title: Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine.
abstract: OBJECTIVE
  This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries.
  
  
  METHODS
  The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries.
  
  
  RESULTS
  It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending.
  
  
  CONCLUSIONS
  It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.
authors.affiliation: Department of Physics and Engineering, Fort Lewis College, 1000 Rim Drive, Durango, CO, 81301, USA. pdleahy@fortlewis.edu.
authors.forename: P Devin
authors.identifier: http://orcid.org/0000-0003-1531-1816
authors.initials: PD
authors.lastname: Leahy
authors.affiliation: Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA.|School of Biomedical Engineering, Colorado State University, Fort Collins, CO, 80523, USA.|Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Puttlitz
mesh_terms: D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000293:injuries*; D020342:Finite Element Analysis; D006801:Humans; D017846:Longitudinal Ligaments / Q000293:injuries*; D016059:Range of Motion, Articular; D012399:Rotation; D013124:Spinal Injuries / Q000175:diagnosis*; D014911:Whiplash Injuries / Q000150:complications
keywords: Cervical spine; Clinical diagnosis; Ligamentous injury; Range of motion measurement