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Reduced shoulder proprioception in patients with whiplash associated disorders (WAD)
University of Gävle, Belastningsskadecentrum (t.o.m. 051231).
University of Gävle, Belastningsskadecentrum (t.o.m. 051231).
University of Gävle, Belastningsskadecentrum (t.o.m. 051231).
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2004 (English)In: 8th International Federation of Orthopaedic Manipulative Therapists' Conference, Cape Town, South Africa: March 21-26, 2004, 2004Conference paper, Published paper (Other academic)
Abstract [en]

INTRODUCTION: Chronic whiplash associated disorders (WAD) are frequent in medical practice and are presented as a complex picture of neck -and shoulder pain along with numerous other symptoms. However, objective findings at physical examination are usually weak and thus the diagnosis of WAD is mostly based on the medical history and interpretation of personal information. Lately attention has focused on proprioceptive disturbances. Reasonably, vertigo, dizziness and fumbling often reported for WAD patients may be associated with alterations in proprioception. Our lab showed that experimentally induced pain directly impacts muscle spindle activity (MSA) in the muscles primarily affected, as well as in contralateral muscles. Since proprioception is mostly dependent upon MSA, pain originating from the neck region could potentially impair proprioception throughout the upper limbs. To validate proprioceptive testing as a diagnostic tool, the aims of the present study were to investigate: (1) shoulder proprioception, in the ability to reproduce a target position, in WAD patients compared to healthy controls; and (2) possible correlations between the degree of position matching error and subjective rating of health status, disability, self-efficacy and pain. METHODS: Participants were 38 WAD patients and 41 healthy subjects. From a start position of 50 degrees to the sagittal plane, shoulder horizontal-adduction movements of the right glenohumural joint to target positions of 18 and 30 degrees were conducted. The variable error (VE) of the position matching was used to assess the outcome. The patients also completed reports of their general health status (SF-36), disability due to pain (Pain disability index), pain-ratings (VAS) and self-efficacy beliefs (Self efficacy scale). RESULTS: The results showed a significantly higher VE in the WAD-group compared to the controls (p .< 0.001). VE and scores of the self-reports was found to correlate for all the questionnaires used. However, this was true only for the shorter (18 deg) target position. Put together in a step-wise multiple regression model the questionnaires could explain 46 percent of the position matching variance (p < 0.001), but again only when short target positions were focused. DISCUSSION AND CONCLUSION: A reduced ability to reproduce shoulder positions after active displacement implies a disturbance of the sensory motor function of patients with chronic WAD. According to our hypothesis, reduced proprioceptive function of muscle spindles could be responsible for this negative effect on precision and quality of movements. The correlation between position- matching errors and self-reports suggests that this in turn could be reflected in the person's everyday life. Correlations only for shorter target positions indicate that the control of different movement extents may depend on partly different mechanisms. The results may stimulate further research and the possibility of using proprioceptive tests to confirm symptoms and subjective disability in various musculo-skeletal disorders.

Place, publisher, year, edition, pages
2004.
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URN: urn:nbn:se:hig:diva-943OAI: oai:DiVA.org:hig-943DiVA: diva2:117605
Available from: 2007-12-04 Created: 2007-12-04Bibliographically approved

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