Dermatomes &

Myotomes of Upper Limb

Presented BY: Dr. Syeda Nida Fatima
UIPT,UOL
Dermatomes & Myotomes
of Upper Limb
 Dermatomes
Dermatomes are the sensory region of skin
inverted by a nerve root.

The area of the skin supplied by a single nerve

root is called dermatome.

There are 31 segments of spinal cord each with

a pair of ventral and dorsal that innervate
motor and sensory function respectively.
 The anterior and posterior nerve roots
combine on each side to form the spinal nerve
as they exist the vertebral canal through IV
foramina.

Dermatomes exist for each of the spinal nerve

except C1.
Sensory information from a
specific dermatomes is transmitted
by sensory nerve fibers to spinal
nerve of specific segment of spinal
cord.

Dermatomes along arms and legs

differ from the pattern of the
trunk dermatomes because they
run longitudinally along limbs.
 28 Total Dermatomes
Two aspects – absent, impaired, normal
Pin prick
Light touch
Proprioception- absent, impaired, normal
Same one joint on each extremity
Index finger and Great Toe
Common Dermatomal levels:
C5-Shoulder

C6-Lateral arm and digits 1 and 2

C7-Middle digit

C8-Digits 4 and 5

L4-Anteromedial Shin
L5-Anterlateral Shin, dorsum of foot
to big toe
 Clinical Significance
• Dermatomes are useful to help localize neurological levels
particularly in radiculopathy.

• Effacement of a spinal nerve may or may not exhibited

symptoms in dermatomic area covered by the compressed
nerve root in addition to weakness.

• Viruses that infect spinal nerves reveal their origin by

showing up as pain full dermatomic area e.g., herpes zoster.
➢C1- vertex of skull.
➢C2- forehead occiput.
➢C3- neck, temporal area.
➢C4- shoulder area, clavicles, upper scapula.
➢C5- deltoid, ant arm till base of thumb.
➢C6- ant arm, rad side of hand to thumb and
index finger.
➢C7- Lat arm n forearm to index, long and
ring fingers.
➢C8- medial arm and forearm to long,
ring and little fingers.
➢T1- medial side of forearm to base of
little finger.
➢ T2- medial side of upper arm to medial
elbow, pectoral and midscapular area.
➢T3 to T12- T3 to T6 upper thorax.
➢T5-T7 coastal margin.
➢T8-T12 abdomen and lumbar region.
➢L1- back, over trochanter and groin.
➢L2- back, front of thigh and knee.
➢L3- back,upper buttock, anterior thigh and
knee ,medial lower leg.
➢L4- medial buttock, lateral thigh, medial
leg, dorsum of foot, big toe.
➢L5- buttock,post.and lateral thigh, lateral
aspect of leg, dorsum of foot, medial half of
sole, first second and third toes.
➢S1- buttock, thigh and leg posterior.
➢S2- same as S1.
➢S3- groin, med.thigh to knee.
➢S4- perineum, genitals, lower sacrum.
 Dermatomes Test:
There are two test:
• Pinprick test:
Gently touch the skin with the pin or back end
and ask the patient whether it feels sharp or
blunt.
• Light touch test:
Dabbing a piece of cotton wool on an area of
skin.
 Procedure:
Test for abnormalities in sensitivity
by pin or cotton.

The patient should close his/her eyes

and give the therapist feedback with
regards to various stimuli.
All these test should be done on a
specific dermatomes and should be
compared bilaterally.
The sensory function of touch that
1

involves in sensing surfaces and

their textures and qualities.
Pink prick test and light touch
test.
Both these test should demonstrated
to the patient first.

Both these test begin distally

and then move proximally.
 Upper Body Test Points
C2- Occipital Protuberance

C3- Supraclavicular Fossa

C4-Acromioclavicular Joint

C5- Lateral Antecubital Fossa

C6- Thumb
1

C7- Middle Finger

C8- Little Finger

T1- Medial Antecubital Fossa

T2- Apex of axilla

 Myotomes

Myotomes are the muscles

inverted by a single nerve root is
known as myotomes.

Myotomes correspond to
muscles that are
controlled by specific
nerve roots from the
spinal cord.
Clinical Significance

Information
about the level in
the spine where a
lesion may be
present.

IV disc Muscle
herniation weakness
➢C1-C2 : Cervical flexion.
➢C3: Cervical lateral flexion.
➢C4: Shoulder elevation.
➢C5: Shoulder abduction.
➢C6: Elbow flexion.
➢C7: Elbow extension.
➢C8: Thumb extension.
➢T1: Finger abduction/adduction.
➢L2: Hip flexion.
➢L3: Knee extension.
➢L4: Ankle DF(dorsiflexion).
➢L5: Great toe extension.
➢S1: Ankle Eversion/hip extension/ankle
PF(planter- flexion)/knee flexion
➢S2: Knee flexion.
 Test for Myotomes
• Note the position of the body that the patient
assumes when sitting on the examination table.

• Paralysis or weakness may become evident when

a patient assumes an abnormal body position.

• A central usually produces grater weakness in the

extensors than in the flexors of the upper
extremities.
 Muscle Strength Grading
• No muscle contraction is detected or present.

• A trace contraction is noted in the muscle

by palpating the muscle while the patient,
attempts to contract it.

• The patient is able to actively move the muscle

when gravity is eliminated.
 1

 The patient may move the muscle against gravity

but not against resistance from the examiner.

 The
patient may move the muscle group against
some resistance from the examiner.

 The patient moves the muscle group and

overcomes the resistance of the examiner and this
is normal muscle strength.
 Levels of
injury with
specific
muscles:
 C1-C3,(Tetraplegia) C4
Sternocleidomastoid, neck accessory
muscles, partial innervation of diaphragm.

Further innervation of diaphragm and

paraspinal muscles.
 C5

Bicep (elbow flexors), deltoids, rhomboids,

partial innervation of serratus anterior
(shoulder flexion, extension and abduction).
 C6

Wrist extensors
 C7-8

Triceps (elbow extensors),

finger flexors.
 T1-9(Paraplegia) T10-T12

Extrinsic and intrinsic finger flexors,

intercostal, para and sacrospinalis.

Lower abdominals and intercostals.

L1 to S5
• Lower limb muscles
• L1/2 hip flexors
• L3 knee extensors
• L4 ankle dorsiflexors
• L5 long toe extensors
• S1/2 ankle planter flexors
References and recommended books
• A Textbook of (Atlas of Human Anatomy) 5th Edition by Frank H. Netter, MD.
• Textbook of (Clinical Anatomy by Regions 9th Edition) Richard Snell, MD, PhD.