What are dermatomes and how do they relate to spinal nerves. How many dermatomes are there in the human body. Which areas of skin do different dermatomes innervate. Why are dermatomes important for medical diagnosis and treatment.

The Basics of Dermatomes and Spinal Nerves

A dermatome is a specific area of skin that receives sensory innervation from a single spinal nerve. The human body has 31 pairs of spinal nerves that branch out from the spinal cord, forming an integral part of the peripheral nervous system (PNS). These nerves play a crucial role in relaying sensory, motor, and autonomic information between the body and the central nervous system (CNS).

How many dermatomes are there in the human body? There are 30 dermatomes, which is one less than the number of spinal nerve pairs. This discrepancy arises because the C1 spinal nerve typically lacks a sensory root, so dermatomes begin with the C2 spinal nerve.

The Five Groups of Spinal Nerves

• Cervical nerves (C1-C8): Originate from the neck
• Thoracic nerves (T1-T12): Originate from the torso
• Lumbar nerves (L1-L5): Originate from the lower back
• Sacral nerves (S1-S5): Associated with the sacrum in the pelvis
• Coccygeal nerves: A single pair originating from the coccyx (tailbone)

Dermatome Distribution Patterns in the Body

Dermatomes follow a segmented distribution throughout the body, with some variation between individuals and potential overlap between neighboring dermatomes. How do dermatome patterns differ between the torso and limbs?

In the torso and core, dermatomes are distributed horizontally, appearing like stacked discs when viewed on a body map. This horizontal pattern is due to the lateral exit of spinal nerves from the spine. In contrast, dermatomes in the limbs follow a vertical pattern along the long axis of the limbs, such as down the leg, due to the elongated shape of these body parts.

Cervical Dermatomes and Their Innervation Areas

The cervical dermatomes, associated with spinal nerves C2 through C8, innervate the head, neck, and upper limbs. What specific areas do each cervical dermatome cover?

• C2: Lower jaw and back of the head
• C3: Upper neck and back of the head
• C4: Lower neck and upper shoulders
• C5: Area of the collarbones and upper shoulders
• C6: Shoulders, outside of the arm, and thumb
• C7: Upper back, back of the arm, pointer and middle fingers
• C8: Upper back, inside of the arm, ring and little fingers

Thoracic Dermatomes and Their Sensory Regions

The thoracic dermatomes, corresponding to spinal nerves T1 through T12, primarily innervate the chest, upper back, and abdomen. How are these dermatomes distributed?

• T1: Upper chest, back, armpit, and front of the arm
• T2-T4: Upper chest and back
• T5-T7: Mid-chest and back
• T8-T9: Upper abdomen and mid-back
• T10: Abdomen (area of the belly button) and mid-back
• T11-T12: Lower abdomen and mid-back

Lumbar and Sacral Dermatomes: Lower Body Innervation

The lumbar (L1-L5) and sacral (S1-S5) dermatomes innervate the lower back, buttocks, and lower limbs. How are these dermatomes distributed across the lower body?

Lumbar Dermatomes

• L1: Lower back, hips, and groin
• L2-L3: Lower back, front and inside of the thigh
• L4: Lower back, front of thigh and calf, area of the knee, inside of the ankle
• L5: Lower back, front and outside of calf, top and bottom of foot, first four toes

Sacral Dermatomes

• S1: Lower back, back of thigh, back and inside of calf, last toe
• S2-S3: Buttocks and genitals
• S4-S5: Buttocks

The single pair of coccygeal nerves innervates the buttocks and the area around the tailbone.

Clinical Significance of Dermatomes in Medical Diagnosis

Dermatomes play a crucial role in medical diagnosis and treatment. How do healthcare professionals use dermatome knowledge in clinical practice?

Understanding dermatome patterns helps clinicians assess and diagnose various conditions, particularly those affecting the nervous system. Symptoms that occur along a specific dermatome may indicate a problem with a particular nerve root in the spine.

Radiculopathies and Dermatomes

Radiculopathies are conditions where a nerve root in the spine is compressed or pinched. These conditions can cause pain, weakness, and tingling sensations that follow one or more dermatome patterns. For example, a herniated disc pressing on a cervical nerve root might cause pain and numbness along the corresponding arm dermatome.

Shingles and Dermatome Involvement

Shingles, caused by the reactivation of the varicella-zoster virus, typically affects one or more adjacent dermatomes. The characteristic rash and pain associated with shingles often follow a specific dermatome pattern, helping clinicians diagnose the condition and determine its extent.

Dermatome Mapping Techniques in Clinical Practice

How do healthcare professionals map and assess dermatomes in patients? Several techniques are employed to evaluate dermatome function and identify potential nerve root issues:

1. Pin-prick testing: A sharp object is used to test sensation along different dermatomes.
2. Light touch assessment: A soft object is used to evaluate fine touch sensation in various dermatome regions.
3. Temperature sensation testing: Hot and cold stimuli are applied to assess temperature perception across dermatomes.
4. Reflex testing: Specific reflexes are checked to evaluate the function of particular spinal nerves and their associated dermatomes.

These assessment techniques help clinicians identify areas of altered sensation, which can indicate underlying neurological issues or spinal cord injuries.

