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Pain referral reference guide

 

If you know which set of images you want to view, click on its link below to go directly there.

          Thermograms           Dermatome charts           Trigger point referral charts

 

Infrared Studies (Thermograms)

Due to the extensive education, significant cost of equipment and controversial findings, thermography is usually restricted in application to research.  The primary reason that it has been excluded from mainstream medicine is due to the variance of subjective interpretation from one practitioner to another.  It should be noted that in a clinical trial to depict the early stages of breast neoplasm, thermograms identified ten individuals with possible neoplastic development. The individuals also received MRIís that failed to detect the neoplasms.  As only the neoplasms confirmed by MRI received treatment, nine of the ten engaged in litigation when it was later determined that they had breast cancer.  Supposedly, as part of the terms of the settlement the names of the individuals as well as the facility could not be released.  Therefore, this cannot be viewed as scientific fact, but food for thought as it pertains to the scientific application of infrared. 

Additional areas in which thermograms have been utilized are in the assessment of peripheral vascular disease; diabetic neuropathy, reflex sympathetic dystrophy and myofascial trigger points to list but a few.  In reviewing the thermograms provided, you should note that the subjects were prepared by allowing their skin temperature to regulate for 20 minutes and that the equipment was calibrated to +/- 5 degrees of their average skin temperature.  White represents the hottest point within the spectrum graduating down to shades of yellow, red, green, and blue with black being the coldest.  More detailed information may be acquired from the internet by browsing medical thermograms and/or infrared studies. 

Click here to view thermograms.

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Dermatome Charts

Hiltonís Law states: ďa nerve trunk which supplies the muscles of any given joint also supplies the muscles which move the joint and the skin over the insertions of such muscles.Ē 

Based upon this law and supporting EMG studies, we can assume that underlying dermatomes are residing myotomes and sclerotomes with resulting sensory and motor dysfunction.Should there be an organic or biomechanical encroachment or compression affecting the ventral nerve root you would anticipate autonomic impairment and subsequent viscerotomes.

If the practitioner is attempting to trace dermatome patterns, they should be aware that segmental nerve supply could vary as to site of innervation or supply from the dermatome charts that they are referencing. Therefore, they should view segmental innervation as a close approximation, but not an absolute.Dermatome, myotome, viscerotome and sclerotome patterns have been developed from an authorís pool of individuals studied. Not only can the segmental supply be off by one or two segments, but also the patterns overlap, thus, making objective specificity difficult to interpret.Additionally, multiple trigger point patterns and their subsequent satellite referral can skew the subjective input of the individual.

Click here to view dermatome charts.

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Trigger Point Referral Charts

The link below will send you to thumbnails for 26 trigger point referral charts , as referenced by Travell and Simons.

Click here to view trigger point referral charts.

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