Nerve Root Pain, Dermatomes, and Evidence…Oh My!
It is commonly believed that nerve root pain would be expected to appear in a specific dermatome, and that this information is useful for making the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement.
In reviewing two hundred twenty-six “irritated” nerve roots in 169 patients, pain related to cervical nerve roots was found to be non-dermatomal in over two-thirds (69.7%) of cases!
In the lumbar spine, the pain was non-dermatomal in 64.1% of cases.
The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n = 5).
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