High blood flow in painful cervical soft tissue: An ultrasound pilot study

Hatem Kalawy
Scandinavian Journal of Pain
Volume 4, Issue 4 , Pages 173-179, October 2013

Highlights

•Painful neck regions in patients with whiplash-associated disorder were studied.

•Grey scale ultrasound and colour Doppler were used to confirm high blood flow.

•Whiplash patients had higher blood flow compared with the control subjects.

•High blood flow was found in painful regions of the neck in whiplash patients.

Abstract
Background
The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neovessels. Grey-scale US and CD are reliable methods used to evaluate structural homogeneity, thickness, and blood flow in the peripheral tendons. The aim of this study was to utilize CD to qualitatively evaluate for the presence of abnormal high blood flow in paravertebral tissues after whiplash injuries in patients with chronic neck pain.

Methods
Twenty patients with chronic neck pain after whiplash-associated disorder (WAD) and 20 pain-free control subjects were included in the study. The same experienced radiologist performed all grey-scale US and CD examinations.

Results
More regions with high blood flow were observed in the patient group than in the control group. At all levels, the high blood flow pattern was detected at the enthesis of the spinous processes and bilaterally juxtapositioned to the facet joints.

Conclusion
All regions identified by the patients as painful and tender corresponded to the positive high blood flow found during the CD examination.

Implications
These findings document increased blood-flow/neovascularisation at insertions of neck muscles which may indicate that there are pathological neovascularisation with accomanying pain- and sympathetic nerves, similar to what has been found in Achilles-tendinosis. These findings promise that similar treatments that now is successful with Achilles tendinosis, may be effective in the WAD-painful muscle insertions of the neck.

Journal Reference:  http://www.scandinavianjournalpain.com/article/S1877-8860(13)00072-4/abstract