Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis

INTRODUCTION Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). RESULTS Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I2 = 83%). CONCLUSIONS The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry

LATE SWING KNEE MECHANICS IN ELITE RUGBY UNION PLAYERS AND TRAINED SPRINTERS

Hamstring injuries are highly prevalent in running-based sports such as sprinting and rugby union, and are thought to occur during the late swing phase where the hamstrings are under great load and strain. The aim of this study was to investigate the knee mechanics of elite rugby players and speed-matched sprinters during the late swing phase of maximum effort over-ground running. Elite rugby players demonstrated reduced knee extension velocity through late swing, which was associated with a smaller maximum knee flexion angle during the mid-swing phase. As rugby players displayed a greater absolute knee flexion moment, power absorption and negative work, we suggest that the kinematic differences displayed by rugby players may be an adaptation to reduce the velocity of hamstring stretch and load on the hamstring muscles during late swing

Atlas-based segmentation of neck muscles from MRI for the characterisation of Whiplash Associated Disorder

Whiplash-associated disorder (WAD) is a commonly occurring injury that often results from neck trauma suffered in car accidents. However the cause of the condition is still unknown and there is no definitive clinical test for the presence of the condition. Researchers have begun to analyze the size of neck muscles and the presence of fatty infiltrates to help understand WAD. However this analysis requires a high precision delineation of neck muscles which is very challenging due to a lack of distinctive features in neck magnetic resonance imaging (MRI). This paper presents a novel atlas-based neck muscle segmentation method which employs discrete cosine-based elastic registration with affine initialization. Our algorithm shows promising results based on clinical data with an average Dice similarity coefficient (DSC) of 0.84±0.0004

Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM):study protocol

Abstract Background It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. Method A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. Discussion It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. Trial registration This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111–12626523. ANZCTR: ACTRN1262100016984

An efficient hybrid method for 3D to 2D medical image registration

PURPOSE: The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement. METHODS: We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy. RESULTS: We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method. CONCLUSION: The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment

Kinematics of knees with osteoarthritis show reduced lateral femoral roll-back and maintain an adducted position. a systematic review of research using medical imaging

Abstract Background While several studies describe kinematics of healthy and osteoarthritic knees using the accurate imaging and computer modelling now possible, no systematic review exists to synthesise these data. Method A systematic review extracted quantitative observational, quasi-experimental and experimental studies from PubMed, Scopus, Medline and Web of Science that examined motion of the bony or articular surfaces of the tibiofemoral joint during any functional activity. Studies using surface markers, animals, and in vitro studies were excluded. Results 352 studies were screened to include 23 studies. Dynamic kinematics were recorded for gait, step-up, kneeling, squat and lunge and quasi-static squat, knee flexion in side-lying or supine leg-press. Kinematics were described using a diverse range of measures including six degrees of freedom kinematics, contact patterns or the projection of the femoral condylar axis above the tibia. Meta-analysis of data was not possible since no three papers recorded the same activity with the same measures. Visual evaluation of data revealed that knees with osteoarthritis maintained a more adducted position and showed less posterior translation of the lateral femoral condylar axis than healthy knees. Variability in activities and in recording measures produced greater variation in kinematics, than did knee osteoarthritis. Conclusion Differences in kinematics between osteoarthritic and healthy knees were observed, however, these differences were more subtle than expected. The synthesis and progress of this research could be facilitated by a consensus on reference systems for axes and kinematic reporting

The Impact of Depression, Anxiety and Personality Disorders on the Outcome of Patients with Functional Limb Weakness – Individual Patient Data Meta-Analysis

Objective: Psychiatric comorbidities such as depression, anxiety, and personality disorders are common in patients with functional limb weakness/paresis (FND-par). The impact of these conditions on the prognosis of FND-par has not been systematically reviewed. The aim of this study was to identify a potential prognostic effect of comorbid depression, anxiety, and/or personality disorder on prognosis in patients with FND-par. Methods: A systematic review was performed to identify studies that reported measures of baseline depression, anxiety, and/or personality disorder, and physical disability. An individual patient data meta-analysis was subsequently performed. Results: Eight studies comprising 348 individuals were included (7 prospective cohorts; 1 case-control study). There was heterogeneity in sample size, follow-up duration, and treatment modality. Depression and anxiety were present in 51.4% and 53.0% of FND-par patients, respectively. In individuals whose FND-par improved, there was no significant difference between those with versus without depression (52.6% vs 47.4%, p = 0.69) or those with versus without anxiety (50.3% vs 49.7%, p = 0.38). Meta-analysis showed no clear impact of baseline depression or anxiety per se [pooled OR for depression 0.85 (95%CI 0.50–1.45; p = 0.40) and anxiety 0.84 (95%CI 0.51–1.38; p = 0.91)]; and of depression or anxiety severity [pooled OR for depression 1.23 (95%CI 0.63–2.39; p = 0.91) and anxiety 1.40 (95%CI 0.70–2.78; p = 0.58)] on FND-par outcome. Insufficient data were available to assess the impact of personality disorders. Conclusion: We found no evidence that depression or anxiety influenced outcome in FND-par. Large-scale, prospective studies in FND-par, and other FND subtypes, are needed to fully contextualize the impact of concurrent mental health concerns on outcomes.</p