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Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. These signals give rise to sensations involving temperature, pressure, and pain.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

  1. Cervical nerves: These exit the neck region and are labeled C1–C8.
  2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
  3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
  4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
  5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

  • C2: the base of the skull, behind the ear
  • C3: the back of the head and the upper neck
  • C4: the lower neck and upper shoulders
  • C5: the upper shoulders and the two collarbones
  • C6: the upper forearms and the thumbs and index fingers
  • C7: the upper back, backs of the arms, and middle fingers
  • C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

  • T1: the upper chest and back and upper forearm
  • T2, T3, and T4: the upper chest and back
  • T5, T6, and T7: the mid-chest and back
  • T8 and T9: the upper abdomen and mid-back
  • T10: the midline of the abdomen and the mid-back
  • T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

  • L1: the groin, upper hips, and lower back
  • L2: the lower back, hips, and tops of the inner thighs
  • L3: the lower back, inner thighs, and inner legs just below the knees
  • L4: the backs of the knees, inner sections of the lower legs, and the heels
  • L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

  • S1: the lower back, buttocks, backs of the legs, and outer toes
  • S2: the buttocks, genitals, backs of the legs, and heels
  • S3: the buttocks and genitals
  • S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

  • a headache
  • sensitivity to bright light
  • a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. These signals give rise to sensations involving temperature, pressure, and pain.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

  1. Cervical nerves: These exit the neck region and are labeled C1–C8.
  2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
  3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
  4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
  5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

  • C2: the base of the skull, behind the ear
  • C3: the back of the head and the upper neck
  • C4: the lower neck and upper shoulders
  • C5: the upper shoulders and the two collarbones
  • C6: the upper forearms and the thumbs and index fingers
  • C7: the upper back, backs of the arms, and middle fingers
  • C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

  • T1: the upper chest and back and upper forearm
  • T2, T3, and T4: the upper chest and back
  • T5, T6, and T7: the mid-chest and back
  • T8 and T9: the upper abdomen and mid-back
  • T10: the midline of the abdomen and the mid-back
  • T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

  • L1: the groin, upper hips, and lower back
  • L2: the lower back, hips, and tops of the inner thighs
  • L3: the lower back, inner thighs, and inner legs just below the knees
  • L4: the backs of the knees, inner sections of the lower legs, and the heels
  • L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

  • S1: the lower back, buttocks, backs of the legs, and outer toes
  • S2: the buttocks, genitals, backs of the legs, and heels
  • S3: the buttocks and genitals
  • S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

  • a headache
  • sensitivity to bright light
  • a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. These signals give rise to sensations involving temperature, pressure, and pain.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

  1. Cervical nerves: These exit the neck region and are labeled C1–C8.
  2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
  3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
  4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
  5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

  • C2: the base of the skull, behind the ear
  • C3: the back of the head and the upper neck
  • C4: the lower neck and upper shoulders
  • C5: the upper shoulders and the two collarbones
  • C6: the upper forearms and the thumbs and index fingers
  • C7: the upper back, backs of the arms, and middle fingers
  • C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

  • T1: the upper chest and back and upper forearm
  • T2, T3, and T4: the upper chest and back
  • T5, T6, and T7: the mid-chest and back
  • T8 and T9: the upper abdomen and mid-back
  • T10: the midline of the abdomen and the mid-back
  • T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

  • L1: the groin, upper hips, and lower back
  • L2: the lower back, hips, and tops of the inner thighs
  • L3: the lower back, inner thighs, and inner legs just below the knees
  • L4: the backs of the knees, inner sections of the lower legs, and the heels
  • L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

  • S1: the lower back, buttocks, backs of the legs, and outer toes
  • S2: the buttocks, genitals, backs of the legs, and heels
  • S3: the buttocks and genitals
  • S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

  • a headache
  • sensitivity to bright light
  • a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. These signals give rise to sensations involving temperature, pressure, and pain.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

  1. Cervical nerves: These exit the neck region and are labeled C1–C8.
  2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
  3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
  4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
  5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

  • C2: the base of the skull, behind the ear
  • C3: the back of the head and the upper neck
  • C4: the lower neck and upper shoulders
  • C5: the upper shoulders and the two collarbones
  • C6: the upper forearms and the thumbs and index fingers
  • C7: the upper back, backs of the arms, and middle fingers
  • C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

  • T1: the upper chest and back and upper forearm
  • T2, T3, and T4: the upper chest and back
  • T5, T6, and T7: the mid-chest and back
  • T8 and T9: the upper abdomen and mid-back
  • T10: the midline of the abdomen and the mid-back
  • T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

  • L1: the groin, upper hips, and lower back
  • L2: the lower back, hips, and tops of the inner thighs
  • L3: the lower back, inner thighs, and inner legs just below the knees
  • L4: the backs of the knees, inner sections of the lower legs, and the heels
  • L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

  • S1: the lower back, buttocks, backs of the legs, and outer toes
  • S2: the buttocks, genitals, backs of the legs, and heels
  • S3: the buttocks and genitals
  • S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

  • a headache
  • sensitivity to bright light
  • a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. These signals give rise to sensations involving temperature, pressure, and pain.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

  1. Cervical nerves: These exit the neck region and are labeled C1–C8.
  2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
  3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
  4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
  5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

  • C2: the base of the skull, behind the ear
  • C3: the back of the head and the upper neck
  • C4: the lower neck and upper shoulders
  • C5: the upper shoulders and the two collarbones
  • C6: the upper forearms and the thumbs and index fingers
  • C7: the upper back, backs of the arms, and middle fingers
  • C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

  • T1: the upper chest and back and upper forearm
  • T2, T3, and T4: the upper chest and back
  • T5, T6, and T7: the mid-chest and back
  • T8 and T9: the upper abdomen and mid-back
  • T10: the midline of the abdomen and the mid-back
  • T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

  • L1: the groin, upper hips, and lower back
  • L2: the lower back, hips, and tops of the inner thighs
  • L3: the lower back, inner thighs, and inner legs just below the knees
  • L4: the backs of the knees, inner sections of the lower legs, and the heels
  • L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