Variations and Overlaps in Dermatome Patterns

While dermatome charts provide a general guide, it’s important to note that some variation exists between individuals. Are dermatome patterns identical in every person?

No, the exact areas covered by each dermatome can vary slightly from person to person. Additionally, there is often some overlap between neighboring dermatomes. This overlap occurs because adjacent spinal nerves may innervate portions of the same skin area, creating zones of dual innervation.

Factors Influencing Dermatome Variations

• Individual anatomical differences
• Developmental variations in nerve growth and distribution
• Potential nerve injuries or surgeries that may alter innervation patterns
• Age-related changes in nerve function and distribution

These variations highlight the importance of comprehensive clinical assessment rather than relying solely on standardized dermatome charts when diagnosing neurological conditions.

Dermatomes and Pain Management Strategies

How does understanding dermatomes contribute to effective pain management? Knowledge of dermatome patterns is crucial for developing targeted pain management strategies, particularly in cases of neuropathic pain or radiculopathies.

Applications in Pain Management

• Targeted medication delivery: Topical analgesics can be applied to specific dermatome areas for localized pain relief.
• Nerve blocks: Anesthetic injections can be administered to specific nerve roots based on the affected dermatome.
• Spinal cord stimulation: Electrode placement for neuromodulation can be optimized based on dermatome involvement.
• Physical therapy: Exercises and treatments can be tailored to address specific dermatome-related pain patterns.

By understanding which dermatomes are affected, healthcare providers can develop more precise and effective pain management plans for their patients.

Dermatomes in Neurological Rehabilitation

How do dermatomes factor into neurological rehabilitation programs? Dermatome knowledge is essential in designing and implementing rehabilitation strategies for patients with spinal cord injuries or other neurological conditions affecting sensory function.

Rehabilitation Applications

• Sensory re-education: Targeted exercises to improve sensation in specific dermatome areas
• Functional task training: Activities designed to improve sensory-motor integration within affected dermatomes
• Adaptive equipment selection: Choosing appropriate assistive devices based on preserved sensory function in specific dermatomes
• Progress monitoring: Tracking improvements in sensory function across dermatomes during the rehabilitation process

By incorporating dermatome-specific assessments and interventions, rehabilitation professionals can create more targeted and effective treatment plans for patients with neurological impairments.

Dermatomes and Their Role in Medical Education

Why is a thorough understanding of dermatomes crucial for medical students and healthcare professionals? Knowledge of dermatome patterns is fundamental to neurological assessment and diagnosis. It forms an essential part of medical education, particularly in fields such as neurology, orthopedics, and pain management.

Educational Importance

• Foundational knowledge: Understanding dermatomes provides a basis for comprehending the organization of the nervous system.
• Diagnostic skills: Familiarity with dermatome patterns enhances the ability to localize neurological lesions.
• Treatment planning: Knowledge of dermatomes informs decisions about interventions and pain management strategies.
• Interdisciplinary communication: A common understanding of dermatomes facilitates clear communication among healthcare professionals.

Medical educators employ various teaching methods, including anatomical models, interactive software, and clinical case studies, to help students master dermatome patterns and their clinical applications.

Future Directions in Dermatome Research and Clinical Applications

What emerging technologies and research areas are shaping the future of dermatome-related clinical practice? Several exciting developments are expanding our understanding and application of dermatome knowledge:

Emerging Technologies and Research Areas

• Advanced imaging techniques: High-resolution MRI and functional neuroimaging are providing more detailed insights into dermatome innervation patterns.
• Artificial intelligence: Machine learning algorithms are being developed to assist in dermatome-based diagnosis and treatment planning.
• Regenerative medicine: Research into nerve regeneration and repair may lead to new treatments for dermatome-related sensory deficits.
• Personalized medicine: Genetic and molecular studies are exploring individual variations in dermatome patterns and their clinical implications.

These advancements promise to enhance our understanding of dermatomes and their role in neurological function, potentially leading to more precise diagnostic tools and targeted therapeutic interventions.

Dermatomes Diagram: Spinal Nerves and Locations

A dermatome is an area of skin supplied by a single spinal nerve. There are 31 pairs of spinal nerves, forming nerve roots that branch from your spinal cord.

Your spinal nerves help to relay sensory, motor, and autonomic information between the rest of your body and your central nervous system (CNS).

So why are dermatomes important? How many are there? And where can they be found? Continue reading as we answer these questions and more.

Each of your dermatomes is supplied by a single spinal nerve. Let’s take a closer look at both of these components of the body.

Your spinal nerves

Spinal nerves are part of your peripheral nervous system (PNS). Your PNS works to connect the rest of your body with your CNS, which is made up of your brain and spinal cord.

You have 31 pairs of spinal nerves. They form nerve roots that branch from your spinal cord. Spinal nerves are named and grouped by the region of the spine that they’re associated with.

The five groups of spinal nerves are:

• Cervical nerves. There are eight pairs of these cervical nerves, numbered C1 through C8. They originate from your neck.
• Thoracic nerves. You have 12 pairs of thoracic nerves that are numbered T1 through T12. They originate in the part of your spine that makes up your torso.
• Lumbar nerves. There are five pairs of lumbar spinal nerves, designated L1 through L5. They come from the part of your spine that makes up your lower back.
• Sacral nerves. Like the lumbar spinal nerves, you also have five pairs of sacral spinal nerves. They’re associated with your sacrum, which is one of the bones found in your pelvis.
• Coccygeal nerves. You only have a single pair of coccygeal spinal nerves. This pair of nerves originates from the area of your coccyx, or tailbone.

