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Wang L, Valencak TG, Shan T. Fat infiltration in skeletal muscle: Influential triggers and regulatory mechanism. iScience 2024; 27:109221. [PMID: 38433917 PMCID: PMC10907799 DOI: 10.1016/j.isci.2024.109221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Fat infiltration in skeletal muscle (also known as myosteatosis) is now recognized as a distinct disease from sarcopenia and is directly related to declining muscle capacity. Hence, understanding the origins and regulatory mechanisms of fat infiltration is vital for maintaining skeletal muscle development and improving human health. In this article, we summarized the triggering factors such as aging, metabolic diseases and metabolic syndromes, nonmetabolic diseases, and muscle injury that all induce fat infiltration in skeletal muscle. We discussed recent advances on the cellular origins of fat infiltration and found several cell types including myogenic cells and non-myogenic cells that contribute to myosteatosis. Furthermore, we reviewed the molecular regulatory mechanism, detection methods, and intervention strategies of fat infiltration in skeletal muscle. Based on the current findings, our review will provide new insight into regulating function and lipid metabolism of skeletal muscle and treating muscle-related diseases.
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Affiliation(s)
- Liyi Wang
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
| | | | - Tizhong Shan
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
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2
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Preiss S, Beinert K, Taube W. Immediate effects of visuomotor tracking with the head on cervical sensorimotor function and pain in chronic neck pain patients. J Back Musculoskelet Rehabil 2024; 37:127-136. [PMID: 37599520 DOI: 10.3233/bmr-220431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Working in awkward and sustained postures is, besides psychosocial risk factors, the most reported physical risk factor for neck pain. Accurate proprioception is fundamental to correcting awkward head-to-trunk positions, but impaired proprioceptive performance has been found in patients with chronic neck pain. OBJECTIVE The aim was to compare the effectiveness of two different interventions in a workplace set-up on sensorimotor performance and pain sensitivity in people with chronic neck pain. METHODS A total of 25 patients with chronic neck pain participated in this double-blind study. Patients were randomly allocated to the visuomotor tracking task group or the video group (watching a massage video, imagining themselves being massaged). The primary outcomes were cervical joint position sense acuity and pressure pain threshold of the cervical spine, evaluated by a blinded assessor. RESULTS There were significant time by group interactions for cervical joint position sense acuity (F1;23: 4.38; p= 0.048) and pressure pain threshold (F1;23: 5.78; p= 0.025), with the tracking task group being more accurate in cervical joint position sense testing and less pain sensitive for pressure pain threshold. CONCLUSIONS The visuomotor tracking task improves cervical joint position sense acuity and reduces pressure pain threshold immediately after intervention in people with chronic neck pain.
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Affiliation(s)
- Sandra Preiss
- Department of Medicine, Movement and Sports Science, University of Fribourg, Fribourg, Switzerland
| | - Konstantin Beinert
- Faculty of Sport, German University of Health and Sport, Mannheim, Germany
| | - Wolfgang Taube
- Department of Medicine, Movement and Sports Science, University of Fribourg, Fribourg, Switzerland
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Bellosta-López P, Doménech-García V, Ortiz-Lucas M, Lluch-Girbés E, Herrero P, Sterling M, Christensen SWM. Longitudinal Changes and Associations Between Quantitative Sensory Testing and Psychological Factors in Whiplash-Associated Disorders: A Systematic Review and Meta-Analyses-Based Data Synthesis. THE JOURNAL OF PAIN 2024; 25:12-30. [PMID: 37517451 DOI: 10.1016/j.jpain.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Whiplash-associated disorders (WAD) represent a multifactorial condition often accompanied by altered nociceptive processing and psychological factors. This systematic review on acute and chronic WAD aimed to investigate the relationship between quantitative sensory testing (QST) and psychological factors and quantify whether their trajectories over time follow a similar pattern to disability levels. Eight databases were searched until October 2022. When 2 prospective studies examined the same QST or psychological variable, data synthesis was performed with random-effects meta-analysis by pooling within-group standardized mean differences from baseline to 3-, 6-, and 12-month follow-ups. From 5,754 studies, 49 comprising 3,825 WAD participants were eligible for the review and 14 for the data synthesis. Altered nociceptive processing in acute and chronic WAD, alongside worse scores on psychological factors, were identified. However, correlations between QST and psychological factors were heterogeneous and inconsistent. Furthermore, disability levels, some QST measures, and psychological factors followed general positive improvement over time, although there were differences in magnitude and temporal changes. These results may indicate that altered psychological factors and increased local pain sensitivity could play an important role in both acute and chronic WAD, although this does not exclude the potential influence of factors not explored in this review. PERSPECTIVE: Acute WAD show improvements in levels of disability and psychological factors before significant improvements in nociceptive processing are evident. Facilitated nociceptive processing might not be as important as psychological factors in chronic WAD-related disability, which indicates that chronic and acute WAD should not be considered the same entity although there are similarities. Nonetheless, pressure pain thresholds in the neck might be the most appropriate measure to monitor WAD progression.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Ortiz-Lucas
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Pablo Herrero
- iHealthy Research Group. IIS Aragon/University of Zaragoza. Department of Physiatry and Nursing. Faculty of Health Sciences, Zaragoza, Spain
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Herston, Australia; Centre of Research Excellence, Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Steffan W M Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Belavy DL, Armbrecht G, Albracht K, Brisby H, Falla D, Scheuring R, Sovelius R, Wilke HJ, Rennerfelt K, Martinez-Valdes E, Arvanitidis M, Goell F, Braunstein B, Kaczorowski S, Karner V, Arora NK. Cervical spine and muscle adaptation after spaceflight and relationship to herniation risk: protocol from 'Cervical in Space' trial. BMC Musculoskelet Disord 2022; 23:772. [PMID: 35964076 PMCID: PMC9375326 DOI: 10.1186/s12891-022-05684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Astronauts have a higher risk of cervical intervertebral disc herniation. Several mechanisms have been attributed as causative factors for this increased risk. However, most of the previous studies have examined potential causal factors for lumbar intervertebral disc herniation only. Hence, we aim to conduct a study to identify the various changes in the cervical spine that lead to an increased risk of cervical disc herniation after spaceflight. Methods A cohort study with astronauts will be conducted. The data collection will involve four main components: a) Magnetic resonance imaging (MRI); b) cervical 3D kinematics; c) an Integrated Protocol consisting of maximal and submaximal voluntary contractions of the neck muscles, endurance testing of the neck muscles, neck muscle fatigue testing and questionnaires; and d) dual energy X-ray absorptiometry (DXA) examination. Measurements will be conducted at several time points before and after astronauts visit the International Space Station. The main outcomes of interest are adaptations in the cervical discs, muscles and bones. Discussion Astronauts are at higher risk of cervical disc herniation, but contributing factors remain unclear. The results of this study will inform future preventive measures for astronauts and will also contribute to the understanding of intervertebral disc herniation risk in the cervical spine for people on Earth. In addition, we anticipate deeper insight into the aetiology of neck pain with this research project. Trial registration German Clinical Trials Register, DRKS00026777. Registered on 08 October 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05684-0.
