NMS 6/17/98
SS, SV, VS, VV reflexes
-all take place by exciting something in here
-heart to heart=VV reflex
Feinstein/Inman
-Scleratogenous pain
-see 10x more of this kind of pain than of dermatomal pain
-1)deep, dull, achy, 2) not dermatomal
-does not correspond to nerve root
-from bone, fascia, periosteum
-radicular
-sharp, burning, superficial
-corresponds to nerve root
1979 Facet Syndrome (Mooney)
-people with pain but no disc bulges
-experiment on prisoners
-inject facets with saline solution
-plotted appearance of pain patterns down arms and legs
-pain corresponded with sclerotomes
-theorized most of sclerotome pain came from facet joints
-fit in well with chiropractic
Scleratogenous
-3)no neurological signs (Note: neurological signs are not subtle)
-4)difficult to reproduce (If true radiculopathy, people avoid doing anything that will bring it on)
-5)never parasthetic
-6)sometimes complain of “numbness” (“numbness” has no neurological meaning)
Sclerotomes
-injected at C1
-referral along side of neck and back of occiput and frontal (tension
headache pattern)
-C2
-C3
-more central and lateral
-C4
-C5
-neck and shoulder area
-neck and shoulder
-cervical arthritis pattern
-suboccipital, shoulder, interscapular
-muscle-rhomboids, levator scapulae
-inflammation in joints

-so, SS reflex (muscle to muscle)
-can poke on area without pain (except at trigger points)
C5 joint-jammed facets
-lot of nociceptors here (A and C)
-pain fibers enter cord along with fibers from other related tissue
Somite-segmentally related
Afferentation
-load up area with neurotransmitters
-excite neighboring interneurons
Sclerotome pain
-spillover probably in area of dorsal horn
-tissue itself is not painful except at trigger points
-why alot of ortho tests don’t seem to work the way you expect
A fibers
-make it all the way to the cortex
-die down
-are what gets stimulated by most ortho tests
-cortex localizes the pain
C fibers
-dull, achy, diffuse pain
-hard to localize
Also see other non-neurological signs
-ex. inc. HR, BP (autonomics, SV reflex)
-muscle hypertonicity and trigger points (in related musculature)
Irritative vs. compressive
Somatic vs. neurological
Use EMG to narrow it down
-test muscles in myotome