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Cervical Pain Maps

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Facetogenic Pain

Symptomatic Patients

Cooper et al (C1/2 to C6/7)

Cervical Pain Maps for Medial Branch Blocks
  • C1-2

    C1-2

  • C2-3

    C2-3

  • C3-4

    C3-4

  • C4-5

    C4-5

  • C5-6

    C5-6

  • C6-7

    C6-7

  • C0-3

    C0-3

  • Blank Grid

    Blank Grid

  • Probabilities C1-C4

    Probabilities C1-C4

  • Probabilities C4-C7

    Probabilities C4-C7

Full Image: File:Cervical Pain Maps Grid.jpg [1]

Media:Cervical_Zygapophysial_Joint_Pain_Maps_-_Cooper_2007.pdf

Fukui et al (C0/1 to C7/T1)

61 symptomatic patients with suspected facet joint pain. Pain reproduced by injection of contrast medium into the joints or by electrical stimulation of the dorsal rami. Below shows the main pain distributions from C0-1 to C7/T1, and the dorsal rami C3 to C7[2]

Cervical facet joint pain map fukui.png

The distribution of referred pain for each zygapophyseal joint.
Joint Pain Referral
C0/1 Occipital region (30%), upper posterolateral cervical region (100%)
C1/2 Occipital region (20%) and upper posterolateral cervical region (100%).
C2/3 Upper posterior cervical region (64%), occipital region (50%), and upper posterolateral cervical region (50%)
C3/4 Upper posterior cervical region (76%), middle posterior cervical region (52%), and occipital region (38%)
C4/5 Lower posterior cervical region (76%), middle posterior cervical region (54%), and suprascapular region (43%)
C5/6 suprascapular region (50%),lower posterior cervical region (46%), superior angle of the scapula (35%), middle posterior cervical region (15%), and shoulder joint (11%)
C6/7 superior angle of the scapula (48%), mid-scapular region (41%), lower posterior cervical region (33%), shoulder joint (15%),and suprascapular region (11%).
C7/T1 Mid-scapular region (86%) and superior angle of the scapula (28%)
The distribution of referred pain for each dorsal ramus
Ramus Pain Referral
C3 Upper posterior cervical region (100%), occipital region (50%), middle posterior cervical region (33%), and upper posterolateral cervical region (25%).
C4 Lower posterior cervical region (55%), suprascapular region (55%), and middle posterior cervical region (45%).
C5 Lower posterior cervical region (52%), superior angle of the scapula (33%), suprascapular region (29%), and shoulder joint (19%).
C6 Superior angle of the scapula (47%), suprascapular region (33%), mid-scapular region (33%), shoulder joint (27%), and lower posterior cervical region (20%).
C7 Mid-scapular region (71%), superior angle of the scapula (71%), shoulder joint (29%), lower posterior cervical region (29%), and suprascapular region (14%)

Media:Referred_pain_distribution_of_the_cervical_ZA_joints_and_cervical_dorsal_rami_-_fukui_1996.pdf

Normal Volunteers

Dwyer et al (C2/3 to C6/7)

Pain maps with noxious stimulation of cervical facet joints in volunteers,[3] which was then validated against symptomatic patients.[4]

Cervical facet joint pain map.png

Media:Cervical_ZA_joint_pain_patterns_1_a_study_in_normal_volunteers_-_Dwyer_1990.pdf

Media:Cervical_ZA_joint_pain_patterns_2_a_clinical_evaluation_-_Dwyer_1990.pdf

Dreyfuss et al (C0/1 and C1/2)

The pain referral patterns of C0-1 and C1-2 were evaluated in 5 normal volunteers.[5]

  • C0-1

    C0-1

  • C1-2

    C1-2

Discogenic Pain

Disc pain has very similar referral patterns to zygapophyseal joint pain. Below is the pattern of pain provoked by discography at each cervical level in a restrospective study of symptomatic patients: C2โ€“C3 (A), C3โ€“C4 (B), C4 โ€“C5 (C), C5โ€“C6 (D), and C6 โ€“C7 (E).[6]

Cervical disc pain joint map Grubb.png

Slipman and colleagues also did a cervical disc pain mapping study in a prospective manner and found slightly different findings.[7]

