Cervical Pain Maps

==Facetogenic Pain==
===Symptomatic Patients===
====Cooper et al (C1/2 to C6/7)====
;Cervical Pain Maps for Medial Branch Blocks
File:C1-2.jpg|C1-2
File:C2-3.jpg|C2-3
File:C3-4.jpg|C3-4
File:C4-5.jpg|C4-5
File:C5-6.jpg|C5-6
File:C6-7.jpg|C6-7
File:Pain maps C0 - C3.png|C0-3
File:Grids.jpg|Blank Grid
File:Probability 1.jpg|Probabilities C1-C4
File:Probability 2.jpg|Probabilities C4-C7
Full Image: :File:Cervical Pain Maps Grid.jpg 
====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
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%)
===Normal Volunteers===
====Dwyer et al (C2/3 to C6/7)====
Pain maps with noxious stimulation of cervical facet joints in volunteers, which was then validated against symptomatic patients.
====Dreyfuss et al (C0/1 and C1/2)====
The pain referral patterns of C0-1 and C1-2 were evaluated in 5 normal volunteers.
File:Atlanto-occipital joint pattern dreyfuss.png|C0-1
File:Atlanto-axial joint pattern dreyfuss.png|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: C2–C3 (A), C3–C4 (B), C4 –C5 (C), C5–C6 (D), and C6 –C7 (E).
Slipman and colleagues also did a cervical disc pain mapping study in a prospective manner and found slightly different findings.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. 
Cervical Disc Pain Patterns
Pain Region 	Level
Posterior or posterior inferior neck 	C2-C3 through C7-T1
Head or Face 	C2–C3 through C6–C7
Anterior chest wall 	C4–C5, C5–C6, C6–C7
Anterior neck 	C2-C3 through C6-7
Anterior shoulder or anterior trapezius 	C3-C4 through C6-C7
Extremity 	C3–C4 through C6–C7 (C7–T1)
Interscapular 	C3-C4 through C7-T1
Mid-posterior neck to mid-thoracic spine	C7-T1
==Radicular Pain and Radiculopathy==
File:C6 and C7 radicular pain.png|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
File:Slipman cervical dynatomes.jpg|Dynatomal patterns of painSlipman 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.
File:Cervical radicular pain scapula.jpg|Periscapular pain pattern in cervical radicular pain. Modified from Mizutamari.
==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.Kellgren. On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clinical Science. 1939.
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===Muscles===
===Trigger Points===
This is a clinical entity, and is very difficult to reproduce in a research setting.
File:Occipitalis, Frontalis Trigger Points.jpg|Occipitalis, Frontalis
File:Semispinalis Capitis, Multifidi Trigger Points.jpg|Semispinalis Capitis, Multifidi
File:Splenius Capitis, Splenius Cervicis Trigger Points.jpg|Splenius Capitis, Splenius Cervicis
File:Splenius Capitis, Splenius Cervicis Trigger Points 2.jpg|Splenius Capitis, Splenius Cervicis 2
File:Sternocleidomastoid Trigger Points.jpg|Sternocleidomastoid
File:Suboccipital Group Trigger Points.jpg|Suboccipital Group
File:Trapezius Trigger Points.png|Trapezius 1
File:Trapezius Trigger Points 2.jpg|Trapezius 2
File:Trapezius Trigger Points 3.jpg|Trapezius 3
==See Also==
*Chronic Post-Traumatic Neck Pain
==References==
Category:Cervical Spine
Category:Pain Maps