Referred Pain to the Knee in Hip Diseases : A Case Series Study / The Japanese Journal of Rehabilitation Medicine

Patient 1, a 75-year-old woman with a past history of osteoarthritis of the right knee and Parkinson disease, had a subarachnoid hemorrhage. She complained of right knee pain during her rehabilitation. It turned out that she had sustained a right trochanteric fracture after falling out of bed in another hospital. Patient 2, an 86-year-old woman with a past history of rheumatoid arthritis, was treated with the Gamma nail technique for a left trochanteric fracture. She described experiencing pain in the region from the left knee to the lateral side of the left thigh during her rehabilitation, about two months after the hip operation. X-ray and computed tomography images showed varus displacement of the femoral head due to screw cut-out. In each of these cases, it took some time for us to detect the underlying hip diseases. The dermatome shows regions of the skin innervated by each single spinal segment. Similarly, the sclerotome shows regions of bone and periosteum innervated by each single spinal segment. According to Inman and Saunders's sclerotome, the proximal portion of the femur is mainly innervated by L3, L4 and L5. On the other hand, in dermatome perspective, L3, L4 and L5 innervate the knee and region around the knee. It means that hip diseases can cause referred pain to the knee.Untypical pain in distant regions from the hip joint makes it difficult to examine the hip joint and causes delay in an accurate diagnosis, as in the cases just described. Therefore, we should keep in mind that hip diseases can cause referred pain to the knee.

On the Variations of Cervical Dermatomes.

Background: Nerve-root related dermatomes have been considered to have quite solid anatomical framings. However, especially in the lumbar region, studies have questioned such firm anatomy. Regarding the cervical nerve roots, many studies have shown an overlap between different dermatomes, which of course affects decisions taken in the clinical work. All the same, dermatome drawings with clear borders are still widely used. Context and purpose of the study: We conducted a literature review in order to find today’s state of the art, including the methods on which the anatomical atlases have been based. The overall pragmatic thoughts were to create summarized guide for clinicians when trying to correlate an MRI-demonstrated prolapse/recess stenosis to pain and neurologic findings, particularly if the nerve root’s peripheral neurology does not follow conventional anatomy. Results: We isolated 24 studies that sufficiently dealt with the issue of cervical dermatomes. Pain and sensory disturbance caused by cervical root affection could deviate from the dermatomal patterns. We found indications that sometimes no paralysis or anaesthesia would be seen after section of a single root. Because the fraction of cases without classical fit between nerve root and anatomical level cannot be given, studies should go into this issue. Conclusion: There are many studies showing that dermatomal distributions are varying, and not only overlapping. We therefore mean that new studies, with modern imaging and surgical techniques, are much needed.

Virtual medical and pedagogical applicability of human dermatome patterns: critical review of the literature

Dermatome is an area of skin supplied by the posterior (sensory) root of a spinal nerve derived from a single cord segment, which is a particular aspect of the peripheral distribution of sensory fibers. Its topographic study is important to identify nerve, radicular, or medullary damage. When mapped, these dermatomes are outlined on the body surface and their assessment poses a special challenge to physicians once the distinguished imaging methods are not concordant in some aspects. Computers have taken over increasingly importance as transmitters of anatomical information in both clinical and educational sceneries. The present study concerning the virtual teaching and learning of the human dermatome patterns carries out an update of the literature and its clinical and radiological applicability. Computed-based anatomy programs do not only complement conventional instructions methods, but also provide the groundbreaking means to represent, standardize, and disseminate knowledge of dermatomes. Computer-based programs capable of standardizing a tridimensional map of human dermatomes still need to be developed.

C5 and C6 human dermatomes: a clinical, electromyographical, imaging and surgical findings / Dermátomos humanos C5 e C6: estudo clínico, eletromiográfico, de imagem e cirúrgico

There is substantial controversy in literature about human dermatomes. In this work, C5 and C6 superior limb dermatomes were studied. The method consisted of comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging findings obtained by computerized tomography (CT) or magnetic resonance imaging (MRI), for each patient. Data analysis from superior members in 18 patients suggests that C5 is located in the lateral aspect of the shoulder and arm, and C6 in the lateral aspect of the forearm and 1st, 2nd, and 3rd fingers. To our knowledge this is the first time that C5 and C6 human dermatomes have been studied by all the following methods together: clinical, electromyographical, CT and MR imaging, and surgical findings.

