Lumbar Pain Maps: Difference between revisions
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==Lumbar Facet Joints== | ==Lumbar Facet Joints== | ||
[[File:Lumbar Facet pain.PNG]] | [[File:Lumbar Facet pain.PNG]] | ||
From | |||
From Manchikanti | |||
== Lumbar Interspinous Ligaments == | == Lumbar Interspinous Ligaments == | ||
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[[File:kellgren lumbar pain.PNG|600px|Referred pain patterns from noxious stimulation of the lumbar interspinous ligaments. Kellgren 1939.]] | [[File:kellgren lumbar pain.PNG|600px|Referred pain patterns from noxious stimulation of the lumbar interspinous ligaments. Kellgren 1939.]] | ||
==Lumbar Radicular Pain== | |||
{{Main|Lumbar Radicular Pain}} | |||
===Sensory Deficit Maps with Nerve Block=== | |||
In 1993 Nitta et al looked at dermatome patterns by doing fluoroscopically guided spinal nerve anaesthetic blocks in patients with radicular pain. They found the following sensory deficits.<ref>{{#pmid:8235861}}</ref> | |||
<gallery widths=250 heights=250> | |||
File:L4 nerve block sensory deficit Nitta.png|L4 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral and anterior side of the thigh and the medial side of the leg to the first digit of the foot. | |||
File:L5 nerve block sensory deficit Nitta.png|L5 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the posterior, lateral aspect of the thigh and leg, to the 5th digit of the foot. | |||
File:S1 nerve block sensory deficit Nitta.png|S1 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral side of the thigh, the lateral side of the leg, and the medial side of the dorsum of the foot to the first digit. | |||
File:L4-S1 nerve block distinctive sensory deficit Nitta.png|Distinctive regions. L4 is medial side of the lower leg in 88%. L5 is first dorsal digit in 82%. S1 is lateral side of 5th digit in 83%. | |||
File:L4-S1 nerve block band like Nitta.png|Proportion having band like deficits. | |||
</gallery> | |||
[[ | ===Inadvertent Pain Maps during TFI=== | ||
Furman et al in 2019 mapped lower limb radicular symptoms based on inadvertent pain patterns during supraneural [[Lumbar Transforaminal Epidural Steroid Injection|transforaminal injections]], the data is modified in table format below. They confirmed that history and pain charts cannot predict the nerve root level. The buttock is a very common pain referral location across all nerve roots, while pain in the thigh and leg frequently follows dermatomal distributions. A significant limitation of the study is that injectate in transforaminal injections frequently traverses segment levels.<ref>{{#pmid:29800710}}</ref> | |||
{| class="wikitable" | |||
|- | |||
! Nerve Root!! L3 !! L4 !! L5 !! S1 | |||
|- | |||
|Buttock || style="background: #75D1F5;"|45% || style="background: #75D1F5;"|43% || style="background: #429EC2;"|62% || style="background: #429EC2;"|64% | |||
|- | |||
|Groin || style="background: #ffffff;"|0% || style="background: #F4FFFF;"|3% || style="background: #ffffff;"|0% || style="background: #ffffff;"|0% | |||
|- | |||
|Anterior Thigh || style="background: #C2FFFF;"|27% || style="background: #C2FFFF;"|29% || style="background: #DBFFFF;"|12% || style="background: #ffffff;"|0% | |||
|- | |||
|Posterior Thigh || style="background: #8EEAFF;"|36% || style="background: #C2FFFF;"|25% || style="background: #5CB8DC;"|59% || style="background: #8EEAFF;"|36% | |||
|- | |||
|Medial Thigh || style="background: #DBFFFF;"|18% || style="background: #DBFFFF;"|11% || style="background: #F4FFFF;"|3% || style="background: #ffffff;"|0% | |||
|- | |||
|Lateral Thigh || style="background: #ffffff;"|0% || style="background: #DBFFFF;"|14% || style="background: #F4FFFF;"|9% || style="background: #ffffff;"|0% | |||
|- | |||
