This page is offered by Simon who became a quadriplegic after a car crash. He has a phenomenal site that helps people understand the complexity of spinal damage and shows how you can choose to do what you want to do in life anyway. Some people let life happen others make things happen. Simon makes things happen! Please visit his site by clicking on the banner on the bottom of this page
This page describes the role of dermatome and myotome locations and how you can have pain at one area when the damage is really somewhere else. We urge people to take a dermatome map into your doctor and show them the pain patterns
Spinal nerves have motor fibers and sensory fibers. The motor fibers innervate certain muscles, while the sensory fibers innervate certain areas of skin. A skin area innervated by the sensory fibers of a single nerve root is known as a dermatome. A group of muscles primarily innervated by the motor fibers of a single nerve root is known as a myotome. Although slight variations do exist, dermatome and myotome patterns of distribution are relatively consistent from person to person.
myotomes-dermatomes by permission Apparelyzed.com
Myotomes
Myotomes- Relationship between the spinal nerve & muscle Dermatomes – Relationship between the spinal nerve & skin.
Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve. The muscle, and its nerve make up a myotome. This is approximately the same for every person and are as follows:
C3,4 and 5 supply the diaphragm (the large muscle between the chest and the belly that we use to breath).
C5 also supplies the shoulder muscles and the muscle that we use to bend our elbow .
C6 is for bending the wrist back.
C7 is for straightening the elbow.
C8 bends the fingers.
T1 spreads the fingers.
T1 –T12 supplies the chest wall & abdominal muscles.
L2 bends the hip.
L3 straightens the knee.
L4 pulls the foot up.
L5 wiggles the toes.
S1 pulls the foot down.
S3,4 and 5 supply the bladder. bowel and sex organs and the anal and other pelvic muscles.
Dermatomes
Dermatome Apparelyzed.com used by permission Click to enlarge (2009)
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Dermatome is a Greek word which literally means “skin cutting”. A dermatome is an area of the skin supplied by nerve fibers originating from a single dorsal nerve root. The dermatomes are named according to the spinal nerve which supplies them. The dermatomes form into bands around the trunk but in the limbs their organisation is more complex as a result of the dermatomes being “pulled out” as the limb buds form and develop into the limbs during embryological development.
In diagrams or maps, the boundaries of dermatomes are usually sharply defined. However, in life there is considerable overlap of innervation between adjacent dermatomes. Thus, if there is a loss of afferent nerve function by one spinal nerve sensation from the region of skin which it supplies is not usually completely lost as overlap from adjacent spinal nerves occurs: however, there will be a reduction in sensitivity.
Radio Frequency Ablation (Denver Pain Management ,2009)
Radiofrequency (RF) and pulsed radiofrequency (PRF) neurolysis are techniques used to treat chronic pain that is transmitted through the sensory nerves. RF neurolysis utilizes heat to destroy selected nerve fibers, which block pain transmission through the neural pathway. These techniques are used when intermittent anesthetic injections no longer provide extended pain relief.
Chronic cervical, lumbar and sacral pain can come from your facet joints. These pain signals can be interrupted by blocking the nerve to the facet joint with an anesthetic injection this is very temporary (facet block), For longer lasting relief the nerve can be heated using a radiofrequency wave (radiofrequency ablation) . This can often prevent the neural transmission of pain. The nerve to the facet joint is sometimes referred to as the “medial branch” and therefore a facet nerve block is also referred to as “medial branch” block. These blocks are performed as a part of a diagnostic workup for back or neck pain. Relief following a precise injection of local anesthetic confirms the facet joint as the source of pain.
Radiofrequency neurolysis is a procedure in which sensory afferent nerve fibers are selectively destroyed with heat produced by radio waves delivered through an electrode. Treatment objectives are to eliminate pain, reduce the likelihood of recurrence and prolong the time to recurrence by selectively destroying pain fibers without inducing excessive sensory loss, motor dysfunction, or other complications. Radiofrequency (RF) neurolysis carries the potential risk of neuritis (nerve inflammation). Histological studies have revealed indiscriminate destruction of both small and large fibers following RF treatment.
Pulsed radiofrequency is thought to be a less destructive alternative to standard RF in that it applies RF energy with a pulsed time cycle that delivers short bursts of RF current instead of a continuous RF flow. By pulsing the electrical current, the needle remains relatively cool (up to 42 degrees celsius compared to temperatures of 60-69 degrees celsius with continuous RF) so that the tissue cools slightly between each burst, reducing the risk of destroying nearby tissue and preventing any long-term damage to the nerve. The reasoning behind this is transmission of impulses across small unmyelinated fibers is disrupted while larger fibers remain protected by the myelin sheath.