  • S1: the lower back, buttocks, backs of the legs, and outer toes
  • S2: the buttocks, genitals, backs of the legs, and heels
  • S3: the buttocks and genitals
  • S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

  • a headache
  • sensitivity to bright light
  • a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

Lumbar Nerves – an overview

Injuries to the Femoral Nerve

The femoral nerve, which arises from the second through the fourth lumbar nerve roots, represents the largest branch of the lumbar nerve plexus. The femoral nerve is formed within the body of the psoas major muscle and then passes inferolaterally within the psoas before emerging just superior to the inguinal ligament, in a groove between the psoas and iliacus muscles.87 The blood supply to the extrapelvic portion of the femoral nerve is the lateral femoral circumflex artery, whereas the intrapelvic component of the femoral nerve is supplied by the iliolumbar and deep circumflex iliac arteries.88 A more extensive collateral blood supply to the right femoral nerve has been demonstrated,89 a finding suggesting that the left femoral nerve may be more susceptible to ischemic injury than the right.88

The femoral nerve contains both sensory and motor components, including the sensory branches of the anterior and medial femoral cutaneous nerve, as well as the long saphenous nerve. Motor innervation from the femoral nerve is provided to the psoas, iliacus, quadriceps femoris, pectineus, and sartorius muscles. Therefore, injury to the femoral nerve may result in weakness of hip flexion, knee extension, adduction, and external rotation.88,90,91 Clinically, femoral nerve injuries usually manifest as difficulty with ambulation in the early postoperative period. Patients whose injuries are not recognized before discharge commonly report difficulty in climbing stairs at home.91 In addition, patients may report numbness and paresthesias of the anteromedial thigh.92 On physical examination, weakness of the quadriceps muscles and diminished or absent deep tendon reflexes at the knee (patellar reflex) are consistent findings.

Femoral nerve injuries may result from patient positioning, retractor-related compression, or direct operative trauma. Direct injury is usually suspected intraoperatively, and careful inspection along the course of the nerve is recommended in such cases. Positioning-related femoral nerve injuries in urology have most consistently been reported from procedures in the lithotomy position,93,94 and they are discussed in the next section.

The most common mechanism for femoral nerve injury during urologic procedures, however, is compression of the nerve by self-retaining retractors. This situation typically occurs during prolonged abdominal cases such as radical cystectomy, although injuries have been reported after radical prostatectomy and even perineal prostatectomy.95 Retractor injuries occur when the blades of the retractor are placed directly on the psoas muscle, where they may compress the nerve directly or indirectly by trapping the nerve against the lateral pelvic wall (Fig. 20-3).88 In addition, retractor blades may compromise the blood supply to the femoral nerve by compressing the iliolumbar artery.92 Thin patients, in whom the retractor blades are more likely to compress the psoas muscle, are at particular risk for femoral nerve injury from retractor compression.96 Moreover, the length of time of retraction has been correlated with the severity of nerve injury.97 Therefore, care should be taken to ensure that retractor blades retract only the rectus muscle and do not sit directly on the psoas muscle. Periodic inspection of retractor placement during the surgical procedure by placing the surgeon’s fingers beneath the blades to ensure clearance off the psoas muscle is mandatory to avoid inadvertent compression injury.

The initial evaluation of a suspected femoral nerve injury includes careful documentation of the neurologic findings, along with physical therapy consultation. Immediate physical therapy helps to prevent muscle atrophy and may decrease the risk of thromboembolic complications associated with prolonged bed rest.96 Ambulation may be facilitated in the case of femoral nerve injury by locking the ipsilateral knee to compensate for the associated thigh muscle weakness.88 Although most femoral nerve injuries in our experience are caused by retractor-related compression, nerve compression from pelvic or retroperitoneal hematomas have been described.88,98 Therefore, if one clinically suspects bleeding, three-dimensional imaging should be obtained as well.

In the setting of a persistent postoperative nerve deficit clinically consistent with a femoral nerve injury, neurologic consultation and an electromyogram to evaluate for anatomic denervation are warranted. Electromyography should be performed ≥3 weeks from the time of injury to maximize its prognostic value.99 Although the recovery process may be prolonged, compression-related nerve injuries usually resolve over time, and patients regain nerve function. Early return of function has been thought to correlate with full recovery,91 and sensory lesions are more frequently transient than are motor lesions.

Prevention of femoral nerve injury is paramount because the consequences may significantly affect patients’ quality of life. Vigilant attention to patient positioning, limiting surgical time, and periodically inspecting retractor placement are key to avoiding these injuries.

Dermatomes – Physiopedia

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A dermatome is an area of skin that is mainly supplied by a single spinal nerve. There are 8 cervical nerves (note C1 has with no dermatome), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these spinal nerves relay sensation from a particular region of the skin to the brain.[1]

[2]

The nerves from the

  • C2 to C4 supply the skin of the neck.
  • C5 to T1 nerves supply the arms. 
  • T2 to L2 nerves supply the chest and abdomen. 
  • L3 to S1 nerves supply the skin of the legs. 
  • S1 to S4 nerves go to the groin.
Nerve Roots Dermatomes[3]
Nerve Root Dermatomes
Cervical
C2 Temple, forehead, occiput
C3 Entire neck, posterior cheek, temporal area, prolongation forward under mandible
C4 Shoulder area, clavicular area, upper scapular area
C5 Deltoid area, anterior aspect of entire arm to base of thumb
C6 Anterior arm, radial side of hand to thumb and index finger
C7 Lateral arm and forearm to index, long, and ring fingers
C8 Medial arm and forearm to long, ring, and little fingers
Thoracic
T1 Medial side of forearm to base of little finger
T2 Medial side of upper arm to medial elbow, pectoral and midscapular areas
T3-T12 T3–T6, upper thorax;

T5–T7, costal margin;

T8–T12, abdomen and lumbar region

Lumbar
L1 Back, over trochanter and groin
L2 Back, front of thigh to knee
L3 Back, upper buttock, anterior thigh and knee, medial lower leg
L4 Medial buttock, latera thigh, medial leg, dorsum of foot, big toe
L5 Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
Sacral
S1 Buttock, thigh, and leg posterior
S2 Same as S1
S3 Groin, medial thigh to knee
S4 Perineum, genitals, lower sacrum

Testing of dermatomes is part of the neurological examination looking for radiculopathy as sensation changes within a specific dermatome may help in determining the pathological disc level.

