Myofascial-entheseal dysfunction in chronic whiplash injury: an observational study

OBJECTIVES To document any consistent clinical findings in a large cohort of patients with whiplash associated disorder. DESIGN Four-year observational study. SETTING Large orthopaedic medicolegal practice in the UK. PARTICIPANTS 1025 consecutive cases of chronic whiplash associated disorder. MAIN OUTCOME MEASURES OBSERVATIONAL STUDY OF THE CLINICAL FEATURES OF WHIPLASH ASSOCIATED DISORDER: detailed examination RESULTS THREE CONSISTENT CLINICAL FEATURES: neck pain; reduced cervical spine range of motion; and myofascial-entheseal dysfunction. With regards to the myofascial-entheseal dysfunction there were trigger points in the upper, middle or lower trapezius; with or without enthesopathy in the lower or middle trapezius. CONCLUSIONS On the basis of this large observational experience we propose a clinically-based definition of chronic whiplash associated disorder: a painful syndrome following acceleration-deceleration injury with neck stiffness; and myofascial-entheseal dysfunction.