Your dermatomes

Each of your dermatomes is associated with a single spinal nerve. These nerves transmit sensations, such as pain, from a specific area of your skin to your CNS.

Your body has 30 dermatomes. You may have noticed that this is one less than the number of spinal nerves. This is because the C1 spinal nerve typically doesn’t have a sensory root. As a result, dermatomes begin with spinal nerve C2.

Dermatomes have a segmented distribution throughout your body. The exact dermatome pattern can actually vary from person to person. Some overlap between neighboring dermatomes may also occur.

Because your spinal nerves exit your spine laterally, dermatomes associated with your torso and core are distributed horizontally. When viewed on a body map, they appear very much like stacked discs.

The dermatome pattern in the limbs is slightly different. This is due to the shape of the limbs as compared with the rest of the body. In general, dermatomes associated with your limbs run vertically along the long axis of the limbs, such as down your leg.

Your dermatomes are numbered based on which spinal nerve they correspond to. Below, we’ll outline each dermatome and the area of the body that it’s associated with.

Remember that the exact area that a dermatome may cover can vary by individual. Some overlap is also possible. As such, consider the outline below to be a general guide.

Cervical spinal nerves

• C2: lower jaw, back of the head
• C3: upper neck, back of the head
• C4: lower neck, upper shoulders
• C5: area of the collarbones, upper shoulders
• C6: shoulders, outside of arm, thumb
• C7: upper back, back of arm, pointer and middle finger
• C8: upper back, inside of arm, ring and little finger

Thoracic spinal nerves

• T1: upper chest and back, armpit, front of arm
• T2: upper chest and back
• T3: upper chest and back
• T4: upper chest (area of nipples) and back
• T5: mid-chest and back
• T6: mid-chest and back
• T7: mid-chest and back
• T8: upper abdomen and mid-back
• T9: upper abdomen and mid-back
• T10: abdomen (area of belly button) and mid-back
• T11: abdomen and mid-back
• T12: lower abdomen and mid-back

Lumbar spinal nerves

• L1: lower back, hips, groin
• L2: lower back, front and inside of thigh
• L3: lower back, front and inside of thigh
• L4: lower back, front of thigh and calf, area of knee, inside of ankle
• L5: lower back, front and outside of calf, top and bottom of foot, first four toes

Sacral spinal nerves

• S1: lower back, back of thigh, back and inside of calf, last toe
• S2: buttocks, genitals, back of thigh and calf
• S3: buttocks, genitals
• S4: buttocks
• S5: buttocks

Coccygeal spinal nerves

buttocks, area of tailbone

Dermatomes are important because they can help to assess and diagnose a variety of conditions. For instance, symptoms that occur along a specific dermatome may indicate a problem with a specific nerve root in the spine.

Examples of this include:

• Radiculopathies. This refers to conditions in which a nerve root in the spine is compressed or pinched. Symptoms can include pain, weakness, and tingling sensations. Pain from radiculopathies can follow one or more dermatomes. One form of a radiculopathy is sciatica.
• Shingles. Shingles is a reactivation of the varicella zoster (chickenpox) virus that lies dormant in the nerve roots of your body. Symptoms of shingles, such as pain and a rash, occur along dermatomes associated with the affected nerve root.

Dermatomes are areas of skin that are connected to a single spinal nerve. You have 31 spinal nerves and 30 dermatomes. The exact area that each dermatome covers can be different from person to person.

Spinal nerves help to relay information from other parts of your body to your central nervous system. As such, each dermatome transmits sensory details from a particular area of skin back to your brain.

Dermatomes can be helpful in evaluating and diagnosing conditions affecting the spine or nerve roots. Experiencing symptoms along a specific dermatome can help inform doctors about which area of the spine may be affected.

Dermatomes Diagram: Spinal Nerves and Locations

A dermatome is an area of skin supplied by a single spinal nerve. There are 31 pairs of spinal nerves, forming nerve roots that branch from your spinal cord.

Your spinal nerves help to relay sensory, motor, and autonomic information between the rest of your body and your central nervous system (CNS).

So why are dermatomes important? How many are there? And where can they be found? Continue reading as we answer these questions and more.

Each of your dermatomes is supplied by a single spinal nerve. Let’s take a closer look at both of these components of the body.

Your spinal nerves

Spinal nerves are part of your peripheral nervous system (PNS). Your PNS works to connect the rest of your body with your CNS, which is made up of your brain and spinal cord.

You have 31 pairs of spinal nerves. They form nerve roots that branch from your spinal cord. Spinal nerves are named and grouped by the region of the spine that they’re associated with.

The five groups of spinal nerves are:

• Cervical nerves. There are eight pairs of these cervical nerves, numbered C1 through C8. They originate from your neck.
• Thoracic nerves. You have 12 pairs of thoracic nerves that are numbered T1 through T12. They originate in the part of your spine that makes up your torso.
• Lumbar nerves. There are five pairs of lumbar spinal nerves, designated L1 through L5. They come from the part of your spine that makes up your lower back.
• Sacral nerves. Like the lumbar spinal nerves, you also have five pairs of sacral spinal nerves. They’re associated with your sacrum, which is one of the bones found in your pelvis.
• Coccygeal nerves. You only have a single pair of coccygeal spinal nerves. This pair of nerves originates from the area of your coccyx, or tailbone.

