Cervical muscle area measurements in acute whiplash patients and controls (original) (raw)
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Injury, 2017
Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inc...
Cervical Whiplash: Assessment, Treatment, and Impairment Rating
2000
Whiplash-associated disorder (WAD) refers to complaints attributed to a shearhyperextension then hyperflexion cervical injury, typically following a rearend motor vehicle collision (MVC). WAD is often challenging; and requires thoughtful assessment of diagnosis, causation, treatment, disability, maximal medical improvement, and impairment. Neck pain and headaches are common following motor vehicle collisions, but there is significant variation in the duration of symptoms. Research suggests chronic whiplash symptoms should be the exception rather than the rule; and most cases of WAD resolve without permanent impairment. Many factors influence the development of chronic whiplash symptoms including preexisting pathology (physical and/or psychological), the severity of the injury, individuals' expectations of pain and disability following a collision, cultural influences, and psychosocial stressors. Clinical evaluation and treatment guidelines derived from the best scientific knowledge available have failed to alter the epidemic of chronic whiplash symptoms in the United States and other countries, probably because they focus on biological treatment of WAD, ignoring cultural, psychological, and sociological influences. Given the questionable nature of much of the treatment rendered for WAD, this article will discuss appropriate care of whiplash, and a progressive approach to management, followed by impairment evaluation. Clinical Perspective Each year 5.5 million people are injured in motor vehicle collisions in the United States 1 including 2.9 million whiplash injuries. 2 Most (78%) patients report symptoms at the scene 3 , with 93% becoming symptomatic within 15 hours. 4 Neck pain generally must be present for inclusion in any statistics or study on WAD. The next most common presenting complaint is headache (17-33%), followed by upper extremity pain (6-13%). 5 Constant symptoms are reported by 43%, while the remaining 57% report intermittent complaints. 6 Recovery from acute whiplash follows a predictable course, with the majority of uncomplicated WAD cases recovering in four to six weeks. 3, 7 However, there is significant variation in the prevalence of chronic
Journal of Rehabilitation Medicine, 2013
To study the presence of cervical motor dysfunctions in acute whiplash-associated disorders, evaluate their course and assess their predictive value for long-term recovery. Design: Systematic literature review. Methods: PubMed and Web of Science databases were used to select studies of the presence of cervical motor dysfunctions within the acute stage (< 6 weeks) after whiplash trauma and/or their predictive value for the development of chronic whiplash-associated disorders. Results: The presence of cervical motor dysfunctions in the acute stage after whiplash trauma was investigated in 4 cohorts. The course of cervical motor dysfunctions in whiplash-associated disorders was examined in 4 cohorts, and the predictive value on outcome 1 year post-whiplash trauma was assessed in 3 cohorts. Reduced cervical mobility, disturbed kinaesthesia, and altered muscle activity were found in the acute stage, and these persisted over time in the moderate/severe group. The predictive value of examining the presence of cervical motor dysfunctions was doubtful. The course and predictive value of initial reduced cervical mobility was inconsistent. Conclusion: Cervical motor dysfunctions are present soon after whiplash trauma persisting in those with moderate/ severe symptoms. However, these dysfunctions have limited predictive value, and hence may not explain the complex clinical picture of whiplash-associated disorders. This systematic review highlights the need for differentiating between patients with acute whiplash-associated disorders taking into account the biopsychological framework.
Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients
Manual Therapy, 2004
There has been little investigation into whether or not differences exist in the nature of physical impairment associated with neck pain of whiplash and insidious origin. This study examined the neck flexor synergy during performance of the cranio-cervical flexion test, a test targeting the action of the deep neck flexors. Seventy-five volunteer subjects participated in this study and were equally divided between Group 1, asymptomatic control subjects, Group 2, subjects with insidious onset neck pain and Group 3, subjects with neck pain following a whiplash injury. The cranio-cervical flexion test was performed in five progressive stages of increasing cranio-cervical flexion range. Subjects' performance was guided by feedback from a pressure sensor inserted behind the neck which monitored the slight flattening of the cervical lordosis which occurs with the contraction of longus colli. Myoelectric signals (EMG) were detected from the muscles during performance of the test. The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all Po0.05) and had significantly greater shortfalls from the pressure targets in the test stages (Po0.05). No significant differences were evident between the neck pain groups in either parameter indicating that this physical impairment in the neck flexor synergy is common to neck pain of both whiplash and insidious origin.
