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SEGMENTAL INNERVATION OF MUSCLES AND SKIN Pairs of spinal nerves arise from segments of the spinal cord which

are related to original embryonic segments. Spinal nerves are mixed nerves that contain nerve fibres of both sensory and motor neurones. Motor nerves fibres are distributed to groups of muscles, each muscle will receive motor fibres from more than one spinal segment. For example nerve fibres carried in spinal nerve C5 are distributed to several muscles including biceps and brachialis. These muscles also receive fibres from the spinal nerve C6. Muscles which share a common action on a joint (in this case flexion of the elbow joint) are supplied by the same two spinal segments. The antagonistic muscles are likewise supplied by two segments which usually run in numerical sequence. Thus extension of the elbow is brought about by triceps supplied by C7 and C8. In the upper limb this "two and two" segment pattern is not as regular as it is in the lower limb. However we can describe, in effect, spinal centres for joint movements. The spinal centre for the elbow therefore is C5,6,7,8 (C5 &6 control flexion while C7 & C8 control extension). This information is important because it can be used to determine the level of spinal injury and forms the basis of understanding the findings from tendon reflex tests (biceps jerk C6 triceps jerk C7). If a patient had no biceps jerk you can deduce that there must be spinal damage at C6. Sensory nerves are distributed in named cutaneous nerves such as the lateral cutaneous nerve of the forearm (LCNFA). This particular nerve carries fibres from three spinal segments C5, 6 and 7 and its distribution can be mapped onto the surface of the skin in those patients who have damaged that particular nerve. What would be the sensory deficit in a patient who had damaged the axillary nerve? Different maps can be described however which show the pattern of distribution of sensory fibres from a single spinal segment e.g. C5. The term dermatome is used to refer to an area of skin that is supplied by a single spinal segment. Sensory fibres with their cell bodies in the dorsal root ganglion of C5 are distributed in the cutaneous branches of the axillary and radial nerves as well as in the LCNFA. In general therefore C5 is distributed on the lateral side of the arm. If there was a lesion of C5 then this entire area would be affected, whereas if there was damage to the cutaneous branch of the axillary nerve then a smaller area (over the lower part of deltoid) would be involved. Knowledge of dermatomes may be useful in the diagnosis of spinal damage. There is overlap between adjacent dermatomes, particularly in the trunk and there is variation between individuals particularly in the limbs. Although the dermatomes can be used to localise the site of a nerve lesion they should be interpreted cautiously; maps of typical dermatomes vary considerably. Compare the dermatome maps in different texts. You may notice for example that British and American authors vary. In general: C4 infraclavicular region, shoulder and above the spine of the scapular C5 lateral arm C6 lateral forearm and thumb C7 middle finger C8 little finger and medial forearm T1 medial arm above and below elbow T2 medial arm axilla and thorax.