Dermatome Testing is done ideally with a pin and cotton wool. Ask the patient to close their eyes and give the therapist feedback regarding the various stimuli. Testing should be done on specific dermatomes and should be compared to bilaterally.

  • Pinprick test (pain sensation) – Gently touches the skin with the pin ask the patient whether it feels sharp or blunt
  • Light touch test (light touch sensation) – Dab a piece of cotton wool on an area of skin [4]

During the review of systems, asking the patient to carefully describe the pattern or distribution of sensory symptoms (e.g., tingling, numbness, diminished, or absent sensation) provides the therapist with preliminary information to help guide the examination and to assist in identifying the dermatome(s) and nerve(s) involved.[5]

Peripheral nerve injuries generally present sensory impairments that parallel the distribution of the involved nerve and correspond to its pattern of innervation.For example, if a patient presents with complaints of numbness on the ulnar half of the ring finger, the little finger, and the ulnar side of the hand, the therapist would be alerted to carefully address ulnar nerve (C8 and T1) integrity during the sensory examination. Complaints of sensory disturbances on the palmar surface of the thumb and the palmar and distal dorsal aspects of the index, middle, and the radial half of the ring finger would be indicative of median nerve (C6–8 and T1) involvement.[5]

There exist some discrepancies among published dermatome maps based on the methodologies used to identify skin segment innervation. In a clinical commentary, Downs and Laporte discuss the history of dermatome mapping, including the variations in methodologies employed, and the inconsistencies in the dermatome maps used in education and practice.[5][[Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):42[6]7-34.]]

Sciatica treatment

Optimal treatment of sciatic nerve and sciatica

Injury to the sciatic nerve often causes severe, sudden pain that can radiate from the lower back to the buttocks and thighs, and even to the feet. This extremely unpleasant phenomenon has many names: pinching of the sciatic nerve, sciatica, irritation of the sciatic nerve, lumbago.

What is the sciatic nerve and what is its function?

The sciatic nerve is the largest nerve in the human body.It performs a central function: it transmits all the commands of the brain through the spinal cord to the muscles of the lower extremities. It consists of many roots that diverge from the spinal cord at different heights.

In the hip region, it extends outward and extends from the outside of the thigh to the patella. There, it splits into the peroneal and tibial nerves, which continue to the foot, causing problems with the sciatic nerve to cause widespread pain that is felt from the last lumbar vertebra to the feet.Pain occurs due to irritation of the nerve, which occurs as a result of pressure, pinching or inflammation. They can be caused by various reasons. In medicine, this phenomenon is called sciatica.

Why does pain occur?

Sciatic nerve pain can have a variety of origins. There are two main reasons: nerve damage and inflammation.

Sciatic nerve injuries occur for the following reasons:

The most common cause of sciatica is a herniated disc.Due to the displacement of the disc, pressure arises on the nerve, as a result of which it is pinched. More about herniated discs

If the sciatic nerve is pinched by the piriformis muscle, piriformis syndrome develops. It is caused by unilateral overloading as a result of improper bending of the back.

Accidents, tumors, metastases, edema, abscesses, surgery and bleeding can also be risk factors for sciatica. External pressure builds up on the nerve, resulting in pinching and pain.Childbirth can also cause sciatica because the baby’s head is close to the path of the nerve during labor.

Sciatic nerve pain can also be caused by structural changes. For example, avid runners develop poor posture due to muscle contraction while running, which over time can lead to a pinched nerve. Another cause of these symptoms may be degenerative changes in the spine.

Overweight and diabetes mellitus are also factors contributing to the development of sciatica.

Inflammation of the sciatic nerve can be caused by the following factors:

  • Lyme disease: An infectious disease carried by ticks can, among other things, cause painful inflammation of the nerve roots.
  • Shingles: This viral disease can affect the sciatic nerve roots and subsequently lead to severe pain.

What are the symptoms of sciatica?

Because of the fairly straightforward symptoms, the diagnosis of sciatica is usually quite simple.It is more difficult to find the cause – what caused the pain from the sciatic nerve? Further examinations may be scheduled depending on the complexity.

Pain can be of varying intensity depending on the site of nerve irritation. Often these are pains of a pulling nature on the back of the thigh, which in the morning, after a long sleep, are felt most strongly, and after movement they can let go for a while. Also, a fairly common symptom is pinpoint pain in the buttocks, combined with induration in this place.Sciatica can also manifest as sudden shooting pains, which are often confused with lumbago (but, unlike lumbago, in sciatica, pain radiates to the legs).

What are the options for treating sciatica?

In case of sciatic nerve inflammation, the underlying disease must be treated. Different remedies are used depending on the severity of the symptoms. In milder cases, the pain can be relieved by lying down in a position that relieves the spine, on a special orthopedic device with leg support, as well as various thermal procedures.Regular movement and proper stress distribution in daily life also contribute to recovery.

But even in severe cases, surgery is not always required. For sciatica, various pain relievers are often prescribed in combination with physical therapy: exercises, massages, relaxation exercises, and various movement exercises. Quite often, this combined approach resolves the symptoms.

Experienced partner in the treatment of sciatica

At the Johannesbad Clinic in Bad Füssing we offer a comprehensive treatment for sciatica .We guarantee a completely individual approach. To this end, we have developed an optimal treatment program with the participation of physiotherapists and osteopaths AGAIN IN FORM.