Manual Therapy, 2008
Cervical muscle function is disturbed in patients with persistent pain related to a whiplash associated disorder (WAD) but little is known about neck extensor muscle morphometry in this group. This study used magnetic resonance imaging to measure relative cross-sectional area (rCSA) of the rectus capitis posterior minor and major, multifidus, semispinalis cervicis and capitis, splenius capitis and upper trapezius muscles bilaterally at each cervical segment. In total, 113 female subjects (79 WAD, 34 healthy control; 18–45 years, 3 months–3 years post-injury) were recruited for the study.Significant main effects for differences in muscle and segmental level were found between the two groups (P<0.0001) as well as a significant group * muscle * level interaction (P<0.0001). The cervical multifidus muscle in the WAD group had significantly larger rCSA at all spinal levels and in contrast, there were variable differences in rCSA measures across levels in the intermediate and superficial extensor muscles when compared to the healthy controls (P<0.0001). There were occasional weak, although statistically significant relationships between age, body mass index (BMI), duration of symptoms and the size of some muscles in both healthy control and WAD subjects (P<0.01).It is possible that the consistent pattern of larger rCSA in multifidus at all levels and the variable pattern of rCSA values in the intermediate and superficial muscles in patients with WAD may reflect morphometric change due to fatty infiltrate in the WAD muscles. Future clinical studies are required to investigate the relationships between muscular morphometry, symptoms and function in patients with persistent WAD.
Assessment of Range of Movement, Pain and Disability Following a Whiplash Injury
The Open Orthopaedics Journal, 2017
Background: Whiplash has been suggested to cause chronic symptoms and long term disability. This study was designed to assess long term function after whiplash injury. Material & Methods: A random sample of patients in the outpatient clinic was interviewed, questionnaire completed and clinical examination performed. Assessment was made of passive cervical range of movement and Visual Analogue Scale pain scores. One hundred and sixty-four patients were divided into four different groups including patients with no whiplash injury but long-standing neck pain (Group A), previous symptomatic whiplash injury and long-standing neck pain (Group B), previous symptomatic whiplash injury and no neck symptoms (Group C), and a control group of patients with no history of whiplash injury or neck symptoms (Group D). Results: Data was analyzed by performing an Independent samples t-test and ANOVA, with level of significance taken as p<0.05. Comparing the four groups using a one-way ANOVA showed ...
Relationship between Pain and Neck Mobility in Patients with Grade II Whiplash Injury
The Medical Journal of Cairo University, 2019
Background: Patients with grade II whiplash injuries have physical signs of decreasing range of neck movement and palpable tenderness. Many patients with whiplash injury report diffuse symptoms of sensory disturbances and generalised muscle weakness. Whiplash injury has profound effects on both peripheral and central pain-processing mechanisms. Approximately 50% of subjects who sustain a whiplash injury will not recover but will continue to report ongoing pain and disability one year after the injury. Aim of Study: This study aimed to evaluate the correlation between pain and neck mobility in Egyptian patients with grade II whiplash injury. Subjects and Methods: Fifteen Egyptian patients with grade II whiplash injury from both genders were selected for this study. All the patients were assessed for pain by visual analogue scale and cervical range of motion by Cervical Range of Motion goniometer (CROM). Results: There is strong negative significant correlation between level of pain by Visual Analogue Scale (VAS) and neck bending to right and left only. Conclusion: There is negative correlation between level of pain and side bending to right and left in Egyptian patients with grade II whiplash injury.