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Affiliation(s)
- Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Gabriele Armbrecht
- Center for Muscle and Bone Research, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kirsten Albracht
- Department of Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Aachen, Germany.,Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Helena Brisby
- Department of Orthopedic Surgery, Sahlgrenska University Hospital, 415 45, Göteborg, Sweden
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Richard Scheuring
- NASA Johnson Space Center, 2101 NASA Parkway SD4, Houston, TX, 77058, USA
| | - Roope Sovelius
- Centre for Military Medicine, Satakunta Air Command, P.O.Box 761, 33101, Tampere, Finland
| | | | - Kajsa Rennerfelt
- Orthopaedics and Spine Surgery, Sahlgrenska University Hospital, Bruna Stråket 11B, Göteborg, 413 45, Sweden
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Michail Arvanitidis
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Fabian Goell
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany
| | - Bjoern Braunstein
- Institute of Movement and Neuroscience, German Sport University, Am Sportpark Müngersdorf 6, Cologne, 50933, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Svenja Kaczorowski
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Vera Karner
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Nitin Kumar Arora
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Purushotham S, Stephenson RS, Sanderson A, Falla D. Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review. BMJ Open 2021; 11:e042729. [PMID: 33619189 PMCID: PMC7903124 DOI: 10.1136/bmjopen-2020-042729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP. METHODS/ANALYSIS This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. ETHICS AND DISSEMINATION The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated. PROSPERO REGISTRATION NUMBER CRD42020198087.
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Affiliation(s)
- Shilpa Purushotham
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Anatomy Department, Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Robert Stanley Stephenson
- Anatomy Department, Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andy Sanderson
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Burian E, Franz D, Greve T, Dieckmeyer M, Holzapfel C, Drabsch T, Sollmann N, Probst M, Kirschke JS, Rummeny EJ, Zimmer C, Hauner H, Karampinos DC, Baum T. Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI. Eur J Radiol 2020; 125:108904. [PMID: 32088656 DOI: 10.1016/j.ejrad.2020.108904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/06/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To understand fat distribution patterns and ectopic fat deposition in healthy adults and to provide normative data, encompassing the borders of physiological regional muscle composition. For this purpose chemical shift encoding-based water-fat Magnetic Resonance Imaging (MRI) was used for proton density fat fraction (PDFF) calculations. MATERIAL AND METHODS 91 volunteers were enrolled (male: n = 28, age = 36.6 ± 11.4 years; female: n = 63, age = 38.5 ± 15.1 years). PDFF values combined for the multifidus, semispinalis and spinalis cervicis muscles at the level of the 3rd cervical vertebral body (C3), the 5th cervical vertebral body (C5) and the first thoracic vertebral body (Th1) were extracted. RESULTS The paraspinal musculature at C3 (14.8 ± 10.1 % vs. 19.2 ± 11.0 %; p = 0.029) and Th1 (13.8 ± 7.0 % vs 17.7 ± 7.4 %; p = 0.011) showed significantly lower PDFF values in men compared to women. Partial correlation testing with BMI as control variable revealed highly significant correlations between the paraspinal musculature PDFF at C3 (men: r = 0.504, p = 0.007; women: r = 0.279, p = 0.028), C5 (men: r = 0.450, p = 0.019; women: r = 0.347, p = 0.006) and Th1 (men: r = 0.652, p < 0.0001; women: r = 0.443, p < 0.0001) with age in both genders. CONCLUSION The present data suggest gender and age-specific fat deposition patterns of the cervical and the upper cervicothoracic paraspinal muscles and may provide reference values for pathology detection.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Christina Holzapfel
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Theresa Drabsch
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Hans Hauner
- Institute for Nutritional Medicine, TUM School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Beckmann NM, West OC, Nunez D, Kirsch CF, Aulino JM, Broder JS, Cassidy RC, Czuczman GJ, Demertzis JL, Johnson MM, Motamedi K, Reitman C, Shah LM, Than K, Ying-Kou Yung E, Beaman FD, Kransdorf MJ, Bykowski J. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019; 16:S264-S285. [DOI: 10.1016/j.jacr.2019.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 02/05/2023]
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Elliott JM, Hancock MJ, Crawford RJ, Smith AC, Walton DM. Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury. Spine J 2018; 18:1489-1497. [PMID: 28774580 PMCID: PMC6874915 DOI: 10.1016/j.spinee.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings. PURPOSE This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes. STUDY DESIGN/SETTING A non-systematic review of the literature is carried out. METHODS A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided. RESULTS An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain. CONCLUSIONS Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.
