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Thoracic dysfunction in whiplash associated disorders: A systematic review.

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Whiplash Associated Disorder (WAD) often involves thoracic pain and dysfunction, primarily affecting nerves and muscles. Further research is needed to fully understand and treat this widespread issue beyond the cervical spine.

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Area of Science:

  • Orthopedics
  • Neurology
  • Pain Management

Background:

  • Whiplash Associated Disorder (WAD) research traditionally focuses on the cervical spine, neglecting widespread symptoms.
  • Thoracic spine pain affects approximately 66% of WAD patients, impacting neck mobility and function.
  • Chronic pain and disability in 50% of WAD patients necessitate a broader understanding of anatomical dysfunction.

Purpose of the Study:

  • To comprehensively evaluate the scope and nature of thoracic region dysfunction in WAD patients.
  • To identify key areas of dysfunction for improved clinical practice and research directions.

Main Methods:

  • Systematic review and data synthesis adhering to a registered protocol (PROSPERO).
  • Inclusion of all observational study types, with a sensitive topic-based search strategy.
  • Independent data extraction and risk of bias assessment by two reviewers, with third reviewer verification.

Main Results:

  • Thirty-eight studies (n>50,000) revealed high prevalence of thoracic pain (>60%), particularly in severe and acute WAD.
  • Evidence of thoracic outlet syndrome and brachial plexus involvement was noted.
  • Significant muscle dysfunction, including heightened sternocleidomastoid activity and myofascial pain in scalene, sternocleidomastoid, and trapezius muscles (48-65%), was identified.

Conclusions:

  • Substantial evidence supports thoracic pain and dysfunction (nerves, muscles) in WAD patients.
  • Findings advocate for expanded clinical evaluation of WAD beyond the cervical spine.
  • High-quality research is essential to characterize thoracic spine and muscle dysfunction for targeted clinical trials.