Greening Jane, Dilley Andrew, Lynn Bruce
Dartford Gravesend and Swanley PCT, NHS Trust and Department of Physiology, University College London, Gower Street, London, WC1E 6BT, UK Department of Physiology, University College London, Gower Street, London, WC1E 6BT, UK.
Pain. 2005 Jun;115(3):248-253. doi: 10.1016/j.pain.2005.02.023.
Chronic pain following whiplash injury and non-specific arm pain (NSAP, previously termed diffuse repetitive strain injury) present clinicians with problems of diagnosis and management. In both patient groups there are clinical signs of altered nerve movement and increased nerve trunk mechanosensitivity. Previous studies of NSAP patients have identified altered median nerve movement at the wrist. The present study uses high frequency ultrasound imaging to examine changes to median nerve movement and clinical examination to assess altered mechanosensitivity of the median nerve. Longitudinal median nerve movement was measured in the forearm during maximal inspiration in nine post-whiplash patients with chronic neck and arm pain and eight controls subjects. Eight NSAP patients and seven controls were also studied. Transverse median nerve movement at the proximal carpal tunnel during 30 degrees wrist extension to 30 degrees flexion was also measured. A clinical examination of nerve trunk allodynia was performed in all subjects. Longitudinal nerve movement in the forearm was reduced by 71% in the post-whiplash patients and by 68% in NSAP patients compared to controls. In the whiplash patients the pattern of transverse median nerve movement at the proximal carpal tunnel was significantly different to controls (patient mean=2.57+/-0.80 mm (SEM) in a radial direction; control mean=0.39+/-0.52 mm in an ulnar direction). Signs of neural mechanosensitivity (i.e. painful responses to median nerve trunk and brachial plexus pressure and stretch) were apparent in both patients groups. Change in nerve tension and neural mechanosensitivity may contribute to symptoms in whiplash and NSAP patients.
挥鞭样损伤后的慢性疼痛和非特异性手臂疼痛（NSAP，以前称为弥漫性重复性劳损损伤）给临床医生带来了诊断和管理方面的问题。在这两组患者中，都存在神经运动改变和神经干机械敏感性增加的临床体征。先前对NSAP患者的研究已经确定了腕部正中神经运动的改变。本研究使用高频超声成像来检查正中神经运动的变化，并通过临床检查来评估正中神经机械敏感性的改变。在9名患有慢性颈部和手臂疼痛的挥鞭样损伤后患者以及8名对照受试者进行最大吸气时，测量了前臂正中神经的纵向运动。还对8名NSAP患者和7名对照进行了研究。在腕关节从伸展30度到屈曲30度的过程中，测量了腕管近端正中神经的横向运动。对所有受试者进行了神经干异常性疼痛的临床检查。与对照组相比，挥鞭样损伤后患者前臂正中神经的纵向运动减少了71%，NSAP患者减少了68%。在挥鞭样损伤患者中，腕管近端正中神经的横向运动模式与对照组有显著差异（患者平均径向运动为2.57±0.80毫米（标准误）；对照组平均尺侧运动为0.39±0.52毫米）。在两组患者中均出现了神经机械敏感性的体征（即对正中神经干和臂丛神经施加压力和拉伸时的疼痛反应）。神经张力和神经机械敏感性的变化可能导致挥鞭样损伤和NSAP患者出现症状。