Slipman 2005 cervical discography.jpg

Cervical Disc Pain Patterns
Pain Region Level
Posterior or posterior inferior neck C2-C3 through C7-T1
Head or Face C2โ€“C3 through C6โ€“C7
Anterior chest wall C4โ€“C5, C5โ€“C6, C6โ€“C7
Anterior neck C2-C3 through C6-7
Anterior shoulder or anterior trapezius C3-C4 through C6-C7
Extremity C3โ€“C4 through C6โ€“C7 (C7โ€“T1)
Interscapular C3-C4 through C7-T1
Mid-posterior neck to mid-thoracic spine C7-T1

Radicular Pain and Radiculopathy

Main article: Cervical Radicular Pain
  • Based off data from Rainville et al. The asterix indicates the only area where there is a statistical difference, with impaired sensation in the distal radial aspect of the dorsal forearm more common in C6 than C7 radiculopathy[8]

    Based off data from Rainville et al. The asterix indicates the only area where there is a statistical difference, with impaired sensation in the distal radial aspect of the dorsal forearm more common in C6 than C7 radiculopathy[8]

  • Dynatomal patterns of pain[9]

    Dynatomal patterns of pain[9]

  • Periscapular pain pattern in cervical radicular pain. Modified from Mizutamari.[10]

    Periscapular pain pattern in cervical radicular pain. Modified from Mizutamari.[10]

Soft Tissue

Interspinous Ligaments

Referred pain patterns from noxious stimulation of the cervical interspinous ligaments. He described injecting into the midline and just off centre into the interspinous ligaments.[11]

Kellgren cervical pain.PNG

Muscles

Feinstein - noxious stimulation of paravertebral muscles in normal volunteers
Feinstein - noxious stimulation of upper limb muscles in normal volunteers

Media:Experiments_on_Pain_Referred_from_Deep_Somatic_Tissues_-_Feinstein_1954.pdf

Trigger Points

This is a clinical entity, and is very difficult to reproduce in a research setting.

  • Occipitalis, Frontalis

    Occipitalis, Frontalis

  • Semispinalis Capitis, Multifidi

    Semispinalis Capitis, Multifidi

  • Splenius Capitis, Splenius Cervicis

    Splenius Capitis, Splenius Cervicis

  • Splenius Capitis, Splenius Cervicis 2

    Splenius Capitis, Splenius Cervicis 2

  • Sternocleidomastoid

    Sternocleidomastoid

  • Suboccipital Group

    Suboccipital Group

  • Trapezius 1

    Trapezius 1

  • Trapezius 2

    Trapezius 2

  • Trapezius 3

    Trapezius 3

See Also

References

  1. โ†‘ Cooper et al.. Cervical zygapophysial joint pain maps. Pain medicine (Malden, Mass.) 2007. 8:344-53. PMID: 17610457. DOI.
  2. โ†‘ Fukui et al.. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain 1996. 68:79-83. PMID: 9252002. DOI.
  3. โ†‘ Dwyer et al.. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine 1990. 15:453-7. PMID: 2402682. DOI.
  4. โ†‘ Aprill et al.. Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine 1990. 15:458-61. PMID: 2402683. DOI.
  5. โ†‘ Dreyfuss et al.. Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994. 19:1125-31. PMID: 8059267. DOI.
  6. โ†‘ Grubb & Kelly. Cervical discography: clinical implications from 12 years of experience. Spine 2000. 25:1382-9. PMID: 10828920. DOI.
  7. โ†‘ Slipman CW, Plastaras C, Patel R, Isaac Z, Chow D, Garvan C, Pauza K, Furman M. Provocative cervical discography symptom mapping. Spine J. 2005 Jul-Aug;5(4):381-8. doi: 10.1016/j.spinee.2004.11.012. PMID: 15996607.
  8. โ†‘ Rainville et al.. Exploration of sensory impairments associated with C6 and C7 radiculopathies. The spine journal : official journal of the North American Spine Society 2016. 16:49-54. PMID: 26253986. DOI.
  9. โ†‘ Slipman CW, Plastaras CT, Palmitier RA, Huston CW, Sterenfeld EB. Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps? Spine (Phila Pa 1976). 1998 Oct 15;23(20):2235-42. doi: 10.1097/00007632-199810150-00019. PMID: 9802168.
  10. โ†‘ Mizutamari et al.. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. Journal of orthopaedic surgery (Hong Kong) 2010. 18:356-60. PMID: 21187551. DOI.
  11. โ†‘ Kellgren. On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clinical Science. 1939.
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