Biomedical subjects

C Hildingsson

Publications and source records attributed to C Hildingsson.

18 recordsLinked to original sources

PubMed2002

Eye motility and auditory brainstem response dysfunction after whiplash injury.

The aim of this study was to identify the prevalence of brain/brainstem dysfunction after acute whiplash trauma (grades II and III according to the Quebec Task Force Classification on whiplash-associated disorders) and to investigate a possible correlation between the development of chronic symptoms and objective findings from auditory brainstem response (ABR) and eye motility tests. We used ABR and oculomotor tests and a thorough clinical, subjective and psychological evaluation in a sample of prospective whiplash trauma patients who were followed up for 2 years after the trauma. The initial test results did not reveal any prognostic clinical signs for the tested group as a whole, but we could discriminate some patients with clinical symptoms and signs paired with pathologic test results. Over time, some patients normalized clinically and their test results improved while others deteriorated clinically and their test results were worse at the 2-year investigation. Our findings of moderate derangements in the tests could be the effects of pain and/or changed cervical afferent activity at the brain/brainstem level, while eye motility dysfunction, in addition to pathological neuro-otological findings in a small proportion of the patients with severe symptoms, could be explained by lesions to the brain/brainstem.

Adult↗

PubMed2001

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system.

We operated on 26 patients with cervical spine disorders (13 with traumatic lesions, 3 with spinal stenosis and myelopathy, 1 with osteomyelitis and 9 with metastasis) with posterior stabilization. A new implant system (Cervi-Fix) based on rods, enabling a choice of either screw or laminar hook fixation in a free combination, was used. The system was evaluated for ease of use, for safety, regarding complications related to the system, and for efficacy, regarding loss of correction and signs of instability. The patients were followed for a mean period of 11 months, with ordinary and flexion/extension radiographs and clinical examination. No complications related to the implant system were observed. Loss of correction was observed in one patient. We found constructs with few vertebral fixation points, especially with screws, easy to handle, whereas multiple-claw constructs were time consuming. This implant system seems to be versatile, safe and efficient, but could be improved by the development of instruments for the insertion of the hooks.

Bone Screws↗

PubMed2001

Prospective study of trigeminal sensibility after whiplash trauma.

Trigeminal sensory impairment is frequent in whiplash cases. The pathophysiology is unknown. The purpose of the present investigation was to prospectively study the trigeminal sensibility for temperature and vibration and to evaluate their relationship with the clinical symptoms. Thirty-four of 43 patients with whiplash injury were investigated through quantitative sensory tests with a mean of 6 weeks and 71 months after injury. Sensory disturbances over the trigeminal skin area persisted over the years ( r = 0.764. p < 0.000). At follow-up, a significant correlation ( r = 0.614, p < 0.000) was found between the sensory disturbances and the symptoms related to the central nervous system, whereas no significant relationship was found with the musculoskeletal symptoms. Trigeminal sensory impairment can either be explained by dysfunction in the central nervous system or by inhibitory mechanisms secondary to pain.

Adult↗

PubMed1998

Treatment of deep cartilage defects of the patella with periosteal transplantation.

Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19-52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11-144 months). During the first 5 postoperative days all patients were treated with continuous passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24-76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenuous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.

Adult↗

PubMed1998

Oculomotor dysfunction in rheumatoid patients with upper cervical dislocation.

Several studies of patients with chronic cervical pain and chronic whiplash syndrome report a high frequency of oculomotor function derangements pointing towards brainstem involvement and/or default sensory input from neck afferents. In light of these reports, it seems important to investigate other patient groups with similar upper cervical spine disorders. In this study, voluntary eye motor performance was evaluated in 11 rheumatoid patients (RA) with upper cervical dislocation and a clearly noticed joint affection of the cervical spine. The results were compared with 6 RA patients without cervical engagement and normal individuals. Nine of the 11 patients with atlanto-axial dislocation showed pronounced oculomotor disturbances of smooth pursuits compared with only minor changes in the control group. The pattern of oculomotor dysfunction in patients with rheumatoid cervical dislocation indicates brainstem involvement, which may be an early sign of brainstem affection/myelopathy.

Aged↗

PubMed1997

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation.

