Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain.

AIM: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). MATERIALS AND METHODS: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2+/-6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. RESULTS: Measures were compared with those of a previous dataset of chronic whiplash patients (n=79, mean age 29.7+/-7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p<0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). CONCLUSION: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash.

Magnetic resonance imaging study of cross-sectional area of the cervical extensor musculature in an asymptomatic cohort.

Magnetic Resonance Imaging (MRI) can be regarded as the gold standard for muscle imaging; however there is little knowledge about in vivo morphometric features of neck extensor muscles in healthy subjects and how muscle size alters across vertebral segments. It is not known how body size and activity levels may influence neck muscle cross-sectional area (CSA) or if the muscles differ from left and right. The purpose of this study was to establish relative CSA (rCSA) data for the cervical extensor musculature with a reliable MRI measure in asymptomatic females within a defined age range and to determine if side-side and vertebral level differences exist. MRI of the cervical spine was performed on 42 asymptomatic female subjects within the age range of 18-45. The rCSA values for the cervical extensor muscles were measured from axial T1-weighted images. We found significant side-side rCSA differences for the rectus capitis posterior minor, major (P < 0.001), multifidus (P = 0.002), and the semispinalis cervicis/capitis (P = 0.001, P < 0.001). There were significant vertebral level differences in rCSA of the semispinalis cervicis/capitis, multifidus, splenius capitis, and upper trapezius (P < 0.001). Activity levels were shown to impact on the size of semispinalis cervicis (P = 0.027), semispinalis capitis (P = 0.003), and the splenius capitis (P = 0.004). In conclusion, measuring differences in neck extensor muscle rCSA with MRI in an asymptomatic population provides the basis for future study investigating relationships between muscular atrophy and symptoms in patients suffering from persistent neck pain. Clin.

Magnetic resonance imaging analysis of the upper cervical spine extensor musculature in an asymptomatic cohort: an index of fat within muscle.

AIM: To establish a simple method to quantify muscle/fat constituents in cervical muscles of asymptomatic women using magnetic resonance imaging (MRI), and to determine whether there is an age effect within a defined age range. MATERIALS AND METHODS: MRI of the upper cervical spine was performed for 42 asymptomatic women aged 18-45 years. The muscle and fat signal intensities on axial spin echo T1-weighted images were quantitatively classified by taking a ratio of the pixel intensity profiles of muscle against those of intermuscular fat for the rectus capitis posterior major and minor and inferior obliquus capitis muscles bilaterally. Inter- and intra-examiner agreement was scrutinized. RESULTS: The average relative values of fat within the upper cervical musculature compared with intermuscular fat indicated that there were only slight variations in indices between the three sets of muscles. There was no significant correlation between age and fat indices. There were significant differences for the relative fat within the muscle compared with intermuscular fat and body mass index for the right rectus capitis posterior major and right and left inferior obliquus capitis muscles (p=0.032). Intraclass correlation coefficients for intraobserver agreement ranged from 0.94 to 0.98. Inter-rater agreement of the measurements ranged from 0.75 to 0.97. CONCLUSION: A quantitative measure of muscle/fat constituents has been developed, and results of this study indicate that relative fatty infiltration is not a feature of age in the upper cervical extensor muscles of women aged 18-45 years.

Activation of the arousal response and impairment of performance increase with anxiety and stressor intensity.

The purpose of this study was to determine the effect of trait anxiety and stressor intensity on arousal and motor performance during a pinch task. We examined the steadiness of a precision task in the presence and absence of an imposed stressor on subjects with moderate and low trait anxiety. Subjects with the 26 highest and 14 lowest anxiety scores were assigned to one of three groups: a control group (5 women, 5 men), a moderate-anxiety group (8 women, 8 men), or a low-anxiety group (7 women, 7 men). Subjects in the anxiety groups received electric shocks and experienced significant increases in cognitive and physiological arousal compared with baseline and control subjects, especially subjects in the moderate-anxiety group. Heart rate, systolic blood pressure, and electrodermal activity were elevated during the stressor, whereas diastolic blood pressure was unchanged. Cognitive and physiological arousal tended to increase with stressor intensity and was accompanied by changes in steadiness. Although steadiness was markedly reduced with the highest intensity of shock, the average electromyogram activity was unaffected by the stressor. These findings indicate that the increase in arousal and the impairment of steadiness increased with trait anxiety and with the intensity of the noxious stimulus.