Some researchers show short term success with pulsed radio frequency in comparison to radio frequency lesioning. However others are reporting success rate of over nineteen months. It would seem that results could be altered by the skill of the spine care practitioner it is crucial to choose carefully.
DIGITAL MOTION X-RAY® is a diagnostic test that records real time, full motion x-ray imaging of any body joint in motion. DMX® can often unlock the mystery of spinal pain. It is common knowledge among spinal care professionals including surgeons that damage to ligaments, tendons and underlying support structures can not be corrected with surgery or physiotherapy alone. Until now it has been difficult to diagnose these injuries objectively. Serious ligamentous and facet joint injuries are well documented at autopsy however this is not a working solution for live patients in need of care! Should you ask your doctor to order a DMX® exam for you?…. To find out ask yourself these questions:
• Do I have pain in one or more of my joints that increases with motion?
• Did I injure myself with a sudden jolt to one or more of my joints, as a whiplash injury, slip and fall or blow from a sporting activity?
• Do I have joint pain, the cause of which has not been determined by conventional x-ray, MRI or other diagnostic tests?
If you have answered yes to any of the above, consider a DMX® examination.
Stretched and torn ligaments can result in a condition called “kinesiopathology” or abnormal motion of the bones that make up the joint. This abnormal motion results in ongoing rubbing and grinding of the bone surfaces during motion, preventing normal healing, and leading to premature onset of degenerative joint disease, a wear and tear type of arthritis. DMX® can fully evaluate internal joint motion, and properly screen for kinesiopathology
What Makes DMX® unique?
Good question! Auto accident injuries occur in milliseconds, too quick for the human nervous system to react and protect. This leaves only bones and ligaments to protect the body. Since cervical bones are rarely broken, the connective tissues are most commonly injured.
The Hidden Culprit – Ligaments
Ligaments are connective tissue that attach bone to bone. The purpose of ligaments is to keep bones in proper position, and work similar to hinges on a door. It has been suspected that ligaments are damaged easily, but until now, it has been difficult to diagnose ligamentous injuries. DMX® can demonstrate these injuries in as little as 15 minutes.
DMX® visually demonstrates aberrant movement of bones, allowing the radiologist to specifically determine which ligaments are injured. Treatment can then be tailored to the patient’s need and progress can be assessed with the help of DMX®. Promising solutions for tissue regeneration are currently in development at the Spinal Injury Foundation.
With the help of DMX® these injuries can be seen from the inside out
A perfect egg sample
Common sense will tell you that one cannot determine the injury an accident victim has suffered by merely looking at the outer shell of the car. When we buy eggs, how often do we open the carton to check if the eggs on the inside are broken? Every time!
Experience teaches that we cannot determine the condition of the egg by looking at the container. The same holds true for a person’s body – the evidence is in the person’s body, not the car.
Although high TESLA MRIs can pick up ligament damage they are sometimes less available that DMX. For information on MRIs see this link
Cervical spine showing nerve compression from Wikipedia 2009
Anterior cervical diskectomy is an operation performed on the upper spine (neck) to relieve pressure on one or more nerve roots, or on the spinal cord. The procedure is explained by the words anterior (front), cervical (neck), and diskectomy (cutting out the disc).
ACD is a surgery used as neck and arm pain, among other symptoms, may occur when an intervertebral disc herniates. This happens, either suddenly with injury or slowly over time, when some of the disc’s jelly-like center (the nucleus pulposus) bulges or ruptures through its tough, fibrous outer ring (the annulus fibrosus) and presses on a nerve. When a disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord. This pressure causes symptoms in the neck, arms, and even legs. Further pressure may be caused by rough edges of bone, called bone spurs, that naturally build up around some herniated discs. If at all possible it is best to not have this done unless it is pressing on a nerve or the spinal cord, if it is a surgeon will often advise the surgery to avoid further damage to the nerve or spinal cord.
In this operation, the cervical spine is reached through a small incision in the front of your neck. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed. The space left between the vertebrae may be left open or filled with a small piece of bone. In time the vertebrae may fuse, or join together.
If used, the pre-formed bone graft may be obtained from a bone bank. It will not be rejected by your body, because it is avascular (contains no blood cells) or artificial bone protien can be used. In some circumstances, or if your surgeon prefers, the bone graft might instead be removed from your own hip through a second incision.
