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.