The program is drawn up after detailed individual consultations and thorough diagnostics. It includes all the necessary examinations, 3-D spine measurements, a stress management program and daily intensive treatment with a personal trainer – an experienced physiotherapist with a variety of required qualifications.

Mon-Fri from 7:00 to 16:30

Pinching of the sciatic nerve: symptoms | Health Blog

Pinched nerve – what is it?

Pinching can occur on any nerve in our body. When altered surrounding tissue (inflammation, tumors, etc.) presses on the nerve endings, they constantly transmit painful sensations. Even if the nerve is healthy, the patient will feel severe pain. And with a long absence of treatment, the nerve often becomes inflamed, which leads to constant unbearable pain.

The sciatic nerve, the largest nerve in the human body, is formed from the fusion of several roots L4-S3 in the lower back – the lumbosacral spine, then goes to the buttock, along the back of the thigh and to the lower leg. Therefore, damage even in one area will lead to pain in the entire limb. And with an advanced disease, sensitivity and mobility begin to be lost, which is especially unpleasant if both legs are affected.

Possible causes of pinching

The nerve can be affected at any level of its location.This can happen for many reasons:

  • Herniated disc is the most common cause. Even a slight deformation of the annulus fibrosus can pinch the nerve roots that form the sciatic nerve;
  • Osteochondrosis, curvature of the spine, marginal bone growths of the vertebral bodies;
  • Displacement of the vertebrae (listez) after back injuries and as a result of degenerative processes;
  • Neoplasms of the spine, small pelvis, gluteal region;
  • Inflammation of the pelvic organs;
  • Thrombosis of nearby vessels;
  • Muscle inflammation and edema: after hypothermia, injury, excessive physical exertion;
  • Piriformis syndrome;
  • Pregnancy in which the uterus with the fetus presses too hard on adjacent tissues.

The disease can develop faster due to obesity and lack of minerals and against the background of endocrine disorders such as diabetes mellitus. In addition, the sciatic nerve can be damaged after previous infections and poisoning.

Symptoms of a pinched sciatic nerve

The main symptom of sciatic nerve damage will be pain. At this stage, the most difficult thing is to correctly determine the cause of the disease, but this must be done: if it is started, then the treatment and rehabilitation will take much longer.

What indicates the initial stage of pinching?

  • Drawing or burning pain that affects only part of the lower back, buttocks, back of the thigh;
  • Feeling creepy on the leg;
  • Increased discomfort when changing position, laughing, coughing, sudden movements.
  • Discomfort and pain when sitting and leaning forward.

In the early stages of the disease, you are unlikely to pay attention to these symptoms.They will be invisible, the pain will subside from time to time. Goosebumps and numbness in the legs can be attributed to an uncomfortable position.

A completely different nature of the symptoms appears at later stages. It is at this moment that most patients notice discomfort with prolonged immobility and periodic sharp pain in the leg. If you do not start to fight the disease at this time, then the symptoms will appear more serious:

  • Sensation of intense burning of the skin and deep layers of the muscles of the back of the leg,
  • Severe limitation of the mobility of the leg and lower back,
  • Weakness of the affected leg,
  • In some cases, patients note redness or blanching of the leg area with an increase or vice versa with a decrease in sweating in this area …

In addition, if the pinching caused another disease, its symptoms will also show up to the full. That is why the disease often goes unnoticed: against the background of a hernia or fracture, numbness and redness of the legs seem to be just another symptom, not serious and not worthy of attention.

What can you do during an illness attack?

If the pinching pain comes on suddenly, you can relieve your condition with home therapy:

  • Choose a body position in which the pain syndrome will be the least pronounced, usually on the back or on a healthy side with a straight leg in which pain is felt.
  • Limit physical activity.
  • You can take analgesics: in the form of tablets or rubbing ointment (if there are no contraindications).

Seek emergency medical attention for unbearable pain.

Remember that pinching cannot be cured at home: even if the symptom is stopped, the disease will not disappear anywhere. So after relieving the exacerbation, you will have to visit a neurologist.

What should not be done if pinching worsens?

It is not recommended to actively move: in case of severe pain, it is necessary to limit physical activity as much as possible.If there is a suspicion of inflammation, then neither warm nor rub the sore spot. Try to sleep on a hard mattress on your side during this time. And, of course, you shouldn’t take prescription medications and anti-inflammatories without a doctor’s recommendation.

Diagnostics and treatment

To make a diagnosis, a neurologist requires, in addition to a visual examination, a more complete examination. It may include:

  • X-ray of the lower back and pelvic bones,
  • Ultrasound of the pelvic organs,
  • Computed or magnetic resonance imaging of the affected area,
  • General and biochemical blood test.

With their help, the doctor will be able to establish the cause of the pinching, examine the affected area in all details, and learn about the presence of an inflammatory process. If necessary, he can prescribe an ultrasound of the affected area and ENMG – a study of nerves using responses to electrical impulses. This will help you understand exactly where the nerve is affected.

For treatment, non-steroidal anti-inflammatory drugs, muscle relaxants, a complex of B vitamins are used. With unbearable pain that cannot be relieved by complex treatment, you can put a blockade.Physiotherapy and exercise therapy have proven themselves very well.

If necessary, the doctor can prescribe additional vitamin complexes, pain relievers, antioxidants. And in parallel with the removal of the symptoms of pinching, there will be a fight against the disease that caused it. This way you can overcome the disease much faster and regain your well-being without the threat of relapse.

Inflammation of the sciatic nerve “Polyclinic No. 2

What can be more excruciating than a sudden, piercing pain in the back? Especially when it comes to pain along the nerve.Of all the nerves and nerve bundles, the sciatic is the largest in the body. The pain that occurs with inflammation of the sciatic nerve can not only deprive a person of working capacity, but also completely immobilize him. Therefore, one can imagine that all a person’s attention will be reduced to only one thing – to calm this terrible pain.

Inflammation of the sciatic nerve is called ishalgia. Often, sciatica is confused with sciatica, however, these are different pathologies, since sciatica includes, in addition to pain, the causes of the disease and factors that lead to the development of inflammation.In addition, it is quite problematic to determine sciatica, due to the fact that pain attacks can appear only a couple of times a year.

