Evidence for increased MRI signal intensity and morphological changes in the brachial plexus and median nerves of patients with chronic arm and neck pain following whiplash injury

Greening, Jane, Anantharaman, Kamakshi, Young, Rupert and Dilley, Andrew (2018) Evidence for increased MRI signal intensity and morphological changes in the brachial plexus and median nerves of patients with chronic arm and neck pain following whiplash injury. Journal of Orthopaedic & Sports Physical Therapy. ISSN 0190-6011 (Accepted)

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Abstract

STUDY DESIGN: Cross-sectional study.
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 sign 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 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: T2 signal was greater in the brachial plexus and median nerve at the wrist in the patient group (mean intensity ratio = 0.52 (0.13 SD) and 2.09 (0.33 SD) respectively) compared to the control group (mean intensity = 0.45 (0.07 SD) and 1.38 (0.31 SD) respectively; p<0.05). Changes in median nerve morphology were also observed, which included an enlargement (mean area = 8.05 (1.29 SD) mm2 in the patient group and 6.52 (1.08 SD) mm2 in the control group; p<0.05) and flattening at the proximal carpal row (mean aspect ratio = 2.46 (0.53 SD) in the patient group and 1.62 (0.30 SD) in the control group; p < 0.05). 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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Neuroscience
School of Engineering and Informatics > Engineering and Design
Subjects: R Medicine > RC Internal medicine > RC0321 Neurosciences. Biological psychiatry. Neuropsychiatry
Depositing User: Andrew Dilley
Date Deposited: 16 Feb 2018 11:44
Last Modified: 16 Apr 2018 10:56
URI: http://sro.sussex.ac.uk/id/eprint/73620

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