Anterior cervical diskectomy is not the only solution. A minimally invasive surgery can be done which leaves almost no scar. This link will lead to where you can see a four minute movie of the procedureThe results are best with single level sugery. There are also procedures which are used to patch tears. Autologous stem cell therapy (using your own stem cells) and platelet rich plasma or PRP can be used to fix tears which can be a major source of pain because of the leakage of fluid which irritates the surrounding tissue.
Some people have artificial disks inserted , rather than a diskectomy or fusion. A great place to get information on this option is the ADR support community
There is considerable press given to the relationship between inflammation, trauma and cancer. This is a concern for trauma survivors who have topped the stress index due to litigation, job loss, relationship tension, drug use, traumatic injury and more. I find there is an almost fatalistic waiting for the blow to come because our stress points have been exceeded. It was with interest that I viewed multiple research articles that shows this link is not as solid statistically or from a science perspective as we were all lead to believe and that trauma only slightly increases cancer risk.
Cancer is actually a multifactorial disease and several areas have to go wrong before a malignancy occurs. People who are susceptible generally have a genetic mutation in the cellular ability to repair itself, or the off signal is defective and the cell grows consistently past its prime. Other areas of the DNA can still catch this by killing off the rogue section but in some people the gate keeper has ceased to work. Even then it takes multiple generations of mutated cells to form a cancer. The cancer cells examined under a high powered microscope look like they have exploded from the inside out. The tendency for mutations to grow out of control multiplies as we age simply because many of them are caused by things in our lifestyle or environment. I had heard erroneously that we all have cancer cells in our body and one day something just goes wrong. This always made me feel that there could be a betrayer with in me whom I could not know until I was already defeated.
The human body is actually much more ordered than this. Three types of genes are involved in cancers, oncogenes which are mutated proto-oncogenes (the signal to stop growing is broken) ,these cell promote cell division and and growth. Then there are tumor -suppressor genes which tell the cell when to stop dividing and finally there are the DNA repair genes which if they are defective let mutation continue unrepaired. So individuals can inherit variants that increase their susceptibility to some cancers but even then it is is not a death sentence.
It is said that at least 30% of cancers are provoked by our lifestyle and that a stable life where we exercise, eat right and avoid smoking and other pollutants can indeed reduce mutations and increase quality of life. Humor and affection also help as they do reduce the stress response and gently lead us away from the bad habits that cause mutations.
So live life to the fullest and be kind to be your personal best. Seven years after severe injuries and multiple stress factors my husband and I found our way back to blood pressure and heart rates that a teen would envy. Indeed some of the degeneration we were consistently assured would put us in wheelchairs has slowly submitted to the power of a life well lived. Before the trauma we never really knew our neighbors, we were too busy globe trotting to form relationships. I recently aarrived home to find homemade cookies in my mailbox, fresh orchids and basil plants left with love and all my school books carefully protected by the mail man until my return. I still never see a day without physical pain but I am glad to be alive. Life is not over it is just different. There is life after trauma!
Ligament injuries can be more painful and take longer to heal than a broken bone. They are common in traumatic injuries like a car crash, fall or sports injury. A ligament is a tough band of white, fibrous, slightly elastic tissue. They are an essential part of the skeletal joints; binding the bone ends together to prevent dislocation and excessive movement that might cause breakage. Some people like to compare ligaments to duct tape; they hold bones together. Another way of seeing this is to compare ligaments with elastic. Have you ever had favorite clothes where the elastic goes and loses its ability to follow and cling to your body? This is how lax ligaments work in your body. Torn ligaments could be compared to a fan belt in your care or a belt in your clothes dryer or vacuum cleaner, once it tears there is no real way to fix the problem because each time the appliance is used it puts pressure on the belt. Ligaments contain signaling features which tell the bones how much to move. Ligaments also protect the joints and nerves. When these structures are injured, the body works to rebuild them but this is a slow process. A severe ligament tear can take 18 months to heal whereas a broken bone heals in weeks. When the tear is bad and the ligament can’t heal the surrounding muscles work overtime and the nerves do not have the same degree of protection which can lead to chronic pain and atrophy of the surrounding muscles. Severe ligament injuries that can’t heal produce instability in the surrounding structures. When this happens, deep supporting muscles get weak, nerves get irritated (causing more muscle weakness), and joints get inflamed and painful. Ligament injuries may be accompanied by popping and cracking. Tight muscles and bad posture that come from the strain of chronic pain and injury can also cause cracking and popping however in this case the popping and cracking relieves pain and pressure. When popping and cracking makes you feel worse and produces more pain, numbness, or burning; it may be due to instability. Special x-ray techniques called flexion-extension views could be done to rule-out any type of instability. Ligament injury can be treated with prolotherapy and adult stem cell treatment. Ligament repair can treat the injured areas as well but surgery is invasive, there is extensive rehabilitation and considerable down time. Targeted physiotherapy can be used to strengthen the area around the ligament to give it the opportunity to heal. Sometimes bracing is used to rest the area to give it time to recover however this is a temporary solution to reduce pain and used long term can make the situation worse because the surrounding support areas weaken with lack of use. There are some antibiotics such as ciproflaxin which can make hinder ligament repair. Anti-inflammatories can also slow the healing process for ligament injury. Supplements that promote cell health such as vitamin C, Glucosamine, Fish oil supplements and anti-oxidants can help. It is important to have high quality protein in your diet to promote a healthy balance of amino acids which help your cells increase the building blocks needed to heal. Getting enough sleep and regular exercise is important. Stress slows your body’s ability to heal. Learning stress busting techniques or avoiding stressors promotes health.