The age category for this disease can be different, but it is more common in people after thirty years.

Causes of inflammation

The most common cause of the disease is the so-called “piriformis syndrome”, when, due to excessive physical exertion, muscle tissue squeezes a nerve that is located just in the middle of this muscle …

Pregnancy, or rather the third trimester of pregnancy, can also become the likely causes of inflammation. This is due to an increase in the load on the lower back, which can cause displacement of the vertebrae with subsequent entrapment of the sciatic nerve. Also, various infections that affect both the sciatic nerve itself and inflammation along the nerve can become the cause of inflammation. In rare cases, colds and viral diseases can cause sciatic nerve inflammation. Infections and inflammations, in turn, lead to diseases such as neuritis, osteomyelitis, abscess of soft tissues adjacent to the nerve.

Even ordinary hypothermia can provoke sciatica, especially if you sit down on cold or frozen surfaces during frost.

Exhausting physical activity, all kinds of injuries and consequences after injuries, in turn, can also lead to inflammation of the sciatic nerve.

The first symptoms of the disease

The main and most striking symptom of sciatica is pain. The nature of the pain ranges from aching, with tingling and numbness, to acute, in which a person loses the ability to move.Usually, pain occurs in the leg and is localized in one half of the body, while numbness of the affected limb may be observed. In this case, pain arises from any slightest movement, not only of the affected area, but of the whole organism. Even coughing and sneezing can cause severe pain. Painful sensations tend to intensify at night and often deprive a person of sleep.

In addition, the presence of sciatica can be indicated by :

  • hyperemia in the back and pelvis;
  • formation of edema;
  • disturbed sleep;
  • temperature;
  • blood and burning sensation when urinating;
  • edema in the area of ​​the sciatic nerve.

If you have these symptoms, you should consult a specialist in a timely manner to avoid further complications. Not taken measures in time can aggravate the situation and more serious methods of treatment will be required to solve it.

Method for assessing the coordination of bioelectric activity of paravertebral muscles

The invention relates to medicine, namely to orthopedics, and can be used for quantitative and qualitative assessment of the functional state of the paravertebral muscles.The method is carried out as follows. In the standing position of the subject, an electromyogram of the paravertebral muscles on the right and left of the spinous processes of ThI – LV is recorded. The average amplitude of muscle biopotentials is recorded. Calculate the indicator of the standardized difference, which is the ratio of the amplitude difference to the maximum of them. To assess the hypothetical deviation of the spine, a diagram of the distribution of standardized differences is built with an approximating curve – a polynomial of the 6th degree.Integral indices for assessing the bioelectrical activity of paravertebral muscles are calculated: total deviation (SD) is the sum of modules of standardized differences; decompensation (D) – the sum of the standardized differences, taken modulo. Normal coordination of the activity of the paravertebral muscles is characterized by the ratio:. Class I (mild) coordination disorder corresponds to the ratio:. Class II (moderate severity) is limited to:. III class (expressed) is described by the inequality:.The method has expanded functionality, allows for a differentiated assessment of the coordination of paravertebral muscle activity and thereby improve the results of treatment of patients with pathological conditions, diseases and injuries of the spine. 3 ill.

The invention relates to medicine, namely to orthopedics, and can be used for quantitative and qualitative assessment of the functional state of the paravertebral muscles.

A known method for assessing the functional asymmetry of the superficial muscles of the back [V.I. I. Alatyrev, E. S. Aristova. Functional asymmetry of the superficial muscles of the back in persons of different ages during physical education and pain in the spine // Human Physiology, 1994. – T. 20. – No. 2. – P.88-93], which consists in the fact that the functions of the superficial muscles are studied electromyographically in the subjects lying on the stomach. In this case, the bioelectric potentials are taken from the lower sections of the trapezius muscle at the level of the 7th thoracic vertebra and the upper sections of the iliocostal muscles at the level of the 2nd lumbar vertebra.Paired surface electrodes are applied to the skin above the muscles under study in symmetrical areas to the right and left of the spinous processes. Registration of bioelectric potentials is carried out using a special installation consisting of an electromyograph, an analyzer and a frequency meter. An integrative indicator of the perfection of coordination of the activity of paired muscles of the body is the coefficient of asymmetry, the value of which is the quotient of dividing the integral of muscle activity on the right by the corresponding value on the left.

The disadvantage of this technique is, first of all, the impossibility of assessing the state of the studied muscles over the course, since with the help of standard electrodes the bioelectric activity of a muscle area up to 2 cm in area is recorded 2 . In addition, a study in the supine position is not very informative for identifying subclinical forms of impaired coordination of the work of symmetrical muscles of the body. The design of a special device for recording bioelectric potentials is rather complicated, which is an obstacle to the widespread use of this technique in the clinic.The use of the asymmetry coefficient does not allow comparing coordination disorders, manifested by the right- and left-sided predominance of muscle activity.

An object of the present invention is to develop a method for assessing the coordination of the bioelectric activity of paravertebral muscles.

The task is carried out by registering the interference electromyogram of the paravertebral muscles at the level of the spinous processes of the thoracic and lumbar vertebrae in the standing position, followed by a mathematical analysis of the parameters of bioelectric activity.

The invention is illustrated by drawings.

Figure 1 shows a diagram of the distribution of the amplitude of muscle biopotentials on the right and left of the spinous processes of the corresponding vertebrae.

Figure 2 shows a diagram of the distribution of the standardized difference in the projections of the spinous processes of the vertebrae.

Figure 3 shows the nomogram “Total deviation – decompensation”.

The method is carried out as follows. In the position of the subject standing, naked to the waist, bony landmarks are noted – the spinous processes of the vertebrae, starting with the first thoracic and ending with the fifth lumbar.Places of application of electrodes in the paravertebral region are treated with alcohol. To the right and left of the landmarks, surface active electrodes are applied to the skin. When registering muscle activity at the level of the thoracic vertebrae, reference electrodes are placed on the skin above the ipsilateral clavicular-acromial joints, at the level of the lumbar – on the skin in the region of the sacrum. The grounding electrode is applied to the patient’s right shoulder.