Your dermatomes

Each of your dermatomes is associated with a single spinal nerve. These nerves transmit sensations, such as pain, from a specific area of your skin to your CNS.

Your body has 30 dermatomes. You may have noticed that this is one less than the number of spinal nerves. This is because the C1 spinal nerve typically doesn’t have a sensory root. As a result, dermatomes begin with spinal nerve C2.

Dermatomes have a segmented distribution throughout your body. The exact dermatome pattern can actually vary from person to person. Some overlap between neighboring dermatomes may also occur.

Because your spinal nerves exit your spine laterally, dermatomes associated with your torso and core are distributed horizontally. When viewed on a body map, they appear very much like stacked discs.

The dermatome pattern in the limbs is slightly different. This is due to the shape of the limbs as compared with the rest of the body. In general, dermatomes associated with your limbs run vertically along the long axis of the limbs, such as down your leg.

Your dermatomes are numbered based on which spinal nerve they correspond to. Below, we’ll outline each dermatome and the area of the body that it’s associated with.

Remember that the exact area that a dermatome may cover can vary by individual. Some overlap is also possible. As such, consider the outline below to be a general guide.

Cervical spinal nerves

• C2: lower jaw, back of the head
• C3: upper neck, back of the head
• C4: lower neck, upper shoulders
• C5: area of the collarbones, upper shoulders
• C6: shoulders, outside of arm, thumb
• C7: upper back, back of arm, pointer and middle finger
• C8: upper back, inside of arm, ring and little finger

Thoracic spinal nerves

• T1: upper chest and back, armpit, front of arm
• T2: upper chest and back
• T3: upper chest and back
• T4: upper chest (area of nipples) and back
• T5: mid-chest and back
• T6: mid-chest and back
• T7: mid-chest and back
• T8: upper abdomen and mid-back
• T9: upper abdomen and mid-back
• T10: abdomen (area of belly button) and mid-back
• T11: abdomen and mid-back
• T12: lower abdomen and mid-back

Lumbar spinal nerves

• L1: lower back, hips, groin
• L2: lower back, front and inside of thigh
• L3: lower back, front and inside of thigh
• L4: lower back, front of thigh and calf, area of knee, inside of ankle
• L5: lower back, front and outside of calf, top and bottom of foot, first four toes

Sacral spinal nerves

• S1: lower back, back of thigh, back and inside of calf, last toe
• S2: buttocks, genitals, back of thigh and calf
• S3: buttocks, genitals
• S4: buttocks
• S5: buttocks

Coccygeal spinal nerves

buttocks, area of tailbone

Dermatomes are important because they can help to assess and diagnose a variety of conditions. For instance, symptoms that occur along a specific dermatome may indicate a problem with a specific nerve root in the spine.

Examples of this include:

• Radiculopathies. This refers to conditions in which a nerve root in the spine is compressed or pinched. Symptoms can include pain, weakness, and tingling sensations. Pain from radiculopathies can follow one or more dermatomes. One form of a radiculopathy is sciatica.
• Shingles. Shingles is a reactivation of the varicella zoster (chickenpox) virus that lies dormant in the nerve roots of your body. Symptoms of shingles, such as pain and a rash, occur along dermatomes associated with the affected nerve root.

Dermatomes are areas of skin that are connected to a single spinal nerve. You have 31 spinal nerves and 30 dermatomes. The exact area that each dermatome covers can be different from person to person.

Spinal nerves help to relay information from other parts of your body to your central nervous system. As such, each dermatome transmits sensory details from a particular area of skin back to your brain.

Dermatomes can be helpful in evaluating and diagnosing conditions affecting the spine or nerve roots. Experiencing symptoms along a specific dermatome can help inform doctors about which area of the spine may be affected.

Treatment of protrusion of the cervical spine in Moscow at the Dikul clinic: prices, appointments

The cervical spine is the most mobile part of the spine. In addition, the neck is a complex anatomical zone where the vessels, trachea, and esophagus pass. Therefore, disc protrusion in the cervical spine is often the cause of both neurological symptoms and vascular disorders associated with exposure to the vertebral arteries. As a rule, disc protrusion is associated with degenerative-dystrophic changes in the spine (osteochondrosis). Degenerative processes in the spine tend to progress. Therefore, timely and adequate treatment of protrusion of the cervical spine allows not only to stop the symptoms, but also to prevent the transformation of the protrusion into a disc herniation and avoid the need for surgical treatment.

But there may be other reasons for the development of disc protrusion. Inflammation, damage, or degeneration of the disc can cause a range of symptoms that vary depending on the severity of the condition. A bulging disc can lead to neck pain radiating to the arm, numbness, tingling, motor disturbances, muscle spasm, or some combination of these symptoms. The most common degenerative changes and disc protrusion occur at the level of C5-C6 and C6-C7. Medical statistics indicate that disc protrusion in the cervical spine occurs in 60% of people over 40 years of age. It is worth noting the fact that the representatives of the stronger sex get sick more often.