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Affiliation(s)
- James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1100, Chicago, IL, USA; School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia
| | - Rebecca J Crawford
- Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Andrew C Smith
- Regis University School of Physical Therapy, 3333 Regis Boulevard, Denver, CO 80221, USA
| | - David M Walton
- School of Physical Therapy, Western University, Room 1588, London, Ontario N6G 1H1, Canada
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Elliott JM, Cornwall J, Kennedy E, Abbott R, Crawford RJ. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskelet Disord 2018; 19:171. [PMID: 29807530 PMCID: PMC5972401 DOI: 10.1186/s12891-018-2074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.
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Affiliation(s)
- James M Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Australia 75 East Street Lidcombe NSW, Sydney, 2141, Australia. .,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Honorary Fellow School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Pedler A, McMahon K, Galloway G, Durbridge G, Sterling M. Intramuscular fat is present in cervical multifidus but not soleus in patients with chronic whiplash associated disorders. PLoS One 2018; 13:e0197438. [PMID: 29795590 PMCID: PMC5967697 DOI: 10.1371/journal.pone.0197438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022] Open
Abstract
The presence of intramuscular fat (IMF) in the cervical spine muscles of patients with whiplash associated disorders (WAD) has been consistently found. The mechanisms underlying IMF are not clear but preliminary evidence implicates a relationship with stress system responses. We hypothesised that if systemic stress system responses do play a role then IMF would be present in muscles remote to the cervical spine. We aimed to investigate if IMF are present in muscle tissue remote (soleus) to the cervical spine in people with chronic WAD. A secondary aim was to investigate associations between IMF and posttraumatic stress symptom levels. Forty-three people with chronic WAD (25 female) and 16 asymptomatic control participants (11 female) participated. Measures of pain, disability and posttraumatic stress symptoms were collected from the WAD participants. Both groups underwent MRI measures of IMF in cervical multifidus and the right soleus muscle. There was significantly greater IMF in cervical multifidus in patients with WAD and moderate/severe disability compared to controls (p = 0.009). There was no difference in multifidus IMF between the mild and moderate/severe disability WAD groups (p = 0.64), or the control and mild WAD groups (p = 0.21). IMF in the right soleus was not different between the groups (p = 0.47). In the WAD group, we found no correlation between PDS symptoms and cervical multifidus IMF or between PDS symptoms and soleus IMF. Global differences in IMF are not a feature of chronic WAD, with differences in IMF limited to the cervical spine musculature. While the mechanisms for the development of IMF in the cervical spine following whiplash injury remain unclear, our data indicate that local factors more likely contribute to these differences.
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Affiliation(s)
- Ashley Pedler
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injury, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Katie McMahon
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Gail Durbridge
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injury, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- * E-mail:
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Kim CY, Lee SM, Lim SA, Choi YS. Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study. Clin Orthop Surg 2018; 10:197-203. [PMID: 29854343 PMCID: PMC5964268 DOI: 10.4055/cios.2018.10.2.197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background Weakness of cervical extensor muscles causes loss of cervical lordosis, which could also cause neck pain. The aim of this study was to investigate the impact of fat infiltration in cervical extensor muscles on cervical lordosis and neck pain. Methods Fifty-six patients who suffered from neck pain were included in this study. Fat infiltration in cervical extensor muscles was measured at each level of C2–3 and C6–7 using axial magnetic resonance imaging. The visual analogue scale (VAS), 12-Item Short Form Health Survey (SF-12), and Neck Disability Index (NDI) were used for clinical assessment. Results The mean fat infiltration was 206.3 mm2 (20.3%) at C2–3 and 240.6 mm2 (19.5%) at C6–7. Fat infiltration in cervical extensor muscles was associated with high VAS scores at both levels (p = 0.047 at C2–3; p = 0.009 at C6–7). At C2–3, there was a negative correlation between fat infiltration of the cervical extensor muscles and cervical lordosis (r = −0.216; p = 0.020). At C6–7, fat infiltration in the cervical extensor muscles was closely related to NDI (p = 0.003) and SF-12 (p > 0.05). However, there was no significant correlation between cervical lordosis and clinical outcomes (VAS, p = 0.112; NDI, p = 0.087; and SF-12, p > 0.05). Conclusions These results suggest that fat infiltration in the upper cervical extensor muscles has relevance to the loss of cervical lordosis, whereas fat infiltration in the lower cervical extensor muscles is associated with cervical functional disability.
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Affiliation(s)
- Choong-Young Kim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Seong-An Lim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Yong-Soo Choi
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Abbott R, Peolsson A, West J, Elliott JM, Åslund U, Karlsson A, Leinhard OD. The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging. Spine J 2018; 18:717-725. [PMID: 28887274 PMCID: PMC8845185 DOI: 10.1016/j.spinee.2017.08.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/30/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING This is a cross-sectional study. PATIENT SAMPLE Thirty-one subjects with WAD and 31 age- and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (p<.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice.
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Affiliation(s)
- Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Janne West
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV)/ Division of Radiological Services, IMH, Linköping University, SE-581 85 Linköping, Sweden
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA,School of Health and Rehabilitation Sciences, The University of Queensland, Australia,Zurich University of Applied Sciences, Gertrudstrasse 15, 8400 Winterthur, Switzerland
| | - Ulrika Åslund
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV)/ Department of Biomedical Engineering, Linköping University, SE 58183 Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization (CMIV)/Division of Radiological Sciences, IMH, Linköping University, SE-581 85 Linköping, Sweden.