Synchronous registration of electromyograms in all channels of collection is carried out using a multichannel electroneuromyograph.According to the authors, the domestic four-channel neuromyoanalyzer NMA-4-01 “Neuromian” (registration certificate No. 104/17/1/97) meets the minimum requirements. Cropping artifacts is done manually. The averaged amplitude of muscle biopotentials on the right and on the left is recorded. For a visual assessment, based on the data obtained, a diagram of the distribution of the amplitude of muscle biopotentials is plotted (figure 1).

An indicator of the asymmetry of the bioelectrical activity of the paravertebral muscles at the level of each vertebra is the standardized difference (CP), which is calculated as follows:

,

where i is the designation of the vertebra corresponding to the level of muscle biopotential removal, i = {ThI ;…; Th XII; LI; …; LV};

CP i – standardized difference at the level of the i-th vertebra;

A Di – the amplitude of muscle biopotentials on the right;

A Si – amplitude of muscle biopotentials on the left;

max [A Di ; A Si ] – the maximum among the amplitudes of muscle biopotentials at the corresponding level of removal.

Taking into account the multidirectional biomechanical effect of the paravertebral muscles in the thoracic and lumbar spine, the CP value at the level of the lumbar vertebrae is taken with the opposite sign.A diagram of the distribution of the CP indicator is plotted, a polynomial of the 6th degree is used as an approximating curve (Fig. 2). The approximating curve gives an idea of ​​the hypothetical line of deviation of the spine from the plumb line for a given state of coordination of muscle tone. The value of the accuracy of the approximation R 2 makes it possible to judge the correctness of the study.

Integral indices for assessing the bioelectrical activity of the paravertebral muscles are the total deviation and decompensation.

The total deviation (SD) is calculated by the formula:

,

where i is the designation of the vertebra corresponding to the level of muscle biopotential removal, i = {ThI; …; Th XII; LI; …; LV};

CP i – standardized difference at the level of the i-th vertebra.

The total deviation shows how pronounced the functional asymmetry of the bioelectrical activity of the paravertebral muscles in general.

Decompensation (D) is calculated by the formula:

,

where i is the designation of the vertebra corresponding to the level of muscle biopotential removal, i = {ThI ;…; Th XII; LI; …; LV};

CP i – standardized difference at the level of the i-th vertebra.

Decompensation is used to assess the predominance of the bioelectric activity of the paravertebral muscles on one side.

Using the values ​​of integral indicators, using the methods of cluster analysis, three main classes of impaired coordination of the activity of the paravertebral muscles were identified, a decision rule was formulated and a nomogram “Total deviation – decompensation” was developed, which allows avoiding cumbersome calculations (Fig.3).

The normal distribution of the bioelectrical activity of the paravertebral muscles is characterized by the following ratio:

.

Class I (mild) of impaired coordination of bioelectrical activity of paravertebral muscles corresponds to the ratio:

Class II (moderate severity) impairment of coordination of bioelectrical activity of paravertebral muscles is limited by the following limits:

.

In turn, it is subdivided into two subclasses.Subclass II A (D – 0.4 · CO≤0) is more compensated in comparison with subclass II B (D – 0.4 · CO> 0).

III class (pronounced) impairment of coordination of bioelectrical activity of paravertebral muscles is described as follows:

.

The data obtained as a result of the examination are displayed in the study card of the bioelectrical activity of the paravertebral muscles.

Clinical example. B-naya S., 7 years old. Diagnosis: poor posture. Under the supervision of the NOU TsChNTs RAMS (Kursk) from 07.06.2004. On examination on October 7, 2004, there was a violation of the coordination of class II A muscle activity (CO = 7.0; D = 2.4). Treatment: orthopedic regimen, symmetrical exercise therapy, massage of the back and abdomen muscles. Re-examination on February 24, 2005 – impaired coordination of class I muscle activity (SD = 4.1; D = 0.1).

Thus, the task was achieved by registering the interference electromyogram of the paravertebral muscles at the level of the spinous processes of the thoracic and lumbar vertebrae with subsequent mathematical analysis of the parameters of bioelectric activity.

A method for assessing the asymmetry of the bioelectrical activity of the paravertebral muscles, characterized in that electromyograms are recorded in the standing position of the subject at the level of the spinous processes of the ThI – LV vertebrae on the right and left using a multichannel electroneuromyograph followed by the calculation of integral indicators of the total deviation (SD):

and decompensation (D):

where i is the designation of the vertebra corresponding to the level of muscle biopotential removal, i = {ThI ;…; Th XII; LI; …; LV};

CP i is the standardized difference at the level of the i-th vertebra,

where A Di is the amplitude of muscle biopotentials on the right;

A Si – amplitude of muscle biopotentials on the left;

max [A Di ; A Si ] – the maximum among the amplitudes of muscle biopotentials at the corresponding level of removal;

and referring the violation of coordination of the bioelectrical activity of the paravertebral muscles to the absence of such, if the condition is met, to class I with; to class II with, including subclass II A with D – 0.4 · CO≤0, subclass II B with D – 0.4 · CO> 0; III class at.

Fabrication of High Contact-Density, Flat-Interface Nerve Electrodes for Recording and Stimulation Applications

Interfacing with the peripheral nervous system (PNS) provides access to highly processed neuro-signals commands as they travel to various structures within the body. These signals are generated by axons enclosed in brochures and surrounded by tightly articulated perineurium cells. The magnitude of the measured potentials due to neural activity depends on the impedance of various layers within the nerve, such as the high-resistance perineurium layer that surrounds the bundles.Consequently, there are two interface approaches have been studied depending on the location of the recording relative to the perineurium layer, namely the intrafascicular and extrafascicular approaches. Intra-fascicular approaches place the electrodes inside the bundles. Examples of such approaches are the Utah array 17, Longitudinal Intra-Beam Electrode (LIFE) 18, and Transverse Intra-Industry Beam Multichannel Electrode (TIME) 32. THESE techniques can record selectively from the nerve, but have not been shown to reliably preserve functionality for extended periods of time in vivo, likely due to size and fit of 12 electrode.