Causes

• Degeneration or wear that results in disc failure.
• Repetitive flexion (extension) and twisting movements, especially in combination. These movements have the greatest impact on the outer annulus of the disc.
• Discs are most susceptible to injury in the sitting or leaning position, as the pressure on the disc shifts forward and the force vector shifts the contents of the disc posterolaterally towards the thinner and weaker part of the annulus.
• Fall or injury, such as a car accident.
• Repetitive stress injury from overhead work or heavy lifting.
• Genetic factors may to some extent contribute to the early development of degenerative changes in the discs (osteochondrosis).
• Smokers are more likely to develop early disc degeneration
• Infection (discitis)

Symptoms

Disc protrusions in the cervical spine are quite common and most of them are not symptomatic. The symptomatology of a protrusion of the disc depends on the location of the bulge and the soft tissue structures that are affected. The process may involve: the back of the head, neck, arms, shoulder girdle and hands. Symptoms can range from mild discomfort to severe and persistent.

The most common symptoms are:

• Pain in the neck, head, shoulder and arm, aggravated by minimal exertion on the arm, coughing, sneezing;
• Cracking and pain in the neck when turning or tilting the head;
• Muscle spasm and changes in posture;
• Numbness, tingling in the arms or legs, burning between the shoulder blades;
• Headache that usually starts in the neck and extends to the occiput and temples;
• Dizziness and even fainting on sudden turning of the head;
• Decreased range of motion in the neck, difficulty in moving the head and neck;
• Prolonged sitting may cause pain in the neck and arm;
• Pain in the neck or radicular pain radiating to the arm if the disc compresses the nerve root.
• Weakness, muscle atrophy, or decreased strength in the arms may occur if motor neuron compression occurs.
• Feeling weak and tired;

Other symptoms of cervical disc protrusion: tinnitus, decreased visual acuity and hearing, and sometimes pain in the heart.

Red flags for neck pain

A serious underlying cause is more likely in people who:

• Onset of symptoms before age 20 or after age 55.
• Weakness associated with more than one myotome or sensory disturbance involving more than one dermatome.
• Intense or increasing pain.

Red flags suggesting possible malignancy, infection or inflammation:

• Fever.
• Unexplained weight loss.
• History of inflammatory arthritis.
• History of malignancy, drug abuse, tuberculosis, AIDS or other infection.
• Immunosuppression.
• Pain that gets worse, is very intense and/or disturbs sleep.
• Lymphadenopathy.
• Local punctate tenderness over the vertebral body.

Red flags suggesting myelopathy (compression of the spinal cord):

• Progression of symptoms.
• Gait disorder; weakness or impaired motor function in the hands; loss of control / bladder / bowel.
• Lhermitte’s sign (flexion of the neck causes electric shock sensations that travel down the spine and radiate to the extremities).
• Pathological symptoms in the lower extremities (Babinski reflex, hyperreflexia, clonus, spasticity) and in the upper extremities (atrophy, hyporeflexia).
• Various sensory changes (loss of proprioception is more pronounced in the arms than in the legs).

Red flags indicating the possibility of severe skeletal injury:

• Trauma history.
• Previous neck surgery.
• Osteoporosis or risk factors for osteoporosis.
• Increase and persistence of pain.

Red flags indicating vascular insufficiency:

• Dizziness and blackout before the eyes (compression of the vertebral artery) when moving, especially when the neck is extended.
• Dizziness, syncopal episodes.

Differential diagnosis of neck pain

As a rule, most back pain is directly related to changes in the discs (protrusion, disc herniation), however, for an accurate diagnosis it is necessary to use medical imaging methods.

Differentials include:

• Cervical spondylosis.
• Traumatic prolapse of the intervertebral disc.
• Neck pain: acute neck deformity, postural neck pain, or pain associated with whiplash
• Headache.
• Referred pain – eg from shoulder.
• Malignancies: primary tumors, metastases or myeloma.
• Infections: discitis, osteomyelitis or tuberculosis.
• Fibromyalgia.
• Vascular insufficiency.
• Psychogenic neck pain.
• Inflammatory diseases (eg rheumatoid arthritis).
• Metabolic diseases: Paget’s disease, osteoporosis.

Diagnosis of a bulging disc

Neck pain associated with radiculopathy and no red flag symptoms usually do not require imaging or other special investigations. However, for verification purposes, the doctor may prescribe the following research methods:

Blood tests may be ordered to rule out infectious or inflammatory diseases (decreased hemoglobin may be a sign of anemia; an increase in ESR can be a sign of both infection and inflammation; rheumatoid factor levels and HLA-B27 determination may indicate systemic diseases of the connective tissue fabrics).

Medical imaging is very important but should be interpreted in the light of the clinical picture as positive results are quite common in people without any complaints:

• Radiography . Plain x-ray of the cervical spine can be used to evaluate chronic degenerative changes, metastatic tumors, infection, spinal deformity, and motion segment stability. Interpretation of research results is often difficult because degenerative signs are almost universal in people over the age of 35.

• MRI. This imaging modality may be indicated if radiography fails to determine the cause of the symptom. MRI should be performed to diagnose disc protrusion (herniation) and the presence of compression of nerve structures.

