Dermatomes and Myotomes

geekymedics.com/dermatomes-and-myotomes

Richard Tyrrell 14 May 2018

This article explains the dermatomes and myotomes of the human body, with an
included dermatome map. Examining myotomes and dermatomes is a vital part of a
thorough neurological examination, particularly when a patient has a spinal cord injury.

To learn how to assess dermatomes and myotomes in a neurological examination you

can check out upper and lower limb neurological examination guides.

Embryology
Dermatomes and myotomes both arise from somites, which are divisions of the body of
an embryo. Somites are paired structures which run cephalocaudally (along the head to
toe axis of the body).

In the developing human embryo, somites form dermatomes and myotomes, as well as
tendons, cartilage and sclerotomes (which form bone).

You might also be interested in our Anatomy Flashcard Collection which contains over
2000 anatomy flashcards in addition to advanced features such as spaced repetition.

Dermatomes
A dermatome is an area of skin supplied by a single spinal nerve.

If you imagine the human body as a map, each dermatome represents the area of skin
supplied with sensation by a specific nerve root.

It is important to bear in mind that the dermatomes of the head are supplied by branches
V1, V2 and V3 of the trigeminal nerve.

When assessing sensation, areas close to dermatomal boundaries should be avoided to

minimise the risk of misinterpretation. The lists below describe locations that can be used
to assess the dermatomes of the head, upper limb, torso and lower limbs.1 We have also
included a selection of dermatomal maps to demonstrate the region of the skin each
dermatome covers.

Dermatomes of the head

Trigeminal nerve (CN V)

V1: ophthalmic branch – the lateral aspect of the forehead

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 V2: maxillary branch – the cheek
V3: mandibular branch – the lower jaw (avoid the angle of the mandible as it is
supplied by C2/C3)

Other

C2: 1-2 cm lateral to the occipital protuberance

C3: the supraclavicular fossa in the midclavicular line.

Trigeminal nerve
dermatomes

Dermatomes of the head

(C2 & C3)

Dermatomes of the upper limb

C4: over the acromioclavicular joint.

C5: the lateral aspect of the lower edge of the deltoid muscle (known as the
“regimental badge”).
C6: the palmar side of the thumb.
C7: the palmar side of the middle finger.
C8: the palmar side of the little finger.
T1: the medial aspect antecubital fossa, proximal to the medial epicondyle of the
humerus.

Upper limb dermatome

map

Locations to assess
dermatomes

Dermatomes of the torso

T2: the apex of the axilla.
T3: the intersection of the midclavicular line and third intercostal space.

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 T4: the intersection of the midclavicular line and the fourth intercostal space at the
level of the nipples.
T5: the intersection of the midclavicular line and the fifth intercostal space,
horizontally located midway between the level of the nipples and the level of the
xiphoid process.
T6: the intersection of the midclavicular line and the horizontal level of the xiphoid
process.
T7: the intersection of the midclavicular line and the horizontal level at one quarter
the distance between the level of the xiphoid process and the level of the umbilicus.
T8: the intersection of the midclavicular line and the horizontal level at one half the
distance between the level of the xiphoid process and the level of the umbilicus.
T9: the intersection of the midclavicular line and the horizontal level at three-
quarters of the distance between the level of the xiphoid process and the level of
the umbilicus.
T10: the intersection of the midclavicular line, at the horizontal level of the
umbilicus.
T11: the intersection of the midclavicular line, at the horizontal level midway
between the level of the umbilicus and the inguinal ligament.
T12: the intersection of the midclavicular line and the midpoint of the inguinal
ligament.

Dermatome map of the torso

Dermatomes of the lower limb

L1: the inguinal region and the very top of the medial thigh.
L2: the middle and lateral aspect of the anterior thigh.
L3: the medial epicondyle of the femur.
L4: the medial malleolus.
L5: the dorsum of the foot at the third metatarsophalangeal joint.
S1: the lateral aspect of the calcaneus.
S2: at the midpoint of the popliteal fossa.
S3: at the horizontal gluteal crease (the horizontal crease formed by the inferior
aspect of the buttocks and the posterior upper thigh).
S4/5: the perianal area.

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 Lower limb dermatome map

To learn how to assess sensation as part of a neurological examination, see our upper
and lower neurological examination guides.

Dermatomal map of the whole body

Whole body dermatome map

Myotomes

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A myotome is a group of muscles innervated by a single spinal nerve.

This list details some important myotome nerve roots and the actions that their associated
muscles produce:

C4: shoulder shrugs

C5: shoulder abduction and external rotation; elbow flexion
C6: wrist extension
C7: elbow extension and wrist flexion
C8: thumb extension and finger flexion
T1: finger abduction
L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: big toe extension
S1: ankle plantarflexion
S4: bladder and rectum motor supply

For information about examining myotomes, see the motor sections of the Geeky Medics
upper and lower limb neurological examination guides.

Plexuses
We can classify groups of nerves into plexuses:

Cervical plexus (C1 – C4): innervates the diaphragm, shoulders and neck.
Brachial plexus (C5 – T1): innervates the upper limbs.
Lumbosacral plexus (L2 – S4): innervates the lower extremities.

References
1. American Spinal Injury Association (ASIA). Key Sensory Points (PDF). June 2008.

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