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Evidence for Increased Magnetic Resonance Imaging Signal Intensity and Morphological Changes in the Brachial Plexus and Median Nerves of Patients With Chronic Arm and Neck Pain Following Whiplash Injury

J. Greening,Rupert C. D. Young,A. Dilley

Published 2018 in Journal of Orthopaedic and Sports Physical Therapy

ABSTRACT

• 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 signs 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 cross‐sectional 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: The T2 signal intensity was greater in the brachial plexus and median nerve at the wrist in the patient group (mean intensity ratio = 0.52 ± 0.13 and 2.09 ± 0.33, respectively) compared to the control group (mean intensity ratio = 0.45 ± 0.07 and 1.38 ± 0.31, respectively; P<.05). Changes in median nerve morphology were also observed, which included an enlargement (mean area: patient group, 8.05 ± 1.29 mm2; control group, 6.52 ± 1.08 mm2; P<.05) and flattening (mean aspect ratio: patient group, 2.46 ± 0.53; control group, 1.62 ± 0.30; P<.05) at the proximal carpal row. 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.

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