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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

Cost$
to have symptoms
at six-months
(Hartling et al. 2001)

$29+ billion
Prognostic factors
to characterize the
acute & chronic
10-25% will
continue to have
symptoms at

USD
condition
(Sterling et al. 2003;2006)
two-years

(Radanov et al. 1995; Sterling et al.


2003;2006)
Injury Mechanics
Patho-Mechanics
Injury Causing Motion
Facet Spearing Mechanism
“Open-Book”

Extensi Facet
on 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
Are and
these muscular
appears uniquechanges UNIQUE
to subjects with to
persistentneck
the posterior whiplash
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

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

These changes are consistent with those


observed in the posterior muscles and are


of potential detriment to the optimal
recovery of patients with WAD

Studies are underway to better investigate


the mechanisms underlying these changes.



Acknowledgements

• U of Queensland • Funding Support


•James Elliott Regis University – SPARC

•Gwen Jull
grant

Physiotherapy Research
Regis Univ –


Foundation-grant, 2009
Denver, USA •
James Elliott, Cliff Barnes,

Tim Noteboom Motor Accident Insurance


• Commission - QLD
• •




THANK YOU