Traction Injuries of the Brachial Plexus: Signal Intensity Changes of the Posterior Cervical Paraspinal Muscles on MRI

Uetani, Masataka; Hayashi, Kuniaki; Hashmi, Rashid; Nakahara, Nobuya; Aso, Nobuya; Ito, Nobuyuki

doi:10.1097/00004728-199709000-00026

Cited by 28 publications

(12 citation statements)

References 33 publications

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“…Neurologic deficits following traumatic spinal injury may call for the use of specific MRI sequences to detect potential nerve root avulsions 52,95 or other posttraumatic sequelae (eg, syrinx and/ or cord tethering). Spinal canal and neuroforaminal compromise and cord compression are also well evaluated with MRI.…”

Section: The Pearls and Pitfalls Of Magnetic Resonance Imaging For Thmentioning

confidence: 99%

The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine

Elliott¹,

Flynn²,

Al-Najjar

et al. 2011

J Orthop Sports Phys Ther

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Section: The Pearls and Pitfalls Of Magnetic Resonance Imaging For Thmentioning

confidence: 99%

The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine

Elliott¹,

Flynn²,

Al-Najjar

et al. 2011

J Orthop Sports Phys Ther

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“…41,56,65,82 Degenerative changes in the deep cervical paraspinal musculature have been found in studies using RUSI and magnetic resonance imaging (MRI) in patients with persistent neck pain following trauma. 15,19,37,73 The semispinalis cervicis muscle (along with the capitii musculature) is considered a primary cervical spine extensor.…”

Section: Posterior Cervical Spine Musculaturementioning

confidence: 99%

Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles

Stokes

Hides

Elliott

et al. 2007

J Orthop Sports Phys Ther

146

125

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T he role of muscles in joint protection and stabilization has been of increasing interest to researchers and clinicians involved in spinal pain and rehabilitation. Evidence for the importance of deep posterior muscles of the spine in the management of people with low back pain (LBP) has been provided by biomechanical 7,60,80,82 and neurophysiological 46,48 investigations. Imaging studies have further allowed definition of both normal morphology and impairments in paraspinal muscles. 22,27,32,33 Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool in physical therapy for the assessment and treatment of these muscles. The advantages of RUSI over other imaging techniques have been discussed in a recently published related cles can be incorporated into neuromusculoskeletal rehabilitation. The main applications of RUSI for measurement of morphological characteristics (morphometry) and visualization of muscle contraction for biofeedback are discussed. The lumbar multifidus is the most widely studied paraspinal muscle, in both healthy populations 68 and people with spinal pain and injury. 22,26,27 Studies of different cervical muscles are also emerging. 37,39,[61][62][63] In the thoracic region, the lower trapezius is the first muscle to be measured with ultrasound imaging. 53Quantitative evaluation of the posterior paraspinal musculature using static and dynamic imaging has been used to study muscle morphology and behavior during contraction. 34,39,64,74,76 In this context, behavior relates to level of contraction (change in thickness), changes in size over time and with respect to other muscles, as well as observation of contraction as a biofeedback tool for the patient or therapist. In this commentary we review what is known about RUSI as applied to the paraspinal musculature, propose guidelines for standardizing the imaging and measurement techniques in clinical and research applications, and propose future directions for research. SYNOPSIS:Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this technique into routine physical therapy practice. This clinical commentary reviews how RUSI can be used as an evaluative and treatment tool and proposes guidelines for its use for the posterior muscles of the lumbar and cervical regions. Both quantitative and qualitative applications are described, as well as measurement reliability and validity. Measurement of morphological characteristics of the muscles (morphometry) in healthy populations and people with spinal pathology are described. Preliminary normal reference data exist for measurements of cross-sectional area (CSA), linear dimensions (muscle depth/thickness and width), and shape ratios. Compared to individuals without low back pain, changes in muscles' size at rest and during the contracted state have been observed using RUSI in people with spinal pathology. Visual observation of the image during contraction indicates that RUSI may be a va...

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“…However, the direction of the association between PPT_local, TF (P = 0.09) and TUF (P = 0.1) was inverse (e.g., those with higher fat content had higher thresholds) and this is more difficult to explain. Nevertheless, the results of this study might provide some preliminary evidence that the presence of cold and widespread mechanical hyperalgesia in conjunction with the MRI findings of muscular fatty infiltrate in the upper cervical musculature could be reflective of a peripheral nerve injury in the cervical region [8,18,21,35,36,63] and could explain the widespread sensory findings in this cohort. The presence of these sensory features in conjunction with the temporal development and magnitude of fatty infiltrate needs to be investigated in a prospective, longitudinal study with a more heterogeneous population to better identify a possible neuropathic [3,24] element in at least some patients who transition to chronicity.…”

Section: Discussionmentioning

confidence: 65%

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

et al. 2009

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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.

show abstract

Traction Injuries of the Brachial Plexus: Signal Intensity Changes of the Posterior Cervical Paraspinal Muscles on MRI

Abstract: MR signal intensity change in the deep posterior cervical paraspinal muscles is related to denervation and suggests the presence of nerve root avulsion.

Cited by 28 publications

References 33 publications

The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine

The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine

Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles

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

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