Extra-fascicular approaches place the contacts around the nerve. Cuff electrodes used in these approaches do not compromise perineuria or epineuria and have been shown to be both safe and effective means of recording from the peripheral nervous system 12. However, complementary-beam approaches do not have the ability to measure a single unit of activity – compared to intra-beam designs. Neuroprosthetics applications that use nerve cuff electrodes include lower limb activation, bladder, diaphragm, chronic pain management, nerve conduction block, sensory feedback, and recording electroneurograms 1. Potential applications for the use of peripheral nerve docking include resting movement in paralysis victims with functional electrical stimulation, recording neurons of motor activity from residual nerves to operate mechanized limb prostheses in amputated ones, and interacting with the autonomic nervous system to deliver bio-electronic drugs 20.

The implementation of the electrode cuff design is a flat electrode nerve interface (FINE) 21. This design reshapes the nerve in a flat section with a larger circumference than a round shape. The advantages of this design increases the number of contacts that can be placed on the nerve, and the close proximity of the contacts to the rearranged internal beams for selective recording and stimulation. In addition, the nerves of the upper and lower extremities in large animals and humans can take different shapes and the shape change generated by FINE does not distort the natural geometry of the nerve.Recent studies have shown that FINE is able to restore sensation in the upper limb 16 and restore movement in the lower limb 22 with functional electrical stimulation in the human body.

The basic structure of a cuff electrode consists of placing several metal contacts on the surface of a nerve segment and then insulating these contacts along with a piece of nerve within the non-conductive cuff. To achieve this basic structure, several designs have been proposed in previous studies including:

(1) Metal contacts are embedded in the Mylar mesh. The mesh is then wrapped around the nerve and the resulting cuff shape follows the geometry of the nerve 4, 5.

(2) Split-cylinder structures , which use pre-formed rigid and non-conductive cylinders to secure the contacts around the nerve … The segment of the nerve that receives this cuff is reorganized into the internal geometry of the cuff at 6 8.

Self-winding construction where the contacts are enclosed between two layers of insulation.The inner layer is drained while stretched from the outer un stretched layer. With different lengths of natural rest over the two layers glued together, the final structure is formed to form a flexible spiral that twists around the nerve. The material used for these layers was typically polyethylene 9 polyimide 10, and silicone rubber 1.

(4) bare lengths of wires placed opposite the nerve to serve as electrode contacts.These wires are either braided into silicone tubing 11 or molded into silicone nested cylinders 12. A similar principle was used to build fines by placing and fusing insulated wires to form an array, and then a hole through the insulation is made by stripping a small section through the middle of these connected wires 13. These designs assume a circular cross-section of the nerve and conform to this proposed geometry of the nerve.

(5) -based flexible polyimide electrodes 33 with contacts formed by the microturned polyimide structure, and then integrated into stretched silicone sheets to form self-winding cuffs. This design also assumes a circular nerve cross-section.

Cuff electrodes should be flexible and self-adhesive to avoid nerve stretching and compression, which can cause nerve damage 3. Some of the known mechanisms by which cuff electrodes can induce these effects are the transfer of forces from adjacent muscles to the cuff and therefore to the nerve, a mismatch between the cuff’s and the mechanical properties of the nerve, and excessive stress in the cuff’s leads. These safety issues lead to a certain set of design constraints on mechanical flexibility, geometrical configuration and size -1. These criteria are particularly challenging in the case of high FINE contact counts, because the cuff must at the same time be laterally stiff in order to reshape the nerve and be flexible longitudinally to prevent damage, and to accommodate multiple contacts.Self-adhesive spiral designs can accommodate multiple cuff contacts 14, but the resulting cuff is somewhat stiff. The flexible design of polyimide can accommodate a large number of contacts, but is prone to delamination. Wire construction array 13 produces FINE with a flat cross-section, but in order to maintain this geometry the wires are joined together along the length of the cuff to produce hard edges and sharp edges making them unsuitable for long-term implants.

The manufacturing technique described in this article results in a high contact density FINE with a flexible structure that can be handcrafted with consistently high precision. It uses a tough polymer (polyetheretherketone (PEEK)) to provide precise contact placement. The PEEK segment maintains a flat cross-section at the center of the electrode while remaining flexible longitudinally along the nerve. This design also minimizes the overall thickness and rigidity of the cuff, as the electrode body does not have to be rigid to flatten the nerve or twist the contacts.

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diagnostics, rehabilitation treatment at the Central Clinical Hospital of the Russian Academy of Sciences, Moscow

Sciatica (Sciatica) – back pain, spreading along the back-outer surface of the thigh to the lower leg and foot.

6 main causes of sciatica

Various diseases of the lumbar spine can cause sciatica. Sciatica is often described as moderate to intense leg pain.It is caused by compression of one or more of the five pairs of nerve roots in the lumbar spine. Sometimes doctors call sciatica radiculopathy. Radiculopathy is the medical term used to describe pain, numbness, tingling, and weakness in the arms or legs caused by nerve root problems. If the problem is in the cervical region, the condition is called cervical radiculopathy. Since sciatica affects the lumbar region, it is also called lumbar radiculopathy.

Causes of pain

5 pairs of nerve roots in the lumbosacral region are combined to create the sciatic nerve. Starting at the back of the pelvis (sacrum), the sciatic nerve runs behind the buttocks and down through the hip joint to the lower extremities. Nerve roots are not separate structures, but part of the general nervous system of the body, capable of transmitting pain and sensations to other parts of the body. Radiculopathy is caused by nerve root compression, a ruptured disc, or bone overgrowth before it joins the sciatic nerve.