|Knee || style="background: #F4FFFF;"|9% || style="background: #F4FFFF;"|7% || style="background: #F4FFFF;"|6% || style="background: #F4FFFF;"|9% | |||
|- | |||
|Anterior Leg || style="background: #ffffff;"|0% || style="background: #DBFFFF;"|14% || style="background: #F4FFFF;"|3% || style="background: #ffffff;"|0% | |||
|- | |||
|Posterior Leg || style="background: #DBFFFF;"|18% || style="background: #DBFFFF;"|18% || style="background: #5CB8DC;"|50% || style="background: #75D1F5;"|45% | |||
|- | |||
|Medial Leg || style="background: #ffffff;"|0% || style="background: #F4FFFF;"|7% || style="background: #F4FFFF;"|6% || style="background: #ffffff;"|0% | |||
|- | |||
|Lateral Leg || style="background: #F4FFFF;"|9% || style="background: #DBFFFF;"|14% || style="background: #C2FFFF;"|24% || style="background: #ffffff;"|0% | |||
|- | |||
|Foot || style="background: #ffffff;"|0% || style="background: #F4FFFF;"|3% || style="background: #ffffff;"|0% || style="background: #ffffff;"|0% | |||
|} | |||
==See Also== | ==See Also== | ||
[[Somatic Referred Pain]] | *[[Sacroiliac Pain Maps]] | ||
*[[Somatic Referred Pain]] | |||
*[[Thoracic Pain Maps]] | |||
*[[Cervical Pain Maps]] | |||
[[ | ==References== | ||
[[Category:Lumbar Spine]] | |||
[[ | [[Category:Pain Maps]] | ||
[[Category:Stubs]] | |||
Latest revision as of 19:05, 3 January 2022
Lumbar Facet Joints
From Manchikanti
Lumbar Interspinous Ligaments
Lumbar Radicular Pain
- Main article: Lumbar Radicular Pain
Sensory Deficit Maps with Nerve Block
In 1993 Nitta et al looked at dermatome patterns by doing fluoroscopically guided spinal nerve anaesthetic blocks in patients with radicular pain. They found the following sensory deficits.[1]
L4 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral and anterior side of the thigh and the medial side of the leg to the first digit of the foot.
L5 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the posterior, lateral aspect of the thigh and leg, to the 5th digit of the foot.
S1 block pattern: Extending from the midline of the trunk posteriorly, across the buttock, through the lateral side of the thigh, the lateral side of the leg, and the medial side of the dorsum of the foot to the first digit.
Distinctive regions. L4 is medial side of the lower leg in 88%. L5 is first dorsal digit in 82%. S1 is lateral side of 5th digit in 83%.
Proportion having band like deficits.
Inadvertent Pain Maps during TFI
Furman et al in 2019 mapped lower limb radicular symptoms based on inadvertent pain patterns during supraneural transforaminal injections, the data is modified in table format below. They confirmed that history and pain charts cannot predict the nerve root level. The buttock is a very common pain referral location across all nerve roots, while pain in the thigh and leg frequently follows dermatomal distributions. A significant limitation of the study is that injectate in transforaminal injections frequently traverses segment levels.[2]
| Nerve Root | L3 | L4 | L5 | S1 |
|---|---|---|---|---|
| Buttock | 45% | 43% | 62% | 64% |
| Groin | 0% | 3% | 0% | 0% |
| Anterior Thigh | 27% | 29% | 12% | 0% |
| Posterior Thigh | 36% | 25% | 59% | 36% |
| Medial Thigh | 18% | 11% | 3% | 0% |
| Lateral Thigh | 0% | 14% | 9% | 0% |
| Knee | 9% | 7% | 6% | 9% |
| Anterior Leg | 0% | 14% | 3% | 0% |
| Posterior Leg | 18% | 18% | 50% | 45% |
| Medial Leg | 0% | 7% | 6% | 0% |
| Lateral Leg | 9% | 14% | 24% | 0% |
| Foot | 0% | 3% | 0% | 0% |
See Also
References
- ↑ Nitta et al.. Study on dermatomes by means of selective lumbar spinal nerve block. Spine 1993. 18:1782-6. PMID: 8235861. DOI.
- ↑ Furman & Johnson. Induced lumbosacral radicular symptom referral patterns: a descriptive study. The spine journal : official journal of the North American Spine Society 2019. 19:163-170. PMID: 29800710. DOI.
