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Spinal and Vth nerve dermatomes are shown in Figure 4.11. There is sometimes overlap between adjacent dermatomes. Root pain is typically perceived both within the dermatome and within the myotome but tends to be less demarcated than pain with a single nerve lesion. For example, with an S1 root lesion from a lumbosacral disc, the sensory disturbance is down the back of the leg, without clear dermatome demarcation. Stretching the root by straight leg raising typically makes matters worse.

When a root entry zone is affected, within the cord, such as in tabes dorsalis, intense stabbing pains involve one or more spots, typically on the ankle, calf, thigh or abdomen – the lightning pains of tabes, seldom seen today.

Neuralgia, persistent burning root pain can follow shingles (post‐herpetic neuralgia, Chapter 23).

Figure 4.11 Spinal and V nerve dermatomes.