Demonstrating Neck Muscle Injury using MRI
Post-Traumatic and Causally Muscle Injury of the Anterior Neck Musculature
Objectively correlating bodily injury to causality and persistent functional loss is a critical part of caring for the injured. Providers have many tools at their disposal, however the most frequently utilized is MRI. Historically the focus of MRI has been on pathology and injury to the intervertebral disc, but recently scholarly works are demonstrating acute trauma evidence in other areas such as ligaments and muscles.
In a research paper by Takhtani et al. (2014), the authors wrote in their introduction “The longus colli muscle (LCM) forms the bulk of the deep flexor muscles of the neck. To our knowledge, very little information on the effects of trauma on this muscle group has been published. We describe MRI findings related to injury of the LCM in patients with a history of neck trauma.” [page 401] The deep cervical flexor muscles [DCF] of the neck are often overlooked since they are often too deep to be palpated, although they will restrict motion. The authors state “The DCF muscles of the neck are a group of four individual muscles that extend from the atlas to the third thoracic vertebra. These muscles, because of their location and attachment, are prone to extension injury. The longus colli muscle (LCM) constitutes the bulk of the DCF muscles, extending from C1 to the T3 vertebral body. [page 401]
Regarding the mechanism of injury, the authors stated “Because the DCF muscles are protected from contusions because of their location deep in the prevertebral layer of the deep cervical fascia, they can be injured only when the extension force exceeds the physiologic range of the normal neck extension. Such injuries are commonly seen in persons with unrestrained neck motion who fall and or are involved in motor vehicle accidents.” [page 403] In relation to the objective findings confirming injury to the DCF, the authors wrote, “Injury of the LCM was diagnosed on the basis of the presence of swelling, increased T2 hyperintensity, or both. T2 hyperintensity in the abnormal muscle was confirmed by comparing it with T2 signal intensity in the other normal adjacent muscles. FMPIR and FSE T2-weighted axial images were evaluated to detect the presence of prevertebral fluid, hemorrhage, or both.” [page 402] The exact views and the nuances of the MRI studies are not important for this discussion, what is important HOWEVER is that injury to the deep muscles of the cervical spine can be visualized on MRI and can help to objectify the injuries sustained as a result of a neck injury.
In conclusion, it is impossible to paint a complete picture of bodily injury unless you have an accurate diagnosis. We arrive at an accurate diagnosis by having an expert understanding of the human body, its response to traumatic forces as well as the modalities that are available to demonstrate traumatic changes. Working with providers that have advanced training in triage and trauma is the only to ensure nothing is missed.
Reference:
1. Takhtani, D., Scortegagna, E., Cataltepe, O., & Dundamadappa, S. (2016). MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma. American Journal of Roentgenology, 207(2), 401-405.
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