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- Title
Evidence for Increased Magnetic Resonance Imaging Signal Intensity and Morphological Changes in the Brachial Plexus and Median Nerves of Patients With Chronic Arm and Neck Pain Following Whiplash Injury.
- Authors
GREENING, JANE; ANANTHARAMAN, KAMAKSHI; YOUNG, RUPERT; DILLEY, ANDREW
- Abstract
* BACKGROUND: Whiplash following a motor vehicle accident can result in chronic neck and arm pain. Patients frequently present with cutaneous hypersensitivities and hypoesthesia, but without obvious clinical signs of nerve injury. T2-weighted magnetic resonance imaging (MRI) has previously been used to identify nerve pathology. * OBJECTIVES: To determine whether there are signs of peripheral nerve pathology on MRI in patients with chronic arm and neck pain following whiplash injury. * METHODS: This cross-sectional study used T2-weighted MRI to examine the brachial plexus and median nerve in patients and age-matched, healthy control subjects. Clinical examination included tests of plexus and nerve trunk mechanical sensitivity. * RESULTS: The T2 signal intensity was greater in the brachial plexus and median nerve at the wrist in the patient group (mean intensity ratio = 0.52 ± 0.13 and 2.09 ± 0.33, respectively) compared to the control group (mean intensity ratio = 0.45 ± 0.07 and 1.38 ± 0.31, respectively; P<.05). Changes in median nerve morphology were also observed, which included an enlargement (mean area: patient group, 8.05 ± 1.29 mm²; control group, 6.52 ± 1.08 mm²; P<.05) and flattening (mean aspect ratio: patient group, 2.46 ± 0.53; control group, 1.62 ± 0.30; P<.05) at the proximal carpal row. All patients demonstrated signs of nerve trunk mechanical sensitivity. *CONCLUSION: These findings suggest that patients with chronic whiplash may have inflammatory changes and/or mild neuropathy, which may contribute to symptoms.
- Subjects
RADIOGRAPHY of the arm; BRACHIAL plexus; INFLAMMATION; MAGNETIC resonance imaging; MEDIAN nerve; NECK pain; PERIPHERAL nervous system; TRAFFIC accidents; WHIPLASH injuries; CROSS-sectional method; DATA analysis software; DESCRIPTIVE statistics
- Publication
Journal of Orthopaedic & Sports Physical Therapy, 2018, Vol 48, Issue 7, p523
- ISSN
0190-6011
- Publication type
Article
- DOI
10.2519/jospt.2018.7875