Bruls et al (1) have recently published the protocol for their arm, neck and shoulder study. It is possible that the study has already started, but there are some aspects that might be worth incorporating if it is not too late or that might be added in one of the follow up stages. Indeed, some aspects might best be added at the end of the study so as not to influence the participants unduly.
That there was no initial trauma might seem to select for chronic repetitive causes as might be expected with university students using keyboard entry so much. But our early unpublished inspection of the effects of accidents and trauma on somewhat similar musculoskeletal problems suggested no clear influences. However the subsequent work (2,3) seemed to explain why. Firstly, the broad category of back/leg trouble needed to be split into subgroups to get a better idea of which were linked to trauma and which were seemingly non-traumatic. Subsequently clinical follow up suggested that patients often did not recognize the initial precipitating incident. This was because they had chronic intermittent symptoms prompted by a variety of trivial mechanisms with little to remind them of the probable original cause. It was as though their memory had failed them. But with prompting they could often enough then recall a whiplash injury or fall. Also they ignored the original cause because the acute traumatic pain often seemed to settle before the more insidious phase settled in. The original trauma may not have seemed sufficient to cause long-term morbidity. The delayed onset of referred symptoms to the limb also obscured mechanisms. Also the patients rarely understood the ensuing limb reflex sympathetic dystrophy because of the even longer delay in onset, and their attendants often failed to recognize the complication with bizarre aches, skin colour and temperature changes in the proximal and distal limb.
However recognition of these aspects in the low back and leg led to findings of similar phenomena in the neck and arm. Indeed very similar examination procedures worked seemingly just as well in the upper spine.
So it would seem important to ask in great depth about earlier whiplash for example, stressing that the severity of jolt to the neck, speed of car impact, and damage to the car are not as important as to whether the subject had any prior warning of the shunt (4). Did they see the crash coming? For this type of problem the direction of oblique seat belt might be important which would be opposites for Holland and the UK! Thus it might well be important to record the side of symptoms as well as to whether they are left or right handed, and whether they have tried to spare use of the affected limb. Such aspects could be checked by postal questionnaire. Aspects of distinct subgroups could be checked if a sample of symptomatic cases were to be examined (3). Selected best cases might be further inspected with pain free non-invasive tests such as dexa scanning of the upper limbs and thermography.
Sweetman BJ. NHS.
Email:- bjsweetman@hotmail.com
References
1. Bruls VEJ, Bastiaenen CHG, de Biel RA. Non-traumatic arm, neck and shoulder complaints: prevalence, course and prognosis in a Dutch university population. BMC Musculoskeletal Disorders 2013, 14:8
2. Sweetman BJ. Numerical classification of common low back pain. MD Thesis, London University, 1985.
3. Sweetman BJ. Low Back Pain, some real answers. 2005. tfm Publishing, Harley SY5 6LX.
4. Ryan GA. Taylor GW, Moore VM, Dolinis J. Neck strain in car occupants: injury status after 6 months and crash-related factors. Injury: International Journal of the care of the injured1994;25 (8): 533-7.
Neck trauma or no trauma, that is the question.
24 January 2013
Bruls et al (1) have recently published the protocol for their arm, neck and shoulder study. It is possible that the study has already started, but there are some aspects that might be worth incorporating if it is not too late or that might be added in one of the follow up stages. Indeed, some aspects might best be added at the end of the study so as not to influence the participants unduly.
That there was no initial trauma might seem to select for chronic repetitive causes as might be expected with university students using keyboard entry so much. But our early unpublished inspection of the effects of accidents and trauma on somewhat similar musculoskeletal problems suggested no clear influences. However the subsequent work (2,3) seemed to explain why. Firstly, the broad category of back/leg trouble needed to be split into subgroups to get a better idea of which were linked to trauma and which were seemingly non-traumatic. Subsequently clinical follow up suggested that patients often did not recognize the initial precipitating incident. This was because they had chronic intermittent symptoms prompted by a variety of trivial mechanisms with little to remind them of the probable original cause. It was as though their memory had failed them. But with prompting they could often enough then recall a whiplash injury or fall. Also they ignored the original cause because the acute traumatic pain often seemed to settle before the more insidious phase settled in. The original trauma may not have seemed sufficient to cause long-term morbidity. The delayed onset of referred symptoms to the limb also obscured mechanisms. Also the patients rarely understood the ensuing limb reflex sympathetic dystrophy because of the even longer delay in onset, and their attendants often failed to recognize the complication with bizarre aches, skin colour and temperature changes in the proximal and distal limb.
However recognition of these aspects in the low back and leg led to findings of similar phenomena in the neck and arm. Indeed very similar examination procedures worked seemingly just as well in the upper spine.
So it would seem important to ask in great depth about earlier whiplash for example, stressing that the severity of jolt to the neck, speed of car impact, and damage to the car are not as important as to whether the subject had any prior warning of the shunt (4). Did they see the crash coming? For this type of problem the direction of oblique seat belt might be important which would be opposites for Holland and the UK! Thus it might well be important to record the side of symptoms as well as to whether they are left or right handed, and whether they have tried to spare use of the affected limb. Such aspects could be checked by postal questionnaire. Aspects of distinct subgroups could be checked if a sample of symptomatic cases were to be examined (3). Selected best cases might be further inspected with pain free non-invasive tests such as dexa scanning of the upper limbs and thermography.
Sweetman BJ. NHS.
Email:- bjsweetman@hotmail.com
References
1. Bruls VEJ, Bastiaenen CHG, de Biel RA. Non-traumatic arm, neck and shoulder complaints: prevalence, course and prognosis in a Dutch university population. BMC Musculoskeletal Disorders 2013, 14:8
2. Sweetman BJ. Numerical classification of common low back pain. MD Thesis, London University, 1985.
3. Sweetman BJ. Low Back Pain, some real answers. 2005. tfm Publishing, Harley SY5 6LX.
4. Ryan GA. Taylor GW, Moore VM, Dolinis J. Neck strain in car occupants: injury status after 6 months and crash-related factors. Injury: International Journal of the care of the injured1994;25 (8): 533-7.
Competing interests
None