• CT myelography can be used if there are any contraindications for MRI.

• EMG (ENMG ) – these methods can be informative in the presence of radiculopathy or the need to determine the level of damage and differentiation of cervical radiculopathy from nervous compression syndromes.

Treatment

As a rule, the treatment of protrusion of the cervical spine uses conservative methods, and surgical treatment is rarely required. Conservative treatment allows you to stop the symptoms and stops the progression of the disease.

The doctor prescribes a course of treatment for the patient, taking into account the clinical picture, age, sex and body characteristics. Treatment of protrusion of the cervical spine can take up to one and a half months. The patient undergoes procedures 2-3 times a week. Neck pain usually resolves after 1-2 weeks of treatment. The following methods can be used in the course of treatment:

Drug treatment:

• Analgesics and muscle relaxants can relieve pain and relieve muscle spasm.
• If pain is chronic and severe, pain relief may be enhanced by the addition of amitriptyline or gabapentin.
• Diazepam for 3-7 days may be useful in patients with severe muscle spasm.

Manual Therapy

The doctor relieves muscle spasm, pain, restores joint mobility and relaxes muscles with the help of manual manipulations.

Osteopathy

Osteopath identifies problems in the body using palpation diagnostics, restores joint mobility, relieves muscle tension.

Apitherapy

The doctor puts the bee in a point with increased blood and lymph flow. Treatment with bee stings relieves pain and inflammation, kills bacteria, and tones the nervous system.

Hirudotherapy (leech treatment)

When bitten, a leech injects various enzymes into the blood (primarily hirudin). Hirudotherapy reduces swelling and inflammation, strengthens blood vessels, accelerates the movement of blood and lymph.

Reflexology (acupuncture)

A reflexologist works with needles on biologically active points. Acupuncture relieves pain, inflammation and spasm of blood vessels, improves tissue nutrition.

Therapeutic massage

The massage therapist uses various methods of influencing soft tissues. Massage allows you to relieve pain and tension in the muscles, improves posture, relieves headaches. Depending on the need, the patient can be assigned a head or neck massage.

The specialist performs the massage with smooth movements. The procedure relieves headaches, relaxes the nervous system and normalizes blood pressure.

Physiotherapy

Exposure to laser, ultrasound, electric current and other physical factors relieves pain, improves blood circulation and tissue nutrition, and accelerates the removal of toxins.

Mud therapy

Therapeutic mud contains biologically active substances and minerals. Mud wraps stimulate metabolism, improve tissue nutrition, eliminate toxins.

Treatment with active oxygen

Ozone-oxygen mixture is administered intravenously or as microinjections. Ozone destroys bacteria and viruses, removes toxins, improves the functioning of the immune system.

Kinesio taping

The doctor applies adhesive tapes (taips) to certain areas of the patient’s body. The method is used to relax muscles, treat sprains and damage to the muscles of the joints.

Plasmolifting

The doctor gives patients injections of his own plasma. The procedure restores tissue around the joints and spine, reduces pain and inflammation, and helps to move more freely.

Exercise Therapy

Individualized exercise therapy by a physiotherapist combines stretching, isometric and weight training to restore range of motion and strengthen the muscles of the cervical spine and shoulder girdle for support, stabilization and stress reduction. loads discs and neck.

Surgery

The most common disc surgery is discectomy, in which the disc is removed through an incision. In the cervical spine, discectomy can be performed either anteriorly or posteriorly. In some cases, a vertebral fusion operation may be recommended. Most patients who have had a discectomy recover fairly quickly from surgery with a course of physical therapy. Discectomy is usually performed in the presence of a herniated disc, as most disc protrusions can be successfully treated conservatively.

Prognosis

In most cases, disc protrusions are successfully treated without surgery, and patients return to normal work and life. The duration of treatment can vary from 4 to 12 weeks depending on the severity of the symptoms. Patients should continue to perform stretching, strengthening and stabilization exercises. For a good long-term prognosis, it is necessary to use the awareness of correct posture, body mechanics and the awareness of the need to maintain a healthy neck.

Headache in the back of the head – treatment and causes

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Headache in the back of the head is a common complaint.

Any pain, including a headache in the back of the head, always has vascular and so-called vegetative components.

The fact is that the brain itself does not hurt! Headache is pain emanating from the vessels and membranes of the brain. They have the highest concentration of pain receptors. Activation (irritation) of these receptors generates pain impulses. They enter the brain through the nerves and conductors of the predominantly autonomic part of the nervous system, causing the so-called minimal brain dysfunction.

Read more about cerebral and dysfunction and how it is related to the autonomic nervous system.

Sufficient and correct diagnosis of the state of blood vessels and the autonomic part of the nervous system allows us to understand the causes and mechanisms of headache. This provides a unique opportunity to eliminate the cause of the headache as well as manage the pain. Especially for chronic headaches. Pain can always be reduced or completely blocked.

At the Meddiagnostics Center, headache treatment is based on identifying the cause of the headache. For this, a protocol developed by the Meddiagnostics Center is used, which has shown its effectiveness over the years:

2. Testing the condition of the vascular wall, its elasticity, evaluation of hydrodynamics and cerebral circulation .
3. Deviations in the functioning of the autonomic nervous system are tested, which makes it possible to find individual approaches to its correction in each patient. Read more about the diagnosis of abnormalities of the autonomic nervous system .
4. In the presence of headache, dizziness, tinnitus and other conditions, deviations in the work of different parts of the brain are specified.