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Rivard J, Unsleber C, Schomacher J, Erlenwein J, Petzke F, Falla D. Activation of the semispinalis cervicis and splenius capitis with cervical pulley exercises. Musculoskelet Sci Pract 2017; 30:56-63. [PMID: 28570930 DOI: 10.1016/j.msksp.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Quasi-Experimental. OBJECTIVE To assess the activation of semispinalis cervicis (d-SSC) and splenius capitis (s-SC) muscles, and the activation between the two during neck pulley and free weight exercises. BACKGROUND Altered activation of cervical extensors may occur with neck pain, suggesting that exercises should be designed to target these muscles. METHODS d-SSC and s-SC activity was recorded unilaterally with intramuscular electromyography from healthy volunteers during cervical isometric exercises: 1) extension with a pulley rope angled from incline to vertical, 2) extension with right, left and central forehead hanging weight, and 3) rotation with pulley rope angled from incline to decline. RESULTS Extension against a vertical force led to greater activation of d-SSC (P < 0.001) and s-SC (P < 0.001) compared to the inclined, declined and horizontal pulley. With each of these conditions, amplitude of muscle activity was higher for the d-SSC compared to the s-SC muscle (P < 0.0001). Extension with free weight hanging on right, left or central forehead, showed no differences across conditions, although in each condition, the d-SSC amplitude was higher than the s-SC. For cervical rotation, the declined pulley led to the greatest activation of both muscles (P < 0.05). Higher levels of activity were observed for the s-SC compared to the d-SSC (P < 0.01) for all rotation conditions. CONCLUSION A vertical resistance during an extension exercise or a declined resistance during cervical rotation, increased neck extensor activation. The results from this preliminary study provide guidance for future work on the exploration and development of low-load exercise design for patients with neck pain disorders.
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Affiliation(s)
- Jim Rivard
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA.
| | - Cindy Unsleber
- The Ola Grimsby Institute, Seattle, WA, USA; MTI Physical Therapy, Bellevue, WA, USA
| | | | - Joachim Erlenwein
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Frank Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Deborah Falla
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Hildebrandt M, Fankhauser G, Meichtry A, Luomajoki H. Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain. BMC Musculoskelet Disord 2017; 18:12. [PMID: 28068962 PMCID: PMC5223418 DOI: 10.1186/s12891-016-1376-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
Background Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. Methods In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0–10%), Grade 1 (10–50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients’ low back dysfunction. Results The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. Conclusion This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.
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Affiliation(s)
| | | | - André Meichtry
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.
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Aktar MN, Alam MJ, Pickering M, Webb A, Perriman D. Non-rigid registration of cervical spine MRI volumes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:1997-2000. [PMID: 26736677 DOI: 10.1109/embc.2015.7318777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Whiplash is the colloquial term for neck injuries caused by sudden extension of the cervical spine. Patients with chronic whiplash associated disorder (WAD) can experience neck pain for many years after the original injury. Researchers have found some evidence to suggest that chronic whiplash is related to the amount of intra-muscular fat in the cervical spine muscles. Hence, an important step towards developing a treatment for chronic WAD is a technique to accurately and efficiently measure the amount of intra-muscular fat in the muscles of the cervical spine. Our proposed technique for making this measurement is to automatically segment the cervical spine muscles using a fused volume created from multi-modal MRI volumes of the cervical spine. Multiple modes are required to enhance the boundaries between the different muscles to assist the following automatic segmentation process. However, before these multiple modes can be fused it is first necessary to accurately register these volumes. Hence, in this paper, we have proposed a new non-rigid multi-modal registration algorithm using the sum of conditional variance (SCV) with partial volume interpolation (PVI) similarity measure and Gauss-Newton (GN) optimization for the accurate registration of multi-modal cervical spine MRI volumes. The performance of the proposed approach is compared with the existing SCV based registration algorithm and the sum of the conditional squared deviation from the mode (SCSDM) method. The experimental results demonstrate that the proposed approach provides superior performance than the best existing approaches.
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De Pauw R, Coppieters I, Kregel J, De Meulemeester K, Danneels L, Cagnie B. Does muscle morphology change in chronic neck pain patients? – A systematic review. ACTA ACUST UNITED AC 2016; 22:42-9. [DOI: 10.1016/j.math.2015.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/23/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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Smith AC, Parrish TB, Hoggarth MA, McPherson JG, Tysseling VM, Wasielewski M, Kim HE, Hornby TG, Elliott JM. Potential associations between chronic whiplash and incomplete spinal cord injury. Spinal Cord Ser Cases 2015; 1. [PMID: 27630770 DOI: 10.1038/scsandc.2015.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN This research utilized a cross-sectional design with control group inclusion. OBJECTIVES Preliminary evidence suggests that a portion of the patient population with chronic whiplash may have sustained spinal cord damage. Our hypothesis is that in some cases of chronic whiplash-associated disorders (WAD), observed muscle weakness in the legs will be associated with local signs of a partial spinal cord injury of the cervical spine. SETTING University based laboratory in Chicago, IL, USA. METHODS Five participants with chronic WAD were compared with five gender/age/height/weight/body mass index (BMI) control participants. For a secondary investigation, the chronic WAD group was compared with five unmatched participants with motor incomplete spinal cord injury (iSCI). Spinal cord motor tract integrity was assessed using magnetization transfer imaging. Muscle fat infiltration (MFI) was quantified using fat/water separation magnetic resonance imaging. Central volitional muscle activation of the plantarflexors was assessed using a burst superimposition technique. RESULTS We found reduced spinal cord motor tract integrity, increased MFI of the neck and lower extremity muscles and significantly impaired voluntary plantarflexor muscle activation in five participants with chronic WAD. The lower extremity structural changes and volitional weakness in chronic WAD were comparable to participants with iSCI. CONCLUSION The results support the position that a subset of the chronic whiplash population may have sustained partial damage to the spinal cord. SPONSORSHIP NIH R01HD079076-01A1, NIH T32 HD057845 and the Foundation for Physical Therapy Promotion of Doctoral Studies program.
