There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment o...There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders(WADs)with both a qualitative method and quantitative sensory testing(QST).Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin(overlying each trigeminal branch bilaterally,and the midpoint of the chin)were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds(i.e.,decreased sensitivity)for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.展开更多
AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed...AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed cadavers. Paraffin sections from these capsules were processed to identify neurofilament and substance P immunoreactive fibers. Nerve fiber presence was also verified by a silver impregnation method.RESULTS: Neurofilament reactive fibers were observed in sections from 9 capsules. They were observed in areas with collagen fibers and areas with irregular connective tissue. Substance P reactive nerve fibers were found in sections from 7 capsules in similar areas. Silver impregnation also revealed the presence of nerve fibers. The nerve fibers were also found as bundles in the lateral margins of the capsule. A Pacinian corpuscle-like ending was also observed in onespecimen.CONCLUSION: Nerve fibers revealed by neurofilament immunoreactivity and silver staining support innervation of the ventral aspect of the facet joint capsule. The presence of substance P reactive fibers supports the potential role of these elements in mediating pain. The presence of a Pacinian-like ending implicates a potential role in joint movement.展开更多
There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction....There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction. Acupuncture's effects are experienced throughout the body but specifically acupuncture can be seen to contribute significantly to nerve metabolism and rebuilding. However, very little is written on the mechanisms for this nerve recovery. This paper will reflect on these mechanisms in relation to the treatment of neck problems associated with nerve root impingement.展开更多
Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical ...Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical and/or dorsal spine injury and with a clinical diagnosis of whiplash syndrome underwent both DITI (AVIO TVS 2000) and US (GE Logic 5) of the following muscles: sternocleidomastoid, splenius, trapezius, longus colli and paravertebral muscles. DITI considered positive in the region with the most altered temperature among the injured area examinated (normal range 0℃ - 0.8℃). US valued the cervical and dorsal region with a comparative examination of the soft tissues. The images taken with DITI were compared with the clinical and the sonographic outcomes respectively. US and DITI were considered a) congruent whether both had a positive outcome for the same muscle clinically injured;b) not congruent whether one of the two instruments had a different outcome then the clinical evidence. Wilcoxon paired test was used for statistical analysis. Results: DITI and US matched 153 of 233 (65%) injured muscles. The association between DITI and US in the evaluation of the injured muscles was statistically significant for the following muscles: left trapezius (p Conclusions: According to our preliminary study, DITI and US were both helpful for assessing soft tissues injuries in patients with whiplash syndrome, defining the extent of the biologic damage for a correct clinical-therapeutical management.展开更多
Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study ...Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3;1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5;1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5;0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility);external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.展开更多
During boreal winter,the invasion of cold air can lead to remarkable temperature drops in East Asia which can result in serious socioeconomic impacts.Here,we find that the intensity of strong synoptic cold days in the...During boreal winter,the invasion of cold air can lead to remarkable temperature drops in East Asia which can result in serious socioeconomic impacts.Here,we find that the intensity of strong synoptic cold days in the East China Sea and Indochina Peninsula are increasing.The enhanced synoptic cold days in these two regions are attributed to surface warming over the South China Sea and Philippine Sea(SCSPS).The oceanic forcing of the SCSPS on the synoptic cold days in the two regions is verified by numerical simulation.The warming of the SCSPS enhances the baroclinicity,which intensifies meridional wind and cold advection on synoptic timescales.This leads to a more extended region that is subject to the influence of cold invasion.展开更多
Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is n...Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in展开更多
Purpose: Whiplash associated disorders remain a major health problem in terms of impact on health care and on societal costs. Aetiology remains con troversial including the old suppos ition that the cervical muscles d...Purpose: Whiplash associated disorders remain a major health problem in terms of impact on health care and on societal costs. Aetiology remains con troversial including the old suppos ition that the cervical muscles do not play a significant role. This study examined the muscle activity from relevant muscles during rear-end impacts in an effort to gauge their influence on the aetiology of whiplash associated disorders. Methods: Volunteers were subjected to a sub-injury level of rear impact. Surface electro my ogra phy (EMG) was used to record cervical muscle activity before, during and after impact. Muscle response time and EMG signal amplitude were analysed. Head, pelvis, and T1 acceleration data were recorded. Results: The activities of the cervical muscles were found to be significant. The sternocleidomastoideus, trapezius and erector spinae were activated on average 59 ms, 73 ms and 84 ms after the impact stimulus, respectively, prior to peak head acceleration (113 ms). Conclusion: The cervical muscles reacted prior to peak head accelerati on, thus in time to influe nee whiplash biomechanics and possibly injury mechanisms. It is recommended therefore, that muscular influences be incorporated into the development of the new rear-impact crash test dummy in order to make the dummy as biofidelic as possible.展开更多
基金supported by the Department of Odontology and the Faculty of Medicine,Umea University,the Folksam Research Foundation and grants from Vasterbotten County Council(TUA)
文摘There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders(WADs)with both a qualitative method and quantitative sensory testing(QST).Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin(overlying each trigeminal branch bilaterally,and the midpoint of the chin)were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds(i.e.,decreased sensitivity)for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.