Há controvérsias na literatura sobre os dermátomos humanos. Neste estudo os dermátomos do membro superior C5 e C6 foram analisados. O método consistiu em comparar os sinais e sintomas com achados eletromiográficos, de imagem e achados cirúrgicos. Análise dos dados do membro superior de 18 pacientes sugere que o dermátomo C5 esteja localizado na região lateral do ombro e braço, e o dermátomo C6 na região lateral do antebraço e 1º, 2º e 3º dedos da mão. Este é o primeiro estudo em que os dermátomos C5 e C6 foram avaliados pelos dados clínicos, eletromiográficos, de imagem e achados cirúrgicos.

L4-L5-S1 human dermatomes: a clinical, electromyographical, imaging and surgical findings / Dermátomos humanos L4, L5 e S1: achados clínicos, eletromiográficos, de imagem e cirúrgicos

There is substantial controversy in literature about human dermatomes. We studied L4, L5, and S1 inferior limb dermatomes by comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging data from computerized tomography (CT) or magnetic resonance imaging (MRI). After analyzing 60 patients, we concluded that L4 is probably located in the medial aspect of the leg, L5 in the lateral aspect of the leg and foot dorsus, and S1 in the posterior aspect of the backside, tight, leg and plantar foot skin. This is the first time that these human dermatomes have been evaluated by combined analysis of clinical, electromyographical, neurosurgical, and imaging data.

Há controvérsia na literatura sobre os dermátomos humanos. Estudamos dermátomos do membro inferior comparando sinais e sintomas com estudos eletromiográficos, de imagem e achados cirúrgicos. Analisando 60 pacientes, concluímos que o dermátomo L4 provavelmente está localizado na região medial da perna, o dermátomo L5 na região lateral da perna e dorso do pé, e o dermátomo S1 na nádega, região posterior da coxa e da perna e na região plantar. Este é o primeiro estudo que os dermátomos do membro inferior foram analisados através de dados clínicos, eletromiográficos, imagem e achados cirúrgicos.

A Case of Segmental Neurofibromatosis of the Left Parietal Scalp in a 76-year-old woman / 대한피부과학회지

Segmental neurofibromatosis is a rare skin disorder characterized by neurofibromas and/or cafe-au-lait spots, limited to one dermatome of the body1. This disorder was first described by Gammel2 in 1931. The neurofibromas of segmental neurofibromatosis are commonly occupied by either a thoracic or a cervical dermatome and are unilateral, occuring more often on the right side than the left in young adults. According to Korean Dermatologic literature, 11 cases of segmental neurofibromatosis were reported. Among them, 7 cases showed unilateral involvement and 4 cases showed bilateral dermatomal involvement. We report a case of segmental neurofibromatosis which developed in a 76-year-old female. The skin lesions were situated on the left parietal scalp of the C2 dermatome, and had not been previously reported. We recommended surgical excision, but the patient refused further treatment.

A Case of He rpes Zoster Meningitis with Involving Multiple Dermatomes

Herpes zoster is manifested by varicella zoster virus(VZV) that involve nerve ganglions. It may be self limited, but some may have complications or sequelae, such as postherpetic neuralgia, optic neuritis, external ocular motor nerve palsy, facial nerve palsy, encephalitis or hemiplegia. It usually involves posterior root ganglia, but there are few case reports involving multiple dermatome with meningitis simultaneously. We report a patient with herpes zoster meningitis involving with multiple dermatome. A 64 year-old female presented with intractable headache, vomiting, and multifocal skin eruptions. Physical examination showed multiple vesicular eruptions on right forehead and upper limb along the dermatomes of V1, C4, C5, C6, C7. There was no localizing or lateralizing sign except for neck stiffness. Brain CT showed no abnormal finding. In the CSF study, the opening pressure was 200 mmH2O and cell count was 36/mm3 in RBC, 1,043/mm3 in WBC(95% lympho-dorminant). The level of protein and glucose were 671mg/dL, 127 mg/dL(serumglucose 270 mg/dL), respectively. It was positive in VZV-PCR, and was negative in tumor marker studies. Under the diagnosis of Herpes zoster meningitis, she was treated and improved with antiviral agent(acyclovir). We report a patient with herpes zoster meningitis involving polydermatomes simultaneously.