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Background. Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain. Objective. The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC. Design. A longitudinal observational study was performed. Methods. A total of 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC. Results. Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC. Limitations. Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias. Conclusions. The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests., Sensorimotor control (SMC) has been suggested as an important measure in the clinical assessment of individuals with chronic idiopathic neck pain. (1-3) Cervical joint position error, (4) postural balance, (5) [...]

The arrival of clinical genomics has heralded a new era in health care. Personalized medicine, a concept that involves the delivery of therapeutic intervention based partly on genomic information derived [...]

Background. Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders. Objective. The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. Design. This was a cross-sectional study. Methods. Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥ 70% for passive external rotation was deemed a positive anesthetic response (PAR). Results. Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR] = 0.26, P = .03), pain at the end of range of all measured active movements (OR = 0.06, P = .02), and global loss of passive glenohumeral movements (OR = 0.23, P = .02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR. Limitations. The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research. Conclusions. None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage., Adhesive capsulitis is a diagnostic label attributed to a disorder of the glenohumeral joint capsule that has been reported to affect up to 5% of the population. (1,2) Primary adhesive [...]

Background. The alar ligaments are integral to limiting occipito-atlanto-axial rotation and lateral flexion and enhancing craniocervical stability. Clinical testing of these ligaments is advocated prior to the application of some cervical spine manual therapy procedures. Given the absence of validation of these tests and the potential consequences if manipulation is applied to an unstable upper cervical spine segment, exploration of these tests is necessary. Objective. The purpose of this study was to examine the direct effect of the side-bending and rotation stress tests on alar ligaments using magnetic resonance imaging (MRI). Design. This was a within-participant experimental study. Methods. Sixteen participants underwent MRI in neutral and end-range stress test positions using proton density-weighted sequences in a 3-Tesla system. Measurements followed a standardized protocol relative to the position of the axis. Distances were measured from dens tip to the inferior margin of the foramen magnum and from midsubstance of the dental attachment of the ligament to its occipital insertion. Between-side differences were calculated for each measurement to account for inherent asymmetries in morphology. Differences were compared between the test and neutral positions using a Wilcoxon signed rank test. Results. Side-bending stress tests produced a median between-side difference in ligament length of +1.15 mm. Rotation stress tests produced a median between-side difference in ligament length of + 2.08 mm. Both results indicate increased measurement of the contralateral alar ligament. Limitations. Assessment could be made only in the neutral position due to imaging limitations. Clinical texts state that tests should be performed in 3 positions: neutral, flexion, and extension. Conclusions. Both side-bending and rotation stress testing result in a measurable increase in length of the contralateral alar ligament. This finding is consistent with mechanisms that have been described to support their use in clinical practice., The lack of established validity of the tests of ligamentous stability of the upper cervical spine brings into question their ability to detect instabilities in this region. There is potential [...]