Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration
Study Design . Single-center prospect i ve longitudinal study . Objective . To study the ( 1 ) temporal development of muscle fatty infiltrates ( MFI ) in the cervical multifidi after whiplash , ( 2 ) differences in multifidi MFI between those who recover or report milder pain – related disability and those who report moderate/severe symptoms at 3 months , and ( 3 ) predictive value of multifidi MFI outcomes . Summary of Background Data . The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors . The replication of such findings has yet to be explored longitudinally . Methods . Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild ( 0%–28 % ) or severe ( ≥30 % ) . A fat/water magnetic resonance imaging measure , patient self-report of pain-related disability , and post-traumatic stress disorder were collected at less than 1 week , 2 weeks , and 3 months postinjury . The effects of time and group ( per Neck Disability Index ) and the interaction of time by group on MFI were determined . Receiver operating characteristic curve analysis was used to determine a cut-point for MFI at 2 weeks to predict outcome at 3 months . Results . There was no difference in MFI across groups at enrolment . MFI values were significantly higher in the severe group than those in the recovered/mild group at 2 weeks and 3 months . The receiver operating characteristic curve analysis indicated that MFI levels of 20.5 % or above result ed in a sensitivity of 87.5 % and a specificity of 92.9 % for predicting outcome at 3 months . Conclusion . Consistent with previous evidence , muscle degeneration occurs soon after injury but only in those patients with poor functional recovery . This study provides further evidence that ( 1 ) multifidi MFI occur in t and em with known predictive risk factors ( older age , pain-related disability , and post-traumatic stress disorder ) and ( 2 ) routine imaging protocol s may need to be reconsidered in the vast majority of patients after whiplash . Level of Evidence :
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .