1. (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 :CRD (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:
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:  /s