基金Grants from Centers for Disease Control to Cavanaugh JM,No.R49-CCR519751 and R49-CE000455
文摘AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed cadavers. Paraffin sections from these capsules were processed to identify neurofilament and substance P immunoreactive fibers. Nerve fiber presence was also verified by a silver impregnation method.RESULTS: Neurofilament reactive fibers were observed in sections from 9 capsules. They were observed in areas with collagen fibers and areas with irregular connective tissue. Substance P reactive nerve fibers were found in sections from 7 capsules in similar areas. Silver impregnation also revealed the presence of nerve fibers. The nerve fibers were also found as bundles in the lateral margins of the capsule. A Pacinian corpuscle-like ending was also observed in onespecimen.CONCLUSION: Nerve fibers revealed by neurofilament immunoreactivity and silver staining support innervation of the ventral aspect of the facet joint capsule. The presence of substance P reactive fibers supports the potential role of these elements in mediating pain. The presence of a Pacinian-like ending implicates a potential role in joint movement.
文摘There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction. Acupuncture's effects are experienced throughout the body but specifically acupuncture can be seen to contribute significantly to nerve metabolism and rebuilding. However, very little is written on the mechanisms for this nerve recovery. This paper will reflect on these mechanisms in relation to the treatment of neck problems associated with nerve root impingement.
文摘Objectives: To compare DITI vs US in a cohort of patients with whiplash syndrome for assessing soft tissues injuries of the cervical and dorsal spine. Methods: 70 patients presenting to clinic with traumatic cervical and/or dorsal spine injury and with a clinical diagnosis of whiplash syndrome underwent both DITI (AVIO TVS 2000) and US (GE Logic 5) of the following muscles: sternocleidomastoid, splenius, trapezius, longus colli and paravertebral muscles. DITI considered positive in the region with the most altered temperature among the injured area examinated (normal range 0℃ - 0.8℃). US valued the cervical and dorsal region with a comparative examination of the soft tissues. The images taken with DITI were compared with the clinical and the sonographic outcomes respectively. US and DITI were considered a) congruent whether both had a positive outcome for the same muscle clinically injured;b) not congruent whether one of the two instruments had a different outcome then the clinical evidence. Wilcoxon paired test was used for statistical analysis. Results: DITI and US matched 153 of 233 (65%) injured muscles. The association between DITI and US in the evaluation of the injured muscles was statistically significant for the following muscles: left trapezius (p Conclusions: According to our preliminary study, DITI and US were both helpful for assessing soft tissues injuries in patients with whiplash syndrome, defining the extent of the biologic damage for a correct clinical-therapeutical management.
文摘Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors;the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3;1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5;1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5;0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility);external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.
基金jointly supported by the National Natural Science Foundation of China (Grant Nos. 42120104001, 41805042)the Science and Technology Program of Guangzhou, China (Grant No. 202102020939)+1 种基金the Fundamental Research Funds for the Central University, Sun Yat-Sen University (Grant No. 22qntd2202)a project of the Center for Ocean Research in Hong Kong and Macao (CORE)
文摘During boreal winter,the invasion of cold air can lead to remarkable temperature drops in East Asia which can result in serious socioeconomic impacts.Here,we find that the intensity of strong synoptic cold days in the East China Sea and Indochina Peninsula are increasing.The enhanced synoptic cold days in these two regions are attributed to surface warming over the South China Sea and Philippine Sea(SCSPS).The oceanic forcing of the SCSPS on the synoptic cold days in the two regions is verified by numerical simulation.The warming of the SCSPS enhances the baroclinicity,which intensifies meridional wind and cold advection on synoptic timescales.This leads to a more extended region that is subject to the influence of cold invasion.
基金General Motors Corporation (GM) and National Natural Science Foundation of China (NSFC) pursuant to an agreement between GM and NSFC,Natural Science Foundation Project of CQ CSTC
文摘Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in
文摘Purpose: Whiplash associated disorders remain a major health problem in terms of impact on health care and on societal costs. Aetiology remains con troversial including the old suppos ition that the cervical muscles do not play a significant role. This study examined the muscle activity from relevant muscles during rear-end impacts in an effort to gauge their influence on the aetiology of whiplash associated disorders. Methods: Volunteers were subjected to a sub-injury level of rear impact. Surface electro my ogra phy (EMG) was used to record cervical muscle activity before, during and after impact. Muscle response time and EMG signal amplitude were analysed. Head, pelvis, and T1 acceleration data were recorded. Results: The activities of the cervical muscles were found to be significant. The sternocleidomastoideus, trapezius and erector spinae were activated on average 59 ms, 73 ms and 84 ms after the impact stimulus, respectively, prior to peak head acceleration (113 ms). Conclusion: The cervical muscles reacted prior to peak head accelerati on, thus in time to influe nee whiplash biomechanics and possibly injury mechanisms. It is recommended therefore, that muscular influences be incorporated into the development of the new rear-impact crash test dummy in order to make the dummy as biofidelic as possible.