Read more about diagnostic methods and methods of treatment at the Neurology Center Medical Diagnostics

Possible causes of pain in the back of the head

1. Osteochondrosis of the spine with reflected pain in the occiput
2. Neuropathy of the occipital greater and occipital lesser nerves
3. Radiculopathy (radiculopathy) C1 and C2
4. Pathology of the vertebral artery in posterior cervical sympathetic syndrome
5. Myogylosis of the muscles of the occipital region
6. Increased blood pressure (arterial hypertension, arterial hypertension)
7. Processes occurring in the posterior cranial fossa (tumor, stroke)

Osteochondrosis of the spine with referred pain in the occiput

Spinal osteochondrosis is understood as degenerative-dystrophic changes in bone and cartilage tissues. The term “osteochondrosis” is used exclusively in the post-Soviet space and is a statement of a set of radiological signs. In relation to the spine, this is sclerosis of the closing plates due to a violation of the trophism (nutrition) of bone and cartilage tissues. Long-term studies Ukrainian Institute of Musculoskeletal Medicine and Neurology conducted since 1985 to 1995 showed that osteochondrosis has nothing to do with the occurrence of pain in the spine. Osteochondrosis is a natural degenerative process (involution of tissues of the supporting apparatus), which is asymptomatic. Changes in the disc itself are important, which are accompanied by a decrease in the height of the disc and a decrease in tension between two adjacent vertebrae. This is manifested by instability of the spinal segment, displacements and secondary trauma to the tissues of the intervertebral joints. Some of the details of these studies have just now been published for the first time:

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osteochondrosis, it should be especially noted that in the vertebral segments of the occipital region (two upper cervical segments of the spine) there are no discs (!) and there cannot be hernias. Pain, as at any level of the spine, occurs due to the so-called. facet syndrome. It was comprehensively studied and described by us in a series of scientific publications and named “ facet subluxation syndrome » more here.

Read more about Facet Subluxation Syndrome (article The essence of subluxation facet syndrome).

In relation to pain in the back of the head due to the so-called. osteochondrosis of the upper cervical spine, it should be noted that (NB!) there are no discs in the upper cervical spine. Accordingly, there can be no herniated discs in these segments of the spine. Therefore, it is not necessary to consider osteochondrosis as a cause of pain in the back of the head. The diagnosis of “osteochondrosis” is a large generalizing concept in relation to a large list of diseases that occur with pain in the spine.

Read about the so-called. osteochondrosis more here.

Neuropathy of the greater occipital and lesser occipital nerves

Involvement of these nerves can have several causes. The main one is the spine. Mechanical compression of the roots or spinal nerves that are related to the formation of the greater or lesser occipital nerves can cause a headache in the occipital region.

The figure shows the innervation zones of the greater and lesser occipital nerves. The lower figure shows the nerves of the head, which are related both to the head itself and to the occipital region.

Nerves pass through the muscle layers of the occipital region (picture below). The muscle mass of the occipital-cervical region is complex. It consists of several layers of muscles multidirectional in their function. These muscles provide movement to the occipital-vertebral region and can compress the nerves, causing pain in the back of the head.

Our studies have shown that muscle spasm often occurs due to subluxation facet syndrome. This process was studied in detail by us in the clinic and in the experiment in the 80s of the last century on the basis of needle electromyography in the clinic and experiment, as well as electron microscopy in the experiment:

Gongalsky V.V.

1. Electrophysiological assessment of neurological manifestations of violations of the topography of the vertebral motor segment//Orthopedics, traumatology and prosthetics.-1988.-N11.-S.43-46.
2. Clinical and electrophysiological assessment of neurological manifestations of osteochondrosis of the spinal column//Medical business.-1988.-N11.-S. 83-85. (co-author Macheret E.L., Lysenyuk V.P.).
3. Ultrastructural characteristics of early musculotonic reactions of deep short back muscles in experimental osteochondrosis // Regional scientific-practical conference “Human health in an intensive industrial zone: Abstracts of reports. — Dnepropetrovsk, 1989.-Ch.2.-S.60 -61
4. Early segmental neurological manifestations of osteochondrosis of the thoracic spine // Abstract of the dissertation for the degree of candidate of medical sciences. Kyiv. 1990.-18s.

Etc.

Radiculopathy (root damage) C1 and C2

Nerves of the occipital region are formed by roots. The nerve root exits through the intervertebral foramen. In these holes, the roots can be injured. The general principle of trauma to the contents of the intervertebral foramen is set out in the above publication (see here).

Such an injury can cause radicular disorders, in particular in the occipital region. The figure below shows a diagram of dermatomes with the capture of the back of the head. The occipital region is innervated by the second (C2) and third (C3) cervical roots (see figure below).

Pathology of the vertebral artery in posterior cervical sympathetic syndrome (cervical migraine, Barre-Lieu syndrome)

Cervical migraine (posterior cervical sympathetic syndrome) occurs when there is insufficient blood flow in the vertebrobasilar basin. The syndrome is often associated with narrowing of the canal of the vertebral artery, as shown in the figure below.

