1. 2005;8;267-270The Presence and Interrater Reliability of Thoracic Allodynia in a Whiplash Cohort
   A Prospective Case Series
   Shannon L. Bock, MMS,PA-C, CMT, Christopher J. Centeno, MD, and James M. Elliott, MSPT.

Background: The need exists for more definitive clinical signs indicative of abnormal central pain processing following a whiplash injury. Our observations have identified the presence of allodynia in the thoracic spine in patients with neck pain following whiplash injury. The evaluation of allodynia in the thoracic spine in a whiplash injured population may assist in the clinical diagnosis of patients believed to be suffering from central nervous system hypersensitivity.

Objective: To evaluate for the presence of allodynia in a cohort of patients with whiplash injury.

Methods: Thirty-one patients with whiplash injuries were evaluated in this prospective study for the presence of allodynia in the thoracic spine. Thoracic vertebrae were marked by the initial evaluating clinician and a Wartenberg pinwheel was utilized to identify areas of hypersensitivity in the thoracic dermatomes. Patients were instructed to give no verbal clues, so only visual clues, as determined by the clinician, were assessed. A second clinician, blinded to the initial examination results, repeated the examination in the same fashion.

Results: Thoracic allodynia was identified in 70.97% of the observed population. There was a high level of agreement between observers (Kappa coefficient of agreement, 0.8039; 95% CI, 0.7465, 0.8613; P<0.05). There was no predilection for a particular thoracic dermatome.

Conclusion: Thoracic allodynia was identified as a common, interrater-reliable, objective physical examination finding in this whiplash cohort.

Keywords: Allodynia, whiplash, interrater reliability, thoracic