STUDY DESIGN: This study was used to evaluate the relationship between magnetic resonance imaging findings and clinical findings after whiplash injury. OBJECTIVES: To identify initial soft-tissue damage after whiplash injury, the development of disc pathology, and the relationship of disc pathology to clinical findings. SUMMARY OF BACKGROUND DATA: Although a few studies have reported pathological magnetic resonance imaging findings after whiplash injuries, there is no prospective study published to our knowledge. METHODS: Thirty-nine patients, 20 women and 19 men with a mean age of 32 years, were treated for whiplash injury. Magnetic resonance imaging and clinical examination were performed in a blinded manner at a mean of 11 days after trauma. The procedure was repeated at a 2-year follow-up visit. Two patients could not be examined with the second magnetic resonance imaging because of claustrophobia and pregnancy, respectively. RESULTS: The authors found 13 patients (33%) with disc herniations with medullary (six cases) or dura (seven cases) impingement over the 2-year follow-up period. At the follow-up examination all patients with medullary impingement had persistent or increased symptoms, and three of 27 patients (11%) with no or slight changes on magnetic resonance imaging had persistent symptoms. No ligament injuries were diagnosed. CONCLUSION: Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits or clinical signs of nerve root compression to diagnose disc herniations requiring surgery.

Adolescent↗

PubMed1996

Late vascular complication after fracture of the proximal humerus.

A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. Early diagnosis and surgical intervention are emphasized.

Angiography, Digital Subtraction↗

PubMed1995

Decreased width of the spinal canal in patients with chronic symptoms after whiplash injury.

STUDY DESIGN: The sagittal diameter of the cervical spinal canal was measured on standard lateral radiographs of 48 consecutive patients with acute whiplash injury. A follow-up was done 12 months after injury. OBJECTIVES: The purpose of this study was to evaluate the relationship between spinal canal width and chronic symptoms after whiplash injury. SUMMARY OF BACKGROUND DATA: A narrow sagittal diameter of the cervical spinal canal has been correlated with neurologic deficits in degenerative conditions and after fractures. The authors are not aware of previous studies on whiplash patients related to this area. METHODS: Forty-eight consecutive patients were evaluated for whiplash trauma after car accidents. Twenty-four patients (12 men and 12 women; mean age, 37 years) had persistent symptoms after 12 months, while 24 patients (12 men and 12 women; mean age, 34 years) were asymptomatic. All measurements were done from standard lateral radiographs with a graphic digitizer connected to a microcomputer. Three anteroposterior and one oblique measurement of the canal were reconstructed for each vertebrae from C2-C6. Multivariate analysis of variance was used to evaluate any association between gender, remaining symptoms at follow-up, and the recorded values of the spinal canal width. RESULTS: The spinal canal was significantly smaller in the patients with persistent symptoms than in the asymptomatic group. A significant difference also was found between men and women. CONCLUSION: Narrow diameter of the cervical spinal canal is unfavorable in patients with whiplash.

Adult↗

PubMed1994

MRI and neurology in acute whiplash trauma. No correlation in prospective examination of 39 cases.

39 consecutive cases of whiplash injury of the neck were examined clinically and with MRI at a mean of 11 days after trauma. 26 of these showed changes on MRI with disc lesions in 25, 10 of which were classified as disc herniations, and a muscle lesion in 1 case. All had neck pain or headache. 29 cases had neurological deficits, mostly sensibility disturbances. 22 of the 26 cases with pathologic MRI findings had neurological signs, as had 7 of the 10 cases with disc herniation. The relationship between the MRI findings and the clinical symptoms and signs was poor.

Adolescent↗

PubMed1993

Negative scintigraphy despite spinal fractures in the multiply injured.

Skeletal injuries may be overlooked in multiply-injured patients. Skeletal scintigraphy, a very sensitive indicator of skeletal injuries, may give complementary information. We therefore performed scintigraphic screening in 20 patients with multiple injuries. In all, 38 fractures were diagnosed by plain skeletal radiography, and were also visualized scintigraphically. Furthermore, scintigraphy revealed a fracture of the pelvis in one patient and a tibial plateau fracture in another. Scintigraphy was, however, negative in three patients; two with fractures of the transverse processes in the lumbar spine and one with a cervical spine fracture of the articular processes with dislocation. The use of scintigraphy as a screening method in patients with multiple injuries may be helpful in the diagnosis of skeletal injuries. However, fractures of the vertebral column were not always visualized, possibly because of technically inadequate examinations in injured patients unable to co-operate.

Accidental Falls↗

PubMed1993

Early complications after anterior dislocation of the shoulder in patients over 40 years. An ultrasonographic and electromyographic study.

The rate of complications after anterior dislocation of the shoulder was evaluated in 65 patients aged over 40 years. 36 of 55 cases had electromyographically verified axillary nerve or brachial plexus injury. Rotator-cuff lesion was seen in 24 of the 63 sonographically examined cases. At follow-up in a telephone interview on average 3 years after the injury, 27 of the 57 cases had complaints from their shoulder. The incidence of initial nerve and/or cuff lesions was higher in those with persisting symptoms at follow-up.

