The aim of our study was to compare the clinical versus radiological diagnosis of patients suffering from a Morton's neuroma. Clinical assessments and pre operative radiological imaging of patients who underwent operative procedures for an excision of a Morton's neuroma were retrospectively compared. This review included 43 excised Morton's neuromas from 36 different patients over a period of 68 months, performed by one surgical team.

The commonest clinical symptoms were those of pain or tingling on the plantar aspect of the affected webspace on direct palpation (100%), pain of weight bearing (91%) which was relieved by rest (81%) and pain on stretching the toes (79%). The most sensitive clinical sign was a Mulder's click.

Our results showed that clinical assessment was the most sensitive method of diagnosing these neuromas (98%). All of our patients had at least one mode of radiological investigation. Ultrasonography was the commonest requested single imaging modality in our series. It was found to have a sensitivity of 90% (28/31). This imaging technique has the disadvantage of being operator dependant, as highlighted by the fact that one of our patients had a correct radiological diagnosis after a repeat ultrasound to the affected area was requested. Magnetic Resonance Image scan is a more expensive technique as it has the advantage of producing static reproducible images. As a single imaging modality, it was found to have a sensitivity of 92% (12/13) in our series. 3 patients had both imaging modalities; initial ultrasound failed to convincingly diagnose a neuroma in 2 cases and in the other case, the initial MRI did not show any pathology. In all these cases, the repeat imaging techniques confirmed the clinical diagnosis.

We conclude that there is no absolute requirement for ultrasonography or magnetic resonance imaging in patients who clinically are suspected to have a Morton's neuroma, as the clinical examination was found to be the most sensitive method of diagnosis. We suggest that the two main indications for performing some form of imaging is (a) an unclear clinical assessment and (b) cases when more than one webspace appears to be affected. An ultrasound of the webspaces should be the radiological investigation of choice, followed by a magnetic resonance scanning if any uncertainty still remains.

Purpose: Whiplash injury occurs due to motor vehicle accidents has its long term consequence, nevertheless very little is written about its long-term follow up. The aim of the study is to find out the long-term follow up of Whiplash injury and the factors affecting the long-term follow up

Method: It is a retrospective study which was done in Russells Hall Hospital in the west midland in UK. 64 patients were selected in this study. Only 54 patients were replied. An inclusion criterion was Whiplash injury due to RTA in years 1995, 1996 and 1997. Initial examination was performed 5.6 +/ – 4.5 days after trauma, and follow-up examinations 3, 6, 12, and 24 months. Exclusion criteria were any cervical spine bony injury, associate head injury and poly-trauma patients. The outcome measures used for assessment are SF36, Whiplash Disability Questionnaire score WDQS, and questions to cover their present symptoms, work circumstances before and after the injury, current and previous treatment

Results: In our study we found that the time it takes for the patient’s symptoms to resolve varies, it took less than 6 weeks in 4 patients, between 6 weeks to 3 months in 10 patients, between 6 months to 1 year in 15 patients and more than one year in 3 patients. The average follow up time was 10.3 years. Our results did show these figures: 22 patients were still symptomatic 10 years after injury, 18 still complaining of pins & needles, 13 still having frontal headache and 7 having occipital headache. Headache was one of the symptoms which annoyed Whiplash injury patients. Headaches following Whiplash injuries were occipital, frontal or generalised. Headache was usually of Muscular contraction type, often associated with greater occipital neuralgia. 16 patients still had treatment in the form of pain killers or physiotherapy. The mean WDQS was less than 20 in 38 patients. The mean WDQS in patients with low back pain was 29.23 and for those without back pain were 12.53. In the smokers the mean whiplash score was 32.2. In the non-smokers the Whiplash score was 17.93. The mean WDQS in those who do not drink alcohol was 26.73 and in those who drink alcohol were 16.58.

Conclusion: Whiplash injury patients have long term residual symptoms mainly pins & needles as well as headache and dizziness. Claiming compensation is a bad prognostic factor on the long-term outcome of Whiplash injury patients. Drinking alcohol, Gender, BMI, treatment given after the initial injury and smoking have no effect on the long-term outcome of these injuries. Age & Low back pains are bad prognostic factors. Whiplash Disability Questionnaire score, SF 36 (for body pain) and time for symptoms to be relieved are sensitive outcome measures to assess those injuries.