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Affiliation(s)
- Andrew C Smith
- Northwestern University Interdepartmental Neuroscience Program, Chicago, IL USA; Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Todd B Parrish
- Northwestern University Department of Radiology, Chicago, IL USA
| | - Mark A Hoggarth
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Jacob G McPherson
- Florida International University Department of Biomedical Engineering, Miami, FL USA
| | - Vicki M Tysseling
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Marie Wasielewski
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
| | - Hyosub E Kim
- Rehabilitation Institute of Chicago, Chicago, IL USA
| | | | - James M Elliott
- Northwestern University Department of Physical Therapy and Human Movement Sciences, Chicago, IL USA
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The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976) 2015; 40:E694-700. [PMID: 25785961 PMCID: PMC4466088 DOI: 10.1097/brs.0000000000000891] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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. The effects of time and group (per Neck Disability Index) and the interaction of time by group on MFI were determined. Receiver operating characteristic curve analysis was used to determine a cut-point for MFI at 2 weeks to predict outcome at 3 months. RESULTS There was no difference in MFI across groups at enrolment. MFI values were significantly higher in the severe group than those in the recovered/mild group at 2 weeks and 3 months. The receiver operating characteristic curve analysis indicated that MFI levels of 20.5% or above resulted in a sensitivity of 87.5% and a specificity of 92.9% for predicting outcome at 3 months. CONCLUSION Consistent with previous evidence, muscle degeneration occurs soon after injury but only in those patients with poor functional recovery. This study provides further evidence that (1) multifidi MFI occur in tandem with known predictive risk factors (older age, pain-related disability, and post-traumatic stress disorder) and (2) routine imaging protocols may need to be reconsidered in the vast majority of patients after whiplash. LEVEL OF EVIDENCE 3.
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Comparison of cross sectional area and fat infiltration of the epaxial muscles in dogs with and without spinal cord compression. Res Vet Sci 2014; 97:646-51. [PMID: 25294251 DOI: 10.1016/j.rvsc.2014.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 09/02/2014] [Accepted: 09/08/2014] [Indexed: 11/23/2022]
Abstract
This study investigated the cross sectional area (CSA) and fat infiltration of the epaxial muscles in Dachshunds with compressive spinal cord lesions due to intervertebral disc herniation (IVDH) and in dogs with non-compressive spinal cord lesions with fibrocartilaginous embolism (FCE). The CSA and fat infiltration of the multifidi and longissimus dorsi muscles were determined from T1 weighted magnetic resonance images. Difference in CSA and fat infiltration between the lesion- and non-lesion side in the Dachshunds was assessed using mixed model analysis. Difference in CSA and fat infiltration between Dachshunds and FCE dogs was analysed with independent sample t-tests. There was no difference in CSA or fat infiltration between sides in the Dachshunds. FCE dogs had greater CSA (multifidus P = 0.036, longissimus P < 0.001) and less fat infiltration compared to Dachshunds (longissimus P = 0.017). Duration of neurological deficits, age, body size and conformation are likely to have influenced the difference between the groups.
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Abstract
STUDY DESIGN A population based cross-sectional study. OBJECTIVE To clarify relative constituents of viable muscle in 2-dimensional cross-sectional area (CSA) measures of ventral and dorsal cervical muscles in patients with chronic whiplash-associated disorders (WAD), idiopathic neck pain, and healthy controls. SUMMARY OF BACKGROUND DATA Previous data using T1-weighted magnetic resonance image demonstrated large amounts of neck muscle fat infiltration and increased neck muscle CSA in patients with chronic WAD but not in idiopathic neck pain or healthy controls. METHODS Magnetic resonance images were obtained for 14 cervical muscle regions in 136 females, including 79 with chronic whiplash, 23 with chronic idiopathic neck pain, and 34 healthy controls. RESULTS Without fat removed, relative CSA of 7 of 14 muscle regions in the participants with chronic WAD was larger, 3 of 14 smaller and 4 of 14 similar to healthy individuals. When T1-weighted signal representing the lipid content of these muscles was removed, 8 of 14 relative muscle CSA in patients with whiplash were similar, 5 of 14 were smaller and only 1 of 14 was larger than those observed in healthy controls. Removal of fat from the relative CSA measurement did not alter findings between participants with idiopathic neck pain and healthy controls. CONCLUSION These findings clarify that previous reports of increased relative CSA in patients with chronic whiplash represent cervical muscle pseudohypertrophy. Relative muscle CSA measures reveal atrophy in several muscles in both patients with WAD and idiopathic neck pain, which supports inclusion of muscle conditioning in the total management of these patients. LEVEL OF EVIDENCE 3.
