Regis Dpt Class Of 2009 Whiplash Project

Cross Sectional Area of Longus Capitis Muscle in Patients with

Cannata E, Christensen E, DeMaris J, Kummrow J, Manning E, Nielsen E, Romero T Elliott J, Barnes C, Noteboom J, Jull G.

WHAT DO WE KNOW?

40% will continue to have symptoms at six-months

Cost$

(Hartling et al. 2001)

$29+ billion USD

Prognostic factors to characterize the acute & chronic condition

10-25% will continue to have symptoms at two-years

(Sterling et al. 2003;2006)

(Radanov et al. 1995; Sterling et al. 2003;2006)

Injury Mechanics

Patho-Mechanics

Injury Causing Motion

Facet Spearing Mechanism “Open-Book”

Extensi on

Facet Spearing

Grauer et al., 1997; Kaneoka et al., 1999; Yoganandan et al., 1999; 2003; Panjabi et al., 2004

Conclusions • Mechanisms – Differential acceleration/deceleration between head and torso – Abnormal non-physiological movement in spinal vertebrae – Implications for injury to myriad of disparate tissues and development of persistent symptoms

Ligamentous

Where is the problem (s)? Facetogenic

Discogenic

Up to 90% of asymptomatic subjects would show signs of lumbar DDD

~40% of healthy subjects over 40 years of age would demonstrate similar/same findings on c-spine scans

Muscle changes have been observed clinically Lumbar spine

Cervical spine Kader et al, 2000; Hyun et al., 2007

Paraspinal Muscle Changes in Chronic Whiplash

Demographics

Cervical Paraspinal Musculature

Multifidus

Semispinalis Cervicis

Semispinalis Capitis

Splenius Capitis

Upper Trapezius

Cross-Sectional Area (mm2) of the Cervical Extensors on MRI

Elliott et al., Man Ther, 2008

The rCSA of extensor musculature (C3-C7) for the WAD and healthy control groups (Log values, averaged across side). * p<0.01

*

*

*

*

*

*

*

* *

*

*

* *

*

*

*

C3

C4

C5

C6

C7 (Elliott et al., 2008)

Could the CSA changes be the result of increased fat content?

Elliott et al., 2006

WAD Healthy Control

Mean differences for the fat indices in the cervical extensor muscles across segmental levels (C3-C7) in the WAD group (p <0.0001) 113 Females

79 WAD & 34 Normal

(Elliott et al., 2006)

What needs to be What do we know? answered? Presence of paraspinal muscular alterations has been quantified with MRI appears unique to subjects with to Are and these muscular changes UNIQUE persistentneck whiplash the posterior muscles?

OUR Investigations

Study #1- Changes in Size/Shape in Oropharynx

Dens

Dens

Oropharynx

Atlas Tip of Uvula

Oropharynx

Condyles of Atlas

MRICroSoftware

MRICro Software Oropharynx

Dens

Condyles of Atlas

Outlined region of interest (ROI) of the oropharynx measure for CSA in a whiplash subject at the C1-2 segmental level. b) filled in ROI of oropharynx used for calculating CSA (mm2)

a

b

P < .0001

34 Healthy Controls & 79 WAD

CSA (mm2) values and the shape ratios (mm2) for the oropharyngeal measures for whiplash and healthy controls

Table 2 CSA (mm2) values and the shape ratios (mm2) for the oropharyngeal measures for whiplash and healthy controls

Data are means ± SD (95% confidence intervals)

Study #2: CSA of the Longus Capitis/Colli in Chronic Whiplash

a b

Hang in there mate! a

b

MRICroSoftware

MRICro Software

*

* p = 0.009

118. 9 9 8.1

*

* p = 0.009

Did covariates influence the size of the longus capitis?

Could these changes reflect fatty Infiltrate?

Elliott et al., submitted

** **

** P < 0.001

**

Summary Muscular degeneration is present the deep anterolateral neck muscles in persistent WAD •

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These changes are consistent with those observed in the posterior muscles and are of potential detriment to the optimal recovery of patients with WAD •

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Studies are underway to better investigate the mechanisms underlying these changes. •

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Acknowledgements •

U of Queensland

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James Elliott •Gwen Jull •

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Regis Univ – Denver, USA •

James Elliott, Cliff Barnes, Tim Noteboom

Funding Support

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Regis University – SPARC grant •

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Physiotherapy Research Foundation-grant, 2009 •

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Motor Accident Insurance Commission - QLD •

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THANK YOU