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Background Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic whiplash associated disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. Objectives This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain. Design Case-control study. Method Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm 3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α Results Ventral and dorsal meniscoids (n = 112) were found in each LAA joint. Greater dorsal meniscoid volume as a percentage of articular cavity volume was associated with higher pain intensity (odds ratio 1.48, p = 0.03; likelihood ratio test chi-square 2 = 6.64, p = 0.04), however no significant differences existed between meniscoid volumes of WAD and control participants. Conclusions Findings indicate a potential link between dorsal LAA joint meniscoid volume and pain, suggesting larger meniscoid size may have pathoanatomical significance in WAD.

OBJECTIVE: To describe clinical presentation and management of neck soft tissue injury in an Australian ED. METHODS: This is a retrospective cohort study conducted in a tertiary hospital ED in Queensland, Australia. This study included all patients aged 18-65 years presenting with neck sprain/strain in 2016. Main outcome measures are patient demographics, comorbidities, presentation, acute management and follow up. RESULTS: Of 339 patients, 176 (52%) had cervical computed tomography (CT) scans and 3% plain radiographs. Two had fractures (CT yield of 2/176; 1.1%) and three were admitted with neurological symptoms, leaving 334 patients. Of 264 patients receiving medications in the ED, simple analgesia + oral opioid (146, 55.3%) was most frequently used, followed by simple analgesia (89, 33.7%) and opioid + benzodiazepine +/- simple analgesia (16, 6%). Opioids were prescribed for 169 (64%) (including i.v. opioids for 34 [12.9%] and for 85/97 (88%) with pain scores ≤4), and benzodiazepines for 22 (8.3%). Ten (3%) were referred for physiotherapy management in ED and eight (2.4%) for outpatient physiotherapy follow up. Of 113/334 (33.8%) receiving discharge prescription, 60 (53.1%) were prescribed oral opioid + simple analgesia, 37 (32.7%) oral opioids and seven (6.2%) opioids + benzodiazepines; 205 (61%) were discharged without a recorded follow-up plan. CONCLUSIONS: There is large practice variation in management of neck soft tissue injury in ED. Over half of the patients received CT scans with modest yield. Opioids were commonly used both in ED and on discharge. There is need for a standard management plan to be developed for patients presenting with acute neck soft tissue injury.

Objective: Describe current practice of medication prescribing for acute whiplash-associated disorders (WAD) in the ED and explore attitudes towards pregabalin prescription for WAD. Methods: Questionnaire-based survey in two EDs collected data on demographics and self-reported medication prescribing for WAD. Comfort in various scenarios for pregabalin prescribing was rated. Results: A total of 145/170 (85%) doctors responded; 42.8% were junior doctors. Self-reported medications prescribed were nonsteroidal anti-inflammatory drug (77.9% [95% confidence interval (CI) 70.1–84.2]), paracetamol (75.2% [95% CI 67.2–81.8]), opioids (43.5% [95% CI 35.3–51.9]) and benzodiazepines (11.0% [95% CI 6.6–17.6]). Most were comfortable to prescribe pregabalin in evidence-based or advised-by-specialists scenarios. Conclusions: Opioids appear to be over-prescribed. Further research into pregabalin prescription in ED is warranted.

Advances in understanding of the anatomy of lateral atlantoaxial joint meniscoids have lead to theories regarding the clinical significance of these structures in head and neck pain. However, there is a paucity of evidence pertaining to anatomical variations of lateral atlantoaxial joint meniscoids in cadaveric research or in vivo. We present the case of a 57-year-old female with a variation in the morphology of the lateral atlantoaxial joint meniscoids. The subject was a symptom-free volunteer in an anatomical study employing magnetic resonance imaging. On review of her scans, the dorsal meniscoid of both left and right lateral atlantoaxial joints extended across the entirety of the articular cavities, with no visible ventral meniscoid. This variation has not previously been reported, and may have clinical implications in the context of cervical spine trauma. With increasing evidence regarding the pathoanatomical potential of lateral atlantoaxial joint meniscoids, appreciation of anatomical variation in a symptom-free population may have future clinical utility. Keywords: anatomy; atlantoaxial joint; cervical spine; meniscoid; synovial folds