting sensory nerves, that supplies many different tissues. When there is an injury at
one site in the network it is possible that when the signal is interpreted in the brain signals are experienced in
the surrounding nervous tissue.

Cardiac pain : Angina pectoris

 Myotome
An adult myotome is defined as ‘a group of muscles innervated by a single spinal
nerve root‘. They are clinically useful as they can determine if damage has occurred
to the spinal cord, and at which level the damage has occurred.
Origin of Myotomes

Somites
Myotome Skeletal muscle
Distribution of Myotomes
Most muscles in the upper and lower limbs receive innervation
from more than one spinal nerve root. They are therefore
comprised of multiple myotomes. For example, the biceps
brachii muscle performs flexion at the elbow. It is innervated by
the musculocutaneous nerve, which is derived from C5, C6 and
C7 nerve roots. All three of these spinal nerve roots can be said
to be associated with elbow flexion.
Biceps reflex Triceps reflex
The list below details which movement is most strongly
associated with each myotome:
C5 – Elbow flexion
C6 – Wrist extension
C7 – Elbow extension
C8 – Finger flexion
T1 – Finger abduction
L2 – Hip flexion
L3 – Knee extension
L4 – Ankle dorsiflexion
L5 – Great toe extension
S1 – Ankle plantarflexion Patellar tendon reflex Calcaneal (Achilles’)
(quadriceps reflex) tendon reflex
Clinical Relevance: Assessing Spinal Cord Lesions
Myotome function : This can help determine if there is spinal cord damage,
and where the damage is located.
Myotomes are tested in terms of power, and graded 1-5:

v 0 = total paralysis.
v 1 = palpable or visible contraction.
v 2 = active movement, full range of motion (ROM)
with gravity eliminated.
v 3 = active movement, full ROM against gravity.
v 4 = active movement, full ROM against gravity and
moderate resistance in a muscle specific position.
v 5 = (normal) active movement, full ROM against
gravity and full resistance in a muscle specific
position expected from an otherwise unimpaired
person.
References
THANK YOU