Rheumatology Advance Access originally published online on December 23, 2005
Rheumatology 2006 45(2):196-200; doi:10.1093/rheumatology/kei119
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Disrupted cortical proprioceptive representation evokes symptoms of peculiarity, foreignness and swelling, but not pain
1 School of Physiotherapy, University of Sydney, Sydney, 2 Division of Physiotherapy, University of Queensland, Brisbane, Australia and Department of Human Anatomy and Genetics and fMRIB Centre, 3 University of Oxford, Oxford, UK.
Correspondence to: L. Moseley, Department of Human Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3QX, UK. E-mail: lorimer.moseley{at}ndm.ox.ac.uk
Objectives. It has been proposed that disruption of the internal proprioceptive representation, via incongruent sensory input, may underpin pathological pain states, but experimental evidence relies on conflicting visual input, which is not clinically relevant. We aimed to determine the symptomatic effect of incongruent proprioceptive input, imparted by vibration of the wrist tendons, which evokes the illusion of perpetual wrist flexion and disrupts cortical proprioceptive representation.
Methods. Twenty-nine healthy and naive volunteers reported symptoms during five conditions: control, active and passive wrist flexion, extensor carpi radialis tendon vibration to evoke illusion of perpetual wrist flexion, and ulnar styloid (sham) vibration. No advice was given about possible illusions.
Results. Twenty-one subjects reported the illusion of perpetual wrist flexion during tendon vibration. There was no effect of condition or of whether or not subjects reported an illusion on discomfort/pain (P>0.28). Peculiarity, swelling and foreignness were greater during tendon vibration than during the other conditions, and greater during tendon vibration in those who reported an illusion of wrist flexion than in those who did not (P<0.05 for all). Symptoms were reported by at least two subjects in each condition and four subjects reported systemic symptoms (e.g. nausea).
Conclusions. In healthy volunteers, incongruent proprioceptive input does not cause discomfort or pain but does evoke feelings of peculiarity, swelling and foreignness in the limb.
KEY WORDS: Body schema, Pathological pain, Sensory–motor incongruence, Cortical organization, Vibration, Illusion
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