Compression of the sciatic nerve

Certain types of spinal disorders can cause spinal nerve compression and sciatica or lumbar radiculopathy. The 6 most common ones are listed below:

  • disc herniation;
  • stenosis of the lumbar spine;
  • spondylolisthesis;
  • trauma;
  • piriformis syndrome;
  • spinal tumors.

Protrusion or herniated disc

Disc protrusion is a condition when the central gel-like part of the disc (nucleus pulposus) protrudes towards the spinal canal, while the integrity of the outer wall of the disc (annulus fibrosus) is not compromised. A herniated disc occurs when the nucleus pulposus extends beyond the annulus fibrosus. When a disc protrudes or is herniated, the bulging portion of the disc can compress the adjacent nerve root and cause sciatica.The consequences of a herniated disc are worse. At the same time, the prolapsed nucleus of the disc not only causes direct compression of the nerve root, but at the same time the substance of the disc contains acid, a chemical irritant (hyaluronic acid), which causes inflammation of the nerve. Nerve compression and irritation causes inflammation and pain, often leading to numbness in the limbs, tingling, and muscle weakness.

Stenosis of the lumbar spine

Spinal stenosis is manifested by nerve compression and most often affects adults.Sciatica-like pain in the lower extremities may result from stenosis of the lumbar spine. The pain is usually positional, manifested when changing position of the body, standing up or walking and relieving when sitting. Nerve roots branch off from the spinal cord and exit through the foraminal foramen, bounded by bones and ligaments. Nerve roots emerge from these openings and innervate other parts of the body. When these holes become narrow and cause compression of the nerve, the term foraminal stenosis is used.

Spondylolisthesis

Spondylolisthesis most commonly affects the lumbar spine. In this case, the overlying vertebra is displaced in relation to the underlying one. When the vertebra slips and shifts, the nerve root is pinched, causing sciatica pain in the legs. Spondylolisthesis is divided into congenital and acquired (due to degenerative changes, trauma, exercise, or heavy lifting.

Injury

Sciatica may result from direct compression of the nerve root caused by external forces on the lumbosacral spine.For example, in the event of a road traffic injury, falling, etc. This effect can damage nerves when fragments of broken bone cause compression of the nerves.

Piriformis syndrome

This syndrome is named for the piriformis muscle and pain is caused when this muscle irritates the sciatic nerve. The piriformis muscle is located in the pelvic region, connects the femur and participates in the rotation of the thigh. The sciatic nerve runs underneath the piriformis muscle. Piriformis syndrome develops when this muscle spasms, thus compressing the sciatic nerve.Due to the lack of information content of X-rays and magnetic resonance imaging, the diagnosis of this pathology is difficult.

Tumors of the spine

Tumors of the spine are characterized by abnormal tissue growth and are divided into benign and malignant. The incidence of spinal tumors is quite rare. However, with the development of a tumor of the lumbar spine, there is a risk of sciatica due to compression of the nerve root.

Treatment of sciatica

To create a treatment plan, diagnostics are required, including a neurological examination, X-ray, and magnetic resonance imaging.There are several treatment options available, depending on the cause of sciatica. Conservative therapy includes changes in activity, physiotherapy, anti-inflammatory therapy and various types of blockade to relieve inflammation of the nerve root. Surgical treatment includes removal of a herniated disc through a small incision (microdiscectomy), and in case of stenosis, decompression surgery with partial or complete removal of the vertebral arch (laminectomy).

Effective treatment of sciatica: sciatic nerve inflammation

One of the necessary conditions for the treatment of sciatica (inflammation of the sciatic nerve)
is the elimination of conditions or diseases that compress the roots of the spinal cord
at the level of the lumbar spine or individual sections of the sciatic nerve.

With prolonged pinching of the sciatic nerve, the neurovascular bundle is fused with
fasciae. With the slightest movement, it causes irritation and pain. First task,
The solution that needs to be addressed is to stratify the adhesion between the fascia and the nerve trunk.

Adhesion stratification is prevented by the skew of the pelvic bones, which is diagnosed in 100%
cases in patients diagnosed with sciatica. Without restoring the correct geometry of the pelvis
resolve the issue with the stratification of adhesions and the elimination of pressure on the nerve roots
almost impossible.

Unfortunately, traditional methods do not always solve the problem completely, and the patient does not
gets the desired effect.

Therefore, in order to help a patient with sciatic nerve inflammation, three
tasks: put the hip joint in the correct position, exfoliate the adhesive
processes and restore the configuration of the lower back and joints.

We solve all three of these problems using the author’s methodology, which has been proven over many
years of work and we fix the result on innovative computer simulators.

Unique method of sciatica treatment

Our method allows you to restore muscle-articular balance, as well as remove displacements
and deformities in the parts of the musculoskeletal system in the pelvis, spine and
joints.

For separation of adhesions, we use a special simulator developed by us.Thanks to the elastic deformation effect, the first stage of sciatica treatment takes place.

The essence of the methodology is to selectively influence the target groups of deep
muscles with the help of patented trainers. These muscles are impossible
mind control and exercise on conventional fitness equipment.

Based on many years of clinical experience, the clinic’s specialists know which layers
muscle groups need to be used to relieve pain and further treatment.IN
special training modules set the exact amplitudes, strength, load angle, the
thereby allowing the necessary target groups of deep muscles to be involved in the process.

Features of treatment in our clinic:

one

We help in difficult cases

Our technique restores patients after severe spinal fractures.Treatment of diseases such as sciatica, disc herniation,
osteochondrosis is a relatively simple task for us.

2

Long-term results

Sciatica treatment in our clinic gives results for many years.We are not only
we remove the problem, but also restore the configuration of the spine and muscle
balance.

3

Individual approach

A personal instructor-methodologist works with each patient, who monitors
during the course of treatment and, if necessary, corrects the set of exercises.

Maxim 35 years old (diagnosis of pinched sciatic nerve)
I can honestly
to admit, he was slowly starting to go crazy. Constant pain, constant nervous
irritation.And not only physically, but also emotionally psychologically …

.