Adult↗

PubMed1993

Eye motility dysfunction after soft-tissue injury of the cervical spine. A controlled, prospective study of 38 patients.

We investigated eye motility prospectively in 40 patients with a soft-tissue injury of the cervical spine. The initial oculomotor test, performed within 3 months, was pathologic in 8 patients. The follow-up test in 38 patients, on average 15 months after the accident, remained pathologic in the 8 patients and 5 additional patients had changed from normal to pathologic test results. At follow-up, all the 13 patients with oculomotor dysfunction had persisting symptoms, while 5 of the 25 cases with normal test results still were symptomatic.

Adolescent↗

PubMed1993

Surgery for chronic symptoms after whiplash injury. Follow-up of 20 cases.

20 patients operated on with discectomy and anterior cervical fusion because of chronic symptoms after whiplash injury were examined 4 years after surgery. The commonest indications for surgery were disabling headache and neck pain and radiographically verified disc protrusion. At follow-up, 11 patients had reduced headache and neck pain, while paresthesia and radicular pain were diminished in 9 patients. Based on Robinsson's criteria for the evaluation of surgical results, 2 patients had good, 9 had fair and 9 had poor results.

Adult↗

PubMed1990

Trigeminal sensory impairment after soft-tissue injury of the cervical spine. A quantitative evaluation of cutaneous thresholds for vibration and temperature.

The cutaneous sensibility for vibration and temperature in the trigeminal skin area was examined with quantitative methods in 30 patients with a previous soft-tissue injury of the cervical spine. Sixteen patients with chronic and disabling symptoms had significantly increased thresholds for vibration over the ophthalmic (p less than 0.001) and mandibular (p less than 0.01) divisions of the trigeminal nerve compared with 14 without symptoms. Temperature thresholds were measured in all three divisions of the trigeminal nerve, and were significantly increased in all three compared with controls (p less than 0.001 in ophthalmic division, p less than 0.01 in maxillary and p less than 0.05 in mandibular divisions). The impairment of vibration and temperature sensibility in the trigeminal skin area in patients with chronic symptoms after soft-tissue injury of the cervical spine indicates damage to the central trigeminal system in upper spinal cord segments and ponto-medullary levels of the brainstem.

Accidents, Traffic↗

PubMed1990

Soft-tissue injury of the neck in a hospital based material.

In a study from northern Sweden, 139 patients with a history of a soft-tissue injury of the neck were studied. The incidence was 1 per 1000 inhabitants. Male patients in the age group 20-29 years were most commonly injured. Traffic accidents constituted the major group with 96 (69%) and falls with 24 (17%). Forty-one cases received sickness benefit for a median time of 16 days for males and 25 days for females. Five persons were on sick-leave for over a year. The calculated total cost of treatment and sickness insurance benefit was about 0.9 million SEK/year.

Adolescent↗

PubMed1990

Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims.

Ninety-three cases with a car-accident soft-tissue injury of the cervical spine were studied prospectively. Neck pain and stiffness were the main initial symptoms, while 4 cases had abnormal neurologic signs. At follow-up, on an average 2 years after the accident, 42 percent had recovered completely, 15 percent had minor discomfort, and 43 percent had discomfort sufficient to interfere with their capacity for work. The statistical analysis of 17 factors, including acute symptoms and physical findings, as well as the forces and directions of impact, head rests, radiographs, length, and sex, did not reveal any factor of prognostic importance.

Adolescent↗

PubMed1989

Scintigraphic findings in acute whiplash injury of the cervical spine.

A prospective scintigraphic and radiographic study was carried out in 35 patients with a whiplash injury of the cervical spine. The scintigraphic findings were within normal limits in 31 of the patients, while four had either a focal or multifocal increase in activity. Plain radiography revealed skeletal changes secondary to spondylosis in three patients and a localized bony spur with avulsion of a barely visible fragment in one. Our investigation shows that skeletal lesions after whiplash injury, although very few, are shown by plain skeletal radiography. Scintigraphy is not indicated for screening purposes.

Adult↗

PubMed1989

Oculomotor problems after cervical spine injury.

Oculomotor function was investigated in 39 patients with a previous soft-tissue injury of the cervical spine. The velocity, the accuracy, and the pattern of the eye movements were disturbed in 20 patients with chronic and disabling symptoms. Oculomotor function in the 19 asymptomatic patients did not differ from a control group. The oculomotor function seems to be impaired, possibly by brain stem lesions, in patients with chronic symptoms of whiplash injury of the cervical spine.

Adult↗