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Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. ACTA ACUST UNITED AC 2013; 18:360-6. [DOI: 10.1016/j.math.2013.05.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 05/13/2013] [Accepted: 05/20/2013] [Indexed: 01/03/2023]
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Hübscher M, Moloney N, Leaver A, Rebbeck T, McAuley JH, Refshauge KM. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis. Pain 2013; 154:1497-1504. [PMID: 23711482 DOI: 10.1016/j.pain.2013.05.031] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
Abstract
Sensitization of the nervous system can present as pain hypersensitivity that may contribute to clinical pain. In spinal pain, however, the relationship between sensory hypersensitivity and clinical pain remains unclear. This systematic review examined the relationship between pain sensitivity measured via quantitative sensory testing (QST) and self-reported pain or pain-related disability in people with spinal pain. Electronic databases and reference lists were searched. Correlation coefficients for the relationship between QST and pain intensity or disability were pooled using random effects models. Subgroup analyses and mixed effects meta-regression were used to assess whether the strength of the relationship was moderated by variables related to the QST method or pain condition. One hundred and forty-five effect sizes from 40 studies were included in the meta-analysis. Pooled estimates for the correlation between pain threshold and pain intensity were -0.15 (95% confidence interval [CI]: -0.18 to -0.11) and for disability -0.16 (95% CI: -0.22 to -0.10). Subgroup analyses and meta-regression did not provide evidence that these relationships were moderated by the QST testing site (primary pain/remote), pain condition (back/neck pain), pain type (acute/chronic), or type of pain induction stimulus (eg, mechanical/thermal). Fair correlations were found for the relationship between pain intensity and thermal temporal summation (0.26, 95% CI: 0.09 to 0.42) or pain tolerance (-0.30, 95% CI: -0.45 to -0.13), but only a few studies were available. Our study indicates either that pain threshold is a poor marker of central sensitization or that sensitization does not play a major role in patients' reporting of pain and disability. Future research prospects are discussed.
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Affiliation(s)
- Markus Hübscher
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia Neuroscience Research Australia and The University of New South Wales, Sydney, New South Wales, Australia
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Stone AM, Vicenzino B, Lim EC, Sterling M. Measures of central hyperexcitability in chronic whiplash associated disorder – A systematic review and meta-analysis. ACTA ACUST UNITED AC 2013; 18:111-7. [DOI: 10.1016/j.math.2012.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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Skou ST, Graven-Nielsen T, Lengsoe L, Simonsen O, Laursen MB, Arendt-Nielsen L. Relating clinical measures of pain with experimentally assessed pain mechanisms in patients with knee osteoarthritis. Scand J Pain 2013; 4:111-117. [PMID: 29913902 DOI: 10.1016/j.sjpain.2012.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/11/2012] [Indexed: 11/25/2022]
Abstract
Background Peripheral and central sensitisation is prominent in knee osteoarthritis (KOA) and could be important for the reduced efficacy in some cases after as well surgery as pharmacological interventions. Although sensitisation is important in KOA it is not known to what degree it contributes to the overall clinical pain problem. The aim was therefore to investigate how much a combination of quantitative pain measures assessing various pain mechanisms (local and spreading hyperalgesia, temporal and spatial summation, descending inhibition) could predict peak pain intensity in patients with KOA. Methods While resting in a comfortable recumbent position the pressure pain thresholds (PPT) in the peripatellar region (eight locations) and at the tibialis anterior muscle (TA) were assessed by handheld pressure algometry, computer-controlled pressure algometry and cuff-algometry in the affected leg of 17 KOA patients without pain or sensory dysfunctions in other regions than the knee. Cuff-algometry was used to detect spatial pain summation of the lower leg. Temporal pain summation was assessed by repeated pressure stimulation on the TA muscle. The conditioning pain modulation (CPM) was evaluated by conditioning tonic arm pain and by PPT from the peripatellar region. The participants rated their peak pain intensity in the previous 24 h using on a 10 cm visual analogue scale. Results A multiple-regression model based on TA pressure pain sensitivity (spreading sensitisation) and temporal pain summation on the lower leg accounted for 55% of the variance in peak pain intensity experienced by the patients (P=0.001). Significant correlations (P< 0.05) were found between PPTs assessed by handheld pressure algometry in the peripatellar region and at TA (R = 0.94), PPTs assessed by computer-controlled pressure algometry and handheld pressure algometry in the peripatellar region (R = 0.71), PPTs assessed by computer-controlled pressure algometry in the peripatellar region and handheld pressure algometry at TA (R = 0.71) and temporal summation at the knee and at TA (R = 0.73). Conclusion Based on the multiple regression model 55% variance of the perceived maximal pain intensity in painful KOA could be explained by the quantitative experimental pain measures reflecting central pain mechanisms (spreading sensitisation, temporal summation). The lack of other correlations between the methods used in assessing pain mechanisms in this study highlights the importance of applying different tests and different pain modalities when assessing the sensitised pain system as different methods add complementary information. Implications Clinical pain intensity can be explained by influences of different central pain mechanisms in KOA. This has implications for pain management in KOA where treatment addressing central pain components may be more important than previously acknowledged.
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Affiliation(s)
- Soren T Skou
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark.,Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, 9000 Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Lasse Lengsoe
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark.,Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, 9000 Aalborg, Denmark
| | - Ole Simonsen
- Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, 9000 Aalborg, Denmark
| | - Mogens B Laursen
- Orthopaedic Surgery Research Unit, Aalborg Hospital - Aarhus University Hospital, 9000 Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
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Content not quantity is a better measure of muscle degeneration in whiplash. ACTA ACUST UNITED AC 2013; 18:578-82. [PMID: 23465963 DOI: 10.1016/j.math.2013.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/22/2022]
Abstract
Whiplash associated disorder (WAD) represents an enormous economic, social and personal burden. Five out of 10 people with WAD never fully recover and up to 25% continue to have moderate to severe pain-related disability. Unfortunately, clear and definitive reasons as to why half of individuals with WAD recover uneventfully and the other half do not, remain elusive. Identifying the factors that can reliably predict outcome holds considerable importance for not only WAD, but arguably for other acute musculoskeletal traumas. The precise pathology present in WAD has been controversial and often biased by outdated models. Fortunately, a combination of new measurement technology that illuminates pain processing, physical and social functioning and post-traumatic stress responses (and possibly markers of altered muscle size/shape/physiology) is providing a clearer picture of the multisystem pathophysiology in individuals with persistent WAD. The aim of this professional issues paper is to illuminate the clinical and research communities with regards to the growing body of knowledge for determining the trajectory of a patient with whiplash.
