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Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma

By |March 12, 2020|Videofluoroscopy, Whiplash|

Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma

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SOURCE:   Int J Environ Res Public Health. 2020 (Mar 5); 17 (5): E1693

Michael D. Freeman, Evan A. Katz, Scott L. Rosa, Bryan G. Gatterman, Ellen M. F. Strömmer, and Wendy M. Leith

CAPHRI School for Public Health and Primary Care,
Faculty of Health, Medicine, and Life Sciences,
Maastricht University, 6211 LM
Maastricht, The Netherlands.


BACKGROUND:   Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of VF for discriminating between injured and uninjured populations.

METHODS:   Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with VF facilities. Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. An ethical review and oversight were provided by the Spinal Injury Foundation, Broomfield, CO.

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The Course of Serum Inflammatory Biomarkers Following Whiplash Injury

By |May 10, 2019|Chronic Neck Pain, Whiplash|

The Course of Serum Inflammatory Biomarkers Following Whiplash Injury and their Relationship to Sensory and Muscle Measures: A Longitudinal Cohort Study

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SOURCE:   PLoS One. 2013 (Oct 17); 8 (10): e77903

Michele Sterling, James M. Elliott, and Peter J. Cabot

Centre of National Research on Disability and Rehabilitation Medicine (CONROD),
The University of Queensland, Brisbane,
Queensland, Australia.


Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (<3 weeks) to chronic (>3 months) stages of whiplash injury.

It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of C-reactive protein (CRP) but by 3 months levels remained elevated only in the moderate/severe group.

The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months.

Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.


From the FULL TEXT Article:

Introduction

Whiplash associated disorders (WAD) are a common and costly health problem for western society. Many (up to 50%) of those injured transition to chronicity [1] and current management approaches for both acute and chronic WAD are only modestly effective. [2, 3] Further understanding of processes underlying ongoing pain and disability following whiplash injury may facilitate new directions for management of this condition and improve health outcomes.

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The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration

By |May 8, 2019|Whiplash|

The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration

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SOURCE:   Spine (Phila Pa 1976). 2015 (Jun 15); 40 (12): E694–700

James M. Elliott, PhD, PT, D. Mark Courtney, MD, Alfred Rademaker, PhD, Daniel Pinto, PhD, PT, Michele M. Sterling, PhD, PT, and Todd B. Parrish, PhD

Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine,
Northwestern University,
Chicago, IL


STUDY DESIGN:   Single-center prospective longitudinal study.

OBJECTIVE:   To study the (1) temporal development of muscle fatty infiltrates (MFI) in the cervical multifidi after whiplash, (2) differences in multifidi MFI between those who recover or report milder pain-related disability and those who report moderate/severe symptoms at 3 months, and (3) predictive value of multifidi MFI outcomes.

SUMMARY OF BACKGROUND DATA:   The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. The replication of such findings has yet to be explored longitudinally.

METHODS:   Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%–28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury.

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Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain

By |May 1, 2019|Chronic Neck Pain, Whiplash|

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-analysis

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SOURCE:   PM R. 2019 (Apr 25) [Epub]

Paul S. Nolet, DC, MS, MPH, Peter C. Emary, DC, MSc, Vicki L. Kristman, PhD, Kent Murnaghan, MA MISt,
Maurice P. Zeegers, PhD, Michael D. Freeman, MedDr, PhD

Care and Public Health Research Institute,
Maastricht University,
Maastricht, Netherlands.



OBJECTIVE:   To summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) in comparison with the population that has not been exposed to neck injury from an MVC.

LITERATURE SURVEY:   Neck injury resulting from a MVC is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population.

METHODOLOGY:   We performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a MVC and future NP published from 1998 to 2018. The outcome of interest was future NP. Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis, meta-regression and testing for publication bias was performed with the pooled data.

SYNTHESIS:   Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in a MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed subjects were either not injured or injury status was unknown, there was no increased risk of future NP.

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Whiplash-associated Disorders: Who Gets Depressed? Who Stays Depressed?

By |July 24, 2017|Depression, Whiplash|

Whiplash-associated Disorders:
Who Gets Depressed? Who Stays Depressed?

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SOURCE:   Eur Spine J. 2010 (Jun); 19 (6): 945–956

Leah A. Phillips, Linda J. Carroll,
J. David Cassidy, and Pierre Côté

Department of Public Health Sciences,
Alberta Centre for Injury Control and Research,
School of Public Health, University of Alberta,
4075 RTF, 8308 114 St, Edmonton, AB, T6G 2E1, Canada.



Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale   (CES-D).   We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants). Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions.


From the FULL TEXT Article:

Introduction

The biopsychosocial model of health posits that in addition to biomedical factors, psychological, and sociological factors play important roles in the diagnosis, treatment, and recovery from illness and disease. [11] According to the Quebec Task Force on whiplash-associated disorders, whiplash is defined as an acceleration–deceleration mechanism of energy transferred to the neck as a result of a motor vehicle collision, and the resulting injury or cluster of symptoms is referred to as whiplash-associated disorders (WAD). [20] WAD is a disorder where the interplay between biological and psychosocial factors appears to have an important effect on recovery. [8]

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Low Speed Frontal Crashes and Low Speed Rear Crashes

By |May 29, 2017|Whiplash|

Low Speed Frontal Crashes and Low Speed Rear Crashes: Is There a Differential Risk for Injury?

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SOURCE:   Annu Proc Assoc Adv Automot Med. 2002; 46: 79–91

Croft AC, Haneline MT, Freeman MD

Spine Research Institute of San Diego,
San Diego, California, USA.



We compared male and female subjects in crash tests in which each subject experienced both frontal and rear impacts. Crash speed and other crash parameters were held constant. We believe this was the first experiment using an independent variable of crash vector and dependent variables of head linear acceleration and volunteer qualitative tolerance.

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