It is not uncommon in the literature that the cause is the so-called. “cervical osteochondrosis”. As mentioned above, osteochondrosis has nothing to do with the development of vertebral artery syndrome.

This syndrome is characterized by headache mainly in the occipital part of the head, dizziness, noise (sometimes ringing) in the ears, the appearance of a veil before the eyes. Often, pain is felt not only in the back of the head, but also in the orbit, resembling cluster pain in its pattern (see above). Cervical migraine may be accompanied by heart and respiratory rhythm disorders (bulbar disorders) and a number of other neurological disorders.

Diagnosis of pain in the back of the head

For the diagnosis of cervical migraine, MRI of the brain with MRI reconstruction of the vessels of the head, ultrasound of the arteries of the head and neck are performed, paying attention to the condition of the vertebral arteries. Informative is the x-ray of the cervical spine and joints of the head (C0\C1, C1\2 segments). In some cases, an MRI of the cervical spine may be needed (see Diagnose Migraine and Any Other Headache). Hardware diagnosis is extremely important, since the clinical picture of cervical migraine can be given, for example, by thrombosis of the vertebral artery, brain tumors or strokes (see more about the causes of headache).

Our equipment

MRI machine Toshiba Vantage Elan 1.5 Tesla

Ultrasound machine Philips AFFINITY 50

X-ray complex “Radspeed” SHIMADZU

Ultrasound machine GE LOGIQ F8

Who treats headaches, dizziness and others at the Meddiagnostics Center neurological and vascular diseases

Gongalsky Vladimir Vladimirovich

Doctor of Medical Sciences, orthopedist-traumatologist, neurologist, vertebroneurologist

Kostyev Igor Kimovich

Medical director, neurologist

Maksimov Grigory Alexandrovich

Doctor of Neurology, Candidate of Medical Sciences

Mikhail Viktorovich Volkov

Neurologist

Oleg V. Mazur

Neurologist

Headache treatment review at the Center “Meddiagnostika”

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Treatment of cervical migraine

when diagnosing causes. Vascular preparations generally accepted in neurology are poorly effective.

Myogylosis of the muscles of the occipital region

The figure below shows the muscles of the suboccipital region. Myogyloses can form in the muscles of this area. Myogylosis is a local painful muscle spasm that can give reflected pain in the back of the head. Read more about myogeloses here.

Our experimental studies using electron microscopy have shown that facet subluxation syndrome is accompanied by local spasm of paravertebral muscles. The spasm can be kept for a long time, up to several months. This is explained by the fact that the deep layer of paravertebral muscles contains more tonic (red) fibers. Local spasms lead to the so-called. recontraction, when spasmodic areas of the muscle are reborn into scar tissue. Innervated vessels and the nerves themselves fall into these scars. Areas of overcontracted muscle are painful and are called myogeloses.

High blood pressure

One of the most common causes of neck pain is high blood pressure. Arterial hypertension (hypertension) is considered to be systolic pressure above 140 and diastolic – above 90 mm Hg.

An increase in blood pressure can be physiological, symptomatic and essential (hypertension).

The physiological rise in blood pressure is asymptomatic and, as a rule, does not cause pain in the back of the head. Occurs with stress, physical activity. After the cessation of the provoking factor, blood pressure quickly returns to normal.

Symptomatic hypertension occurs more often in pathology of the kidneys or vessels related to the kidneys:

Hypertension. Most often occurs with a headache in the back of the head. See more here.

Processes occurring in the posterior cranial fossa

Processes such as tumors, insufficiency of cerebral blood flow and impaired CSF flow, impaired cerebral blood flow (stroke) can occur with a headache in the back of the head.

Diagnosis of any headache, including pain in the back of the head, except for interview and neurological examination, includes the use of:

• MRI of the brain with MRI – reconstruction of the vessels of the head
• Dopplerography of neck and head vessels with functional tests (see details)
• Neck x-ray with head joints
• Laboratory testing when clinically indicated

Treatment of pain in the back of the head

Tactics for the treatment of headache in the back of the head depends on the diagnosis.

If subluxation facet syndrome occurs, manipulation techniques are indicated. It is necessary to restore mobility to natural ratios in the joints of the spine (in the absence of contraindications).

If the joints are inflamed (arthritis), you need to look for the cause of the inflammation and eliminate it.

For neuropathies of the occipital nerves, local drug therapy is carried out. In some cases, in the absence of contraindications, physiotherapy is used. Diagnosis of the state of the intervertebral foramens as a possible cause of neuropathy is shown.

Treatment for radiculopathy depends on the cause, which is more likely to be sought in the spinal cord or spine. If there are signs of radiculo-ischemia, vascular therapy and work with radicular sleeves and intervertebral foramens of the spine are indicated.

Posterior cervical sympathetic syndrome is treated by removing the irritation from the vertebral artery, releasing it if there are signs of compression. There are many methods of treatment, the tactics depend on the presence and nature of the neurological deficit in the vertebrobasilar basin and the cause of compression of the vertebral artery.

Myogylosis of the muscles of the occipital region. First of all, they find out the cause of the appearance of myogylosis, determine its localization and eliminate it. The second stage is work with myogelosis itself and the muscle (local drug therapy, massage, muscle mobilization, etc.