(MTP, timing, enthesopathy) CONCLUSION & CLINICAL IMPLICATIONS THORACIC DYSFUNCTION IN WHIPLASH ASSOCIATED DISORDERS Heneghan NR, Smith R, Rushton A University of Birmingham BACKGROUND RESULTS: Table 1 Study characteristics WAD research has largely focused on the neck, yet symptoms are often reported elsewhere; perhaps indicative that the injury affects other musculoskeletal regions. With many individuals experiencing persistent pain & disability and the thoracic spine contributing to neck mobility, it is perhaps time to look beyond the neck to fully understand thoracic anatomical dysfunction in WAD. Dysfunction & Author Results Sample size n= Acute Chronic WAD Quality  BRACIAL PLEXUS TENSION TEST  Ide 2001 Prevalence 61% 119 x   3/9 Sterling 2002 Positive 156 WADII - III  4/9 Sterling 2004 80 6/9 Alexandre 2005 + thoracic outlet syndrome 24 mild Sterling 2009 85 Ferrari 2010 69 WADI - II 5/9  THORACIC PAIN (PREVALENCE)  Yeung 1997 Slump 75% 20 WADI – II?  Koelbeck 1999 Positive (reduced PPT, hyperalgesia & referral) 8 Bergland 2001 232 Mild Bock 2005 71% 22 Bortsov 2014 47% 948 WADI - II  McLean 2014 21% (upper thoracic/shoulder 23%) Sterling 2005 54% 76 7/9 Hincapie 2010 66-75% 6481 2/9  CHEST PAIN (PREVALENCE)  Hincapie 2010* 19%  WADII Bortsov 2014* McLean 2014* 8% MUSCLE DYSFUNCTION AND PAIN Klein 2001 SCM muscle activation: normal 48 WADI - III 1/9 Sterling 2003 SCM muscle activity heightened 66 Sterling 2004*  WADII - III Bismil 2005 Mid/Low trapezius enthesopathy (myofascial pain +TP) 48% 25 Ettlin 2008 SCM and Scaleneus medius MTP prevalence 24%, 30% 47 Helgadottir 2011b Serratus anterior : delayed onset and reduced duration of activation. No change for lower and mid trapezius 27   WADII Fernandez-de-las-Perez 2012 SCM and Scaleneus medius MTP 40 WADII  Castaldo 2014 SCM Latent and active TP 49 WADII - III  THORACIC OUTLET SYNDROME (PREVALENCE) Capistrant 1976 86% 35 Capistrant 1986 36% 111 x? Magnusson 1994 32% 38  WADI-III Kai 2001 74% 110  THORACIC POSTURE  Helgadottir 2011a No change 23 Wirth 2014 Reduced kyphosis (chest expansion) 7 PURPOSE To investigate thoracic dysfunction in individuals with WAD and secondarily to describe dysfunction in relation to severity and chronicity METHODS A systematic review designed using CRD guidelines, reported using PRISMA & MOOSE guidelines. PROSPERO :CRD42015026983 (Heneghan et al., 2016). A sensitive topic-based search strategy was used (inception to 1/3/16). Databases & grey literature were searched using key words derived from scoping search. (S) adults patients >19 years. (PI) WAD. (D)All types of observational study design (E) Any patient reported or performance based measure of thoracic dysfunction (R) quantitative research Two reviewers independently searched sources, assessed for inclusion & extracted data. Summary data: sample size & characteristics, outcomes of interest, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Strength of the overall evidence was assessed using GRADE. Thoracic outlet Chronic WAD 32-86% Acute & Chronic Muscle dysfunction (MTP, timing, enthesopathy) Thoracic Pain Acute WAD 21% Chronic WAD 47-75% Chest pain 8-19% DISCUSSION With evidence of pain and dysfunction in the acute and chronic WAD further research is required to: understand the contribution this makes to persistent pain & disability investigate interventions targeting thoracic dysfunction in WAD Limitations: limited to English language publications RESULTS From an initial search of 896 articles 27 meet the eligibility criteria. Sample size of included studies 10,047 with BPPT n=6, thoracic pain n=8, chest pain n=3, muscle dysfunction n=8, TOS n=4, thoracic posture n=2. See table 1 for study details and risk of bias. Overall risk of bias was graded as moderately low based on GRADE. CONCLUSION & CLINICAL IMPLICATIONS There is evidence, albeit moderately low quality of thoracic dysfunction in WAD involving musculoskeletal structures. Anatomical dysfunction post WAD is not exclusive to the cervical spine and evidence of thoracic dysfunction should be a consideration for clinicians examining patients with WAD Contact details: n.heneghan@bham.ac.uk Heneghan NR, Smith R, Rushton A (2016) Thoracic dysfunction in whiplash-associated disorders: a systematic review and meta-analysis protocol. Systematic Reviews. 5:26. DOI: 10.1186/s13643-016-0201-0