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Armijo-Olivo S, Magee D. Cervical musculoskeletal impairments and temporomandibular disorders. J Oral Maxillofac Res 2013; 3:e4. [PMID: 24422022 PMCID: PMC3886095 DOI: 10.5037/jomr.2012.3404] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/13/2012] [Indexed: 12/04/2022]
Abstract
Objectives The study of cervical muscles and their significance in the development and
perpetuation of Temporomandibular Disorders has not been elucidated. Thus
this project was designed to investigate the association between cervical
musculoskeletal impairments and Temporomandibular Disorders. Material and Methods A sample of 154 subjects participated in this study. All subjects underwent a
series of physical tests and electromyographic assessment (i.e. head and
neck posture, maximal cervical muscle strength, cervical flexor and extensor
muscles endurance, and cervical flexor muscle performance) to determine
cervical musculoskeletal impairments. Results A strong relationship between neck disability and jaw disability was found (r
= 0.82). Craniocervical posture was statistically different between patients
with myogenous Temporomandibular Disorders (TMD) and healthy subjects.
However, the difference was too small (3.3º) to be considered
clinically relevant. Maximal cervical flexor muscle strength was not
statistically or clinically different between patients with TMD and healthy
subjects. No statistically significant differences were found in
electromyographic activity of the sternocleidomastoid or the anterior
scalene muscles in patients with TMD when compared to healthy subjects while
executing the craniocervical flexion test (P = 0.07). However, clinically
important effect sizes (0.42 - 0.82) were found. Subjects with TMD presented
with reduced cervical flexor as well as extensor muscle endurance while
performing the flexor and extensor muscle endurance tests when compared to
healthy individuals. Conclusions Subjects with Temporomandibular Disorders presented with impairments of the
cervical flexors and extensors muscles. These results could help guide
clinicians in the assessment and prescription of more effective
interventions for individuals with Temporomandibular Disorders.
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Affiliation(s)
- Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, Department of Physical Therapy and Faculty of Medicine and dentistry, Department of Pediatrics, University of Alberta Canada
| | - David Magee
- Faculty of Rehabilitation Medicine Department of Physical Therapy, University of Alberta Canada
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Spearing NM, Connelly LB, Nghiem HS, Pobereskin L. Research on injury compensation and health outcomes: ignoring the problem of reverse causality led to a biased conclusion. J Clin Epidemiol 2012; 65:1219-26. [DOI: 10.1016/j.jclinepi.2012.05.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 05/06/2012] [Accepted: 05/09/2012] [Indexed: 11/25/2022]
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Abstract
STUDY DESIGN Literature review. OBJECTIVE To review the evidence related to the morphological changes (atrophy and fatty degeneration) of neck muscles in whiplash-associated disorders (WAD) and to highlight emerging evidence for the pathophysiological mechanisms behind muscle degeneration and their potential role in the transition from acute to chronic pain after whiplash injury from a motor vehicle crash (MVC). SUMMARY OF BACKGROUND DATA Magnetic resonance imaging (MRI) can be regarded as the gold standard for muscle imaging. There is emerging evidence to highlight in vivo features of neck muscle degeneration in patients with chronic WAD and the temporal development of such acute changes after MVC. However, the precise underlying mechanisms for such changes and their influence on functional recovery after whiplash remain largely unknown. METHODS Literature review of available evidence from both the authors' previous studies and other similar bodies of work. RESULTS Studies have quantified degenerative changes in the neck muscles of patients with acute and chronic whiplash with structural MRI applications. CONCLUSION Current evidence from structural MRI based studies demonstrates the widespread presence of fatty infiltrates in neck muscles of patients with chronic whiplash. Such findings have not shown to feature in patients with chronic insidious onset neck pain, suggesting traumatic factors play a role in their development. Recent studies have revealed that muscle fatty infiltrates manifest soon after whiplash but only in those with higher pain and disability and symptoms of post-traumatic stress disorder. The possibility that such muscle changes are associated with a more severe injury including poor functional recovery remains the focus of current research efforts.
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Abstract
STUDY DESIGN Review article. OBJECTIVE To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. SUMMARY OF BACKGROUND DATA There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. METHODS Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. RESULTS Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. CONCLUSION The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.
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Abstract
The creation of a magnetic resonance image (MRI) and its inherent contrast are controlled by a variety of anatomical structure- and sequence-dependent parameters. While these may seem confusing to the uninitiated, they provide MRI with great flexibility and make it a powerful clinical tool. This article describes the principles of basic physics behind magnetic resonance spectroscopy (MRS) and imaging, including a basic description of the properties of magnetic resonance compatible nuclei, how a radiofrequency (RF) pulse produces a signal, and how this signal can be spatially encoded to produce an image. The relaxation properties of the MRI signal depend on biological tissue type and can provide information on tissue composition, environment, and pathological changes. The contrast properties within an image can be manipulated based on the relaxation properties of the anatomical sample and the nature of the imaging sequence. The benefits of T1- and T2-weighted images in musculoskeletal imaging and the common sequences used (including turbo spin echo [TSE], fat suppression sequences such as STIR, and rapid breath-hold sequences such as HASTE and FISP) are discussed. The principles behind contrast agents and diffusion-weighted imaging and how they can be applied in the body are considered.
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Abstract
Musculoskeletal imaging of the spine can be an invaluable tool to inform clinical decision making in patients with spinal pain. An understanding of the technology involved in producing and interpreting high-resolution images produced from magnetic resonance imaging (MRI) of the human spine is necessary to better appreciate which sequences can be used for, or tailored to, individual patients and their conditions. However, there is substantial variability in the clinical meaningfulness of some MRI findings of spinal tissues. For example, normal variants can often mimic significant musculoskeletal pathology, which could increase the risk of misinformed clinical decisions and, even worse, poor or adverse outcomes. This clinical commentary will highlight some of the pearls and pitfalls of MRI for the cervical, thoracic, and lumbar regions, and include cases to illustrate some of the common imaging artifacts and normal variants for MRI of the spine.
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Elliott J, Pedler A, Kenardy J, Galloway G, Jull G, Sterling M. The temporal development of fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress. PLoS One 2011; 6:e21194. [PMID: 21698170 PMCID: PMC3116885 DOI: 10.1371/journal.pone.0021194] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/23/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Radiological findings associated with poor recovery following whiplash injury remain elusive. Muscle fatty infiltrates (MFI) in the cervical extensors on magnetic resonance imaging (MRI) in patients with chronic pain have been observed. Their association with specific aspects of pain and psychological factors have yet to be explored longitudinally. MATERIALS AND FINDINGS 44 subjects with whiplash injury were enrolled at 4 weeks post-injury and classified at 6 months using scores on the Neck Disability Index as recovered, mild and moderate/severe. A measure for MFI and patient self-report of pain, loss of cervical range of movement and posttraumatic stress disorder (PTSD) were collected at 4 weeks, 3 months and 6 months post-injury. The effects of time and group and the interaction of time by group on MFI were determined. We assessed the mediating effect of posttraumatic stress and cervical range of movement on the longitudinal relationship between initial pain intensity and MFI. There was no difference in MFI across all groups at enrollment. MFI values increased in the moderate/severe group and were significantly higher in comparison to the recovered and mild groups at 3 and 6 months. No differences in MFI values were found between the mild and recovered groups. Initial severity of PTSD symptoms mediated the relationship between pain intensity and MFI at 6 months. Initial ROM loss did not. CONCLUSIONS MFI in the cervical extensors occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent PTSD in patients with persistent symptoms.
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Affiliation(s)
- James Elliott
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Australia.
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Kammerlind AS, Bladström M, Svensson K. Test–retest reliability of two short Swedish versions of the Dizziness Handicap Inventory. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14038196.2011.559667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Diffusion-weighted magnetic resonance imaging for the healthy cervical multifidus: a potential method for studying neck muscle physiology following spinal trauma. J Orthop Sports Phys Ther 2010; 40:722-8. [PMID: 20811164 DOI: 10.2519/jospt.2010.3423] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To develop a new magnetic resonance imaging (MRI) measure for the diffusive properties of the healthy cervical multifidus and to determine the interrater and intrarater reliability of the measurement. BACKGROUND Diffusion-weighted MRI, via calculation of the apparent diffusion coefficient (ADC), provides a representation of microscopic movements of water molecules in human tissues and may be useful to assess structural changes in neck muscle, as has been observed following whiplash. The optimal imaging parameters, however, have not been established. METHODS A diffusion-weighted MRI measure was developed, and, for the basic examination, the right cervical multifidus muscle at the C5 level was studied. A total of 6 asymptomatic volunteer individuals (3 females and 3 males) underwent a single diffusion-weighted MRI scan. Interrater and intrarater agreement was evaluated using Bland-Altman plots and intraclass correlation coefficients. RESULTS Mean ADCb0-b50 and ADCb50-250 were significantly different from one another (P=.03). The plots confirmed the agreement of raters for ADC of the right cervical multifidus at C5. CONCLUSIONS A quantitative and reliable diffusion-weighted MRI measure of cervical multifidus ADC has been described. There appears to be a fast and slow component ADC for the healthy multifidus, suggesting changes in extracellular and intracellular volume. Further comparative study is needed to quantify ADCs in the neck muscles in patients with traumatic whiplash.
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Webb A, Darekar A, Rassoulian H. The influence of age, anthropometrics and range of motion on the morphometry of the synovial folds of the lateral atlanto-axial joints: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:542-9. [PMID: 20711618 DOI: 10.1007/s00586-010-1553-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 05/23/2010] [Accepted: 08/01/2010] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to investigate the effect of age, anthropometrics and cervical range of motion upon synovial fold volume. Ten healthy female subjects aged 20-40 years were included in the study. Age, height, body mass, dimensions of the head and neck and cervical range of motion of each subject were measured. Magnetic resonance (MR) images of the cervical spine were acquired; the volume of the ventral and dorsal synovial folds of the right and the left lateral atlanto-axial joints was measured using seed growing and thresholding methods. Using Spearman's correlation coefficient, it was determined that there was no correlation between synovial fold volume and age. Synovial fold volume was positively correlated with subject height and neck length but negatively correlated with body mass, body mass index and the circumference of the head and neck. The relationship between synovial fold volume and range of cervical motion varied with the plane of movement. The ability to image the synovial folds of the lateral atlanto-axial joints using MR imaging to determine their normal morphology provides the basis for investigating synovial fold pathology in patients with neck pain and headache.
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Affiliation(s)
- Alexandra Webb
- Centre for Learning Anatomical Sciences, University of Southampton, School of Medicine, Southampton General Hospital, Mailpoint 845, Tremona Road, Southampton, SO16 6YD, UK.
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