Prolotherapy prompts the body to naturally heal damaged and degenerated tissues. This is not a steroid which can block healing by inhibiting the natural inflammation cycle whereby new cells can regenerate and repair tissue, but a natural substance that promotes healing. In Roman times, soldiers with joint injuries would have those wounds cauterized to promote healing and reduce infection. While modern techniques are much more sophisticated, the concept is the same.
Prolotherapy works by prompting your body’s natural repair mechanisms to heal damaged or degenerated tissues. It’s done when ligaments have been stretched/damaged or torn. This technique can be used in most joints that are unstable. It’s most commonly used for SI joint dysfunction with instability or chronic low back pain. This technique can help repair some of the ligaments and provide normal support to the joint. While most of our daily injuries heal completely, severe ligament tears, degenerated and worn out tissues, and those with a poor blood supply (such as in the knee) don’t usually mend themselves. This is because low grade inflammation is taking place and causing pain but it is not strong enough to signal initiation of the repair process.
Prolotherapy practitioners start by injecting a growth factor stimulant which is not a growth hormone or steroid, but contains a mild irritant such as glucose mixed with local anesthetic to trigger healing response in the damaged area. This otherwise harmless, natural substance, causes a brief period of inflammation 3-5 days after the injection which triggers inflammation that causes the body to release it’s own natural growth factors in the injured tissue.
Most practitioners do these injections in a series, with 3-6 times being considered the norm. This technique can be used in most joints that are unstable. It’s most commonly used for SI joint dysfunction with instability or chronic low back pain. These go to work immediately, directing your body’s natural healing mechanisms to repair damaged and degenerated tissue. The first stage of healing usually takes about a week, but the tissue continues to restore itself for 4-6 weeks after the injection.
It is very important that this treatment is done with fluoroscopy guidance. Fluoroscopy is like an xray movie. Some doctors inject with out xray guidance. For this treatment to be effective it needs to be precisely targeted and done by a practitioner who is getting consistently good results for treatment. It may be good to ask the doctor for the name of a couple of satisfied recipients. They will be able to tell you about the procedure and what to expect as well.
Of the 1.4 million who sustain a TBI each year in the United States: 50,000
die; 235,000 are hospitalized; and 1.1 million are treated and released from an
emergency department. The number of people with TBI who are not seen in an
emergency department or who receive no care is unknown.
Major causes of TBI are: Falls (28%); Motor vehicle-traffic crashes
(20%); Struck by/against events (19%); and Assaults (11%). TBI costs the USA
approximately 60 billion dollars per year in care and lost productivity (Statistics supplied by BIAA)
TBI can cause a wide range of functional changes affecting thinking, language, learning, emotions, behavior, and/or sensation. It can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.
Survivors report the areas they most need help are: Improving memory and problem solving; Managing stress and emotional upsets; Controlling one’s temper; and improving social and employment skills.
A mind is a terrible thing to lose…if you have sustained a head injury all is
not lost help is available .The links above in blue contain help and information.
We are often asked how do I find a good treating professional? Ask your local brain injury association. Word of mouth is good. Check with healthcare facilities, neighbors and friends. Find a professional who will work with you or your family member to get results rather than just tell you to learn to adjust to the problem.
Here is a place where you can try brain games for free. This site is monitored by scientists from Stanford university who are collecting brain function data for a mega study.