Activation of the arousal response can impair performance on a simple motor task.

The purpose of this study was to determine the effect of arousal in men and women on the moment-to-moment performance of a simple motor task. We examined the control of a precision task in the presence and absence of imposed stressors. Twenty-nine subjects (14 men, 15 women; 18--44 yr) were randomly assigned to either a control group or one of two stressor groups, Mental Math or Electric Shock. Subjects presented with Math and Shock stressors, which lasted 10 min, experienced significant increases in cognitive and physiological arousal compared with baseline and control subjects. Heart rate, systolic blood pressure, and electrodermal activity were elevated 5--80% with presentation of the stressors, whereas diastolic blood pressure and salivary cortisol were unchanged. The greater levels of cognitive and physiological arousal were associated with reductions in steadiness of a pinch grip for the Shock subjects (approximately 130% reduction from baseline) but not for the subjects in the Math group, who experienced heightened arousal but no change in steadiness (10% reduction from baseline). Although women exhibited more of a reduction in steadiness than men, the effect was largely unrelated to the magnitude of the change in arousal.

Precision-grip force changes in the anatomical and prosthetic limb during predictable load increases.

This study examined precision-grip force applied to an instrumented test object held aloft while the weight of the object was predictably varied by transporting and placing loads (50, 100, or 200 g) atop the test object. Transport of the loads was performed either by the subject or the experimenter. Grip force was examined in four non-amputee control subjects and in the anatomical and prosthetic hand of a subject with a prosthetic device. As subjects transported the load, anticipatory grip-force changes occurred in the anatomical hands and prosthetic hand, which were scaled in relation to the load. When the experimenter transported the load to the anatomical hands of control subjects or the prosthetic user, anticipatory increases in grip force occurred that also were scaled in relation to load. However, when the experimenter transported the load to the prosthetic hand, anticipatory grip-force adjustments were absent. During the phase in which the load was being assumed by the postural hand, grip forces in the anatomical hands and prosthetic hand were further scaled to load demands. Ability to adapt grip force in the prosthetic hand during this phase suggested that the subject was utilizing sensory information from the residual limb to adjust grip force. Thus, while anticipatory changes precede the process of adaptation to load changes, actual sensory consequences resulting from added weight remain necessary to fully adapt grip force to load demands, even for the prosthetic user.

Bilateral simultaneous infrapatellar tendon ruptures: a case study.

This case study reports on a patient with a diagnosis of bilateral patellar tendon ruptures. Bilateral ruptures of the infrapatellar tendons are rare occurrences; approximately 20 cases have been reported in the medical literature. Much of the medical literature concentrates on surgical repair, immediate postoperative follow-up, and final outcome. There is a void in the literature concerning the rehabilitative process of these patients. The subject of this study is a 26-year-old male former collegiate athlete who suffered simultaneous bilateral patellar tendon ruptures while jumping. A rehabilitation model is provided that may assist others treating patients with similar conditions.

Effects of electrical and electromagnetic stimulation after anterior cruciate ligament reconstruction.

A need exists to develop new methods of neuromuscular electrical stimulation (NMES) that are both effective and relatively pain-free. The purpose of this pilot study was to determine the effects of both NMES and a new method of electromagnetic (NMES/PEMF) stimulation for reducing girth loss and for reducing pain and muscle weakness of the knee extensor muscles in patients during the first 6 weeks after reconstructive surgery of the anterior cruciate ligament (ACL). Seventeen patients receiving ACL reconstructive surgery participated as a control group (N = 3), as an NMES group (N = 7), and with combined NMES and magnetic field stimulation (NMES/PEMF) (N = 7). Patients receiving NMES/PEMF rated each type of stimulation for perceived pain and were measured for their torque. Torque results revealed a mean decrease of 13.1% for NMES/PEMF patients. The mean percent of thigh girth decreased 8.3% for controls, 0.5% for NMES, and 2.3% for NMES/PEMF patients. The NMES/PEMF patients rated NMES as causing about twice the pain intensity as NMES/PEMF during treatments. As a result of this data, the authors conclude that both NMES and NMES/PEMF are effective in reducing girth loss and that NMES/PEMF is less painful than NMES alone in treating patients after ACL reconstruction.