The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation

Eur Spine J. 2009 Sep;18(9):1371-8. doi: 10.1007/s00586-009-1130-6. Epub 2009 Aug 12.


The objective was to determine whether any measurable changes in sensory responses, kinesthetic sense, cervical motion, and psychological features were related to established fatty infiltration values in the cervical extensor musculature in subjects with persistent whiplash. It is unknown if fatty infiltrate is related to any signs or symptoms. Data on motor function, Quantitative Sensory Testing, psychological and general well-being, and pain and disability were collected from 79 female subjects with chronic whiplash. Total fat values were created for all subjects by averaging the muscle fat indices by muscle, level, and side from our MRI dataset of all the cervical extensor muscles. Results of this study indicate the presence of altered physical, kinesthetic, sensory, and psychological features in this cohort of patients with chronic whiplash. Combined factors of sensory, physical, kinesthetic, and psychological features all contributed to a small extent in explaining the varying levels of fatty infiltrate, with cold pain thresholds having the most influence (r (2) = 0.28; P = 0.02). Identifying and relating quantifiable muscular alterations to clinical measures in the chronic state, underpin some clinical hypotheses for possible pathophysiological processes in this group with a chronic and recalcitrant whiplash disorder. Future research investigations aimed at accurate identification, sub-classification, prediction, and management of patients with acute and chronic whiplash is warranted and underway.

MeSH terms

  • Adipose Tissue / pathology*
  • Adipose Tissue / physiopathology
  • Adolescent
  • Adult
  • Choristoma / pathology
  • Choristoma / physiopathology
  • Chronic Disease
  • Cohort Studies
  • Disability Evaluation
  • Disease Progression
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Movement Disorders / diagnosis
  • Movement Disorders / etiology
  • Movement Disorders / physiopathology
  • Muscular Atrophy / etiology
  • Muscular Atrophy / pathology*
  • Muscular Atrophy / physiopathology
  • Neck Muscles / injuries*
  • Neck Muscles / pathology*
  • Neck Muscles / physiopathology
  • Neck Pain / etiology
  • Neck Pain / pathology
  • Neck Pain / physiopathology
  • Neurologic Examination
  • Neuropsychological Tests
  • Pain Measurement
  • Predictive Value of Tests
  • Sensation Disorders / diagnosis
  • Sensation Disorders / etiology
  • Sensation Disorders / physiopathology
  • Sex Factors
  • Whiplash Injuries / pathology*
  • Whiplash Injuries / physiopathology
  • Young Adult