Case Report: Whiplash-Associated Disorder From a Low-Velocity Bumper Car Collision: History, Evaluation, and Surgery

Duffy, Michael; Stuberg, Wayne; DeJong, Stacey L.; Gold, Kurt; Nystrom, N Ake

doi:10.1097/01.brs.0000137064.85554.fa

Cited by 10 publications

(6 citation statements)

References 14 publications

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“…Permanent solutions for the chronic pain conditions of the subjects in the present study are few; one suggestion is to surgically excise or ablate symptomatic trigger points that are associated with a decrease in local and generalized pain following anesthetization. [20] Such an approach, although intriguing, requires further description and study.…”

Section: Discussionmentioning

confidence: 99%

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

Freeman

Nyström

Centeno³

2014

J Brachial Plex Peripher Nerve Inj

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Objectiveit has been established that chronic neck pain following whiplash is associated with the phenomenon of central sensitization, in which injured and uninjured parts of the body exhibit lowered pain thresholds due to an alteration in central pain processing. it has furthermore been hypothesized that peripheral sources of nociception in the muscles may perpetuate central sensitization in chronic whiplash. the hypothesis explored in the present study was whether myofascial trigger points serve as a modulator of central sensitization in subjects with chronic neck pain.Designcontrolled case series.Settingoutpatient chronic pain clinic.Subjectsseventeen patients with chronic and intractable neck pain and 10 healthy controls without complaints of neck pain.Interventionsymptomatic subjects received anesthetic infiltration of myofascial trigger points in the upper trapezius muscles and controls received the anesthetic in the thigh.Outcome measures: pre and post injection cervical range of motion, pressure pain thresholds (ppt) over the infraspinatus, wrist extensor, and tibialis anterior muscles. sensitivity to light (photophobia) and subjects' perception of pain using a visual analog scale (vas) were also evaluated before and after injections. only the ppt was evaluated in the asymptomatic controls.Resultsimmediate (within 1 minute) alterations in cervical range of motion and pressure pain thresholds were observed following an average of 3.8 injections with 1–2 cc of 1% lidocaine into carefully identified trigger points. cervical range of motion increased by an average of 49% (p = 0.000) in flexion and 44% (p = 0.001) in extension, 47% (p = 0.000) and 28% (p < 0.016) in right and left lateral flexion, and a 27% (p = 0.002) and 45% (p = 0.000) in right and left rotation. ppt were found increased by 68% over the infraspinatus (p = 0.000), by 78% over the wrist extensors (p = 0.000), and by 64% over the tibialis anterior (p = 0.002). among 11 subjects with photophobia, only 2 remained sensitive to light after the trigger point injections (p = 0.033). average vas dropped by 57%, from 6.1 to 2.6 (p = 0.000). no significant changes in ppt were observed in the control group following lidocaine infiltration of the thigh.Conclusionthe present data suggest that myofascial trigger points serve to perpetuate lowered pain thresholds in uninjured tissues. additionally, it appears that lowered pain thresholds associated with central sensitization can be immediately reversed, even when associated with long standing chronic neck pain. although the effects resulting from anesthesia of trigger points in the present study were temporary, it is possible that surgical excision or ablation of the same trigger points may offer more permanent solutions for chronic neck pain patients. further study is needed to evaluate these and other options for such patients.

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Section: Discussionmentioning

confidence: 99%

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

Freeman

Nyström

Centeno³

2014

J Brachial Plex Peripher Nerve Inj

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“…Another 14 articles were excluded because they lacked a mention of the headache measure used or they lacked a description of the intervention. At the end of this full review (see Figure 1), 36 of the 64 articles met the final criteria [17‐52]. Two external expert reviewers were asked to review the methods and evidence tables.…”

Section: Methodsmentioning

confidence: 99%

Systematic Review of Interventions for Post‐traumatic Headache

Watanabe

Bell

Walker

et al. 2012

PM&R

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“…Cervical joint dysfunctions and muscle TrPs are thought, by some researchers, to be the most relevant sources of nociception in whiplashassociated disorders [36]. In a review of the whiplash literature, Fernández-de-las-Peñas et al [37] found that the most common muscles affected by TrPs are the scalenes [38], splenius capitis [39], sternocleidomastoid [40,41], upper trapezius, posterior neck muscles [42], or pectoralis minor [43]. The S-shaped cervical curvature occurring during a rear-end impact may result in a lengthening position of the sternocleidomastoid, which will result in a contraction-induced overload of this stretched muscle [44].…”

Section: Muscle Trps In Whiplash-associated Disordersmentioning

confidence: 99%

The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck

Fernández‐de‐las‐Peñas

Simons²,

Cuadrado³

et al. 2007

Current Science Inc

101

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Neck and head pain syndromes are common problems seen in clinical practice. Pain features of commonly designated idiopathic neck pain and some primary headaches (ie, tension-type headache or migraine) fit the descriptions of referred pain originating in muscle trigger points (TrPs). This article discusses the scientific evidence supporting the role of muscle TrPs in chronic musculo-skeletal disorders of the neck and head. The relevance of referred pain elicited by muscle TrPs in patients with neck pain has been investigated in few studies. Some authors found that both muscle TrPs in neck-shoulder muscles and cervical joint dysfunctions contribute at the same time to neck pain perception. Furthermore, it seems that referred pain originated in muscle TrPs could also contribute to neck symptoms perceived by subjects after a rear-end crash. In addition, several recent studies reported that both TTH and migraine are associated with referred pain from TrPs in the suboccipital, upper trapezius, sternocleidomastoid, temporalis, or superior oblique muscles. Referred pain elicited by active TrPs mimics the pain areas observed during head pain attacks in these primary headaches. Based on available data, it seems that the pain profile of neck and head syndromes may be provoked referred pain from TrPs in the posterior cervical, head, and shoulder muscles. Additional studies are needed to delineate more information on the relation between muscle TrPs and musculoskeletal pain syndromes of the head and neck.

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Case Report: Whiplash-Associated Disorder From a Low-Velocity Bumper Car Collision: History, Evaluation, and Surgery

Cited by 10 publications

References 14 publications

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation

Systematic Review of Interventions for Post‐traumatic Headache

The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck

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