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Cervical Whiplash
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Contents
Other Names
- Whiplash Syndrome
- Whiplash
- Whiplash-associated Disorders (WAD)
- Whiplash injury
- Cervical Sprain
- Cervical Strain
Background
- This page describes 'whiplash' and whiplash-associated disorders (WAD) as well as cervical sprains and strains
- Primarily a clinical diagnosis as there are no diagnostic radiological, electrophysiological or neuropchological studies[1]
- Because of the diagnostic challenges, the diagnosis is considered controversial
Epidemiology
- Incidence between 4 and 325 per 100,000 person years depending on cited study[2][3]
- Affects up to 83% of patients involved in motor vehicle accidents[4]
- Economic burden estimated at $3.9 billion annually in the United States, which balloons to $29 when including litigation.[5]
Pathophysiology
- Caused by rapid acceleration and/or deceleration injuries with energy transfer to the neck
- Theorized to be hyperextension of lower cervical vertebrae with flexion of the upper cervical vertabrae producing an S-shape cervical spine at the time of impact[6]
- Subsequent cervical sprain or strain
- Pathophysiology is generally poorly understood
- Believed to be complex injury pattern to ligaments, tendons, nerves, muscles, discs, and bones of the neck
Etiology
- Most commonly due to motor vehicle crashes
- Other etiologies
- Sports accident
- Domestic violence
- Amusement park rides
- ATV
Risk Factors
- Hyperextension
- Hyperflexion
- Lateral Flexion/ Sidebending
Differential Diagnosis
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Clinical Features
- General: Physical Exam Neck
- History
- Patients will endorse a history of trauma, typically MVC
- They often report some combination of neck pain and stiffness that may or may not radiate down the arm(s)
- They also have headaches, visual disturbances, memory and concentration problems and psychological distress
- Tempormandibular joint dysfunction is also common
- Psychosocial symptoms include g depression, anger, fear, anxiety, and hypochondriasis[7]
- Physical Exam
- Physical exam often reveals myofascial pain and tenderness along the cervical spine and paracervical musculature
- Range of motion may be diminished and/or a painful arc of motion
Evaluation
- There are no reliable radiographic findings for whiplash[8]
- The role of imaging is in excluding other diagnoses
Radiographs
- Standard Cervical Spine Radiographs
- Typically normal, may demonstrate loss of cervical lordosis
CT
- Typically normal
- Used to exclude fractures associated with trauma
MRI
- Most valuable for evaluating soft tissue pathology of the neck and cervical spine
- Potential findings[9]
- Loss of lordosis
- Prevertebral edema
- Ligamentous injury (often the alar and the transverse ligaments)
- Fractures of the articulating facet
- Not indicated immediately following trauma due to high false positive rate
- In a study of 100 patients following normal radiographs, only 1 had abnormal MRI of the cervical spine (prevertebral edema)[10]
Classification
Quebec Classification Of Whiplash-associated Disorders[11]
- Grade 0: no neck complaints and no physical signs
- Grade I: neck pain, stiffness or tenderness, and no physical signs
- Grade II: neck complaints accompanied by musculoskeletal signs, with decreased range of motion and point tenderness
- Grade III: neck complaints accompanied by musculoskeletal and neurologic signs, with muscle weakness and sensory deficits
- Grade IV: neck complaints accompanied by fracture or dislocation
Management
Prognosis
- Most patients will recover within a few weeks
- Approximately 50% of patients will still have pain or discomfort at one year post injury[12]
- Subsequently, they can develop chronic pain
- Implications for morbidity, economic burden
- Studies have suggested between 25-40% of patients have persistent symptoms at 1 year and up to 40% at 7 years[13]
- Factors associated with delayed recovery[14]
- Female gender
- Older age
- Initial intensity of neck pain
- Neurologic deficit
- Preexisting neck pain
Acute
- By definition, nonsurgical clinnical entity
- Ice
- Cervical Collar, typically soft
- Analgesia including NSAIDS
- Physical Therapy
- Active (as opposed to passive) intervention had reduced pain intensity and sick leave at 6 months and 3 years[15]
- Exercise
- Range of motion exercises result in reduced pain, improved function[16]
- Oral Corticosteroids
- High dose steroids given within 8 hours of injury reduces number of sick days and disabling symptoms compared to controls[17]
Chronic
- Overall dearth of research on chronic management of whiplash
- Physical Therapy
- Vendrig et al: following 6 months of exercise, group therapy, and occupational therapy[18]
- 65% of patients had complete return to work
- 92% reporting complete or partial return to work
- 81% reported no medical or paramedical treatments
- Cervical radiofrequency neurotomy (CRFN)
- Prushansky et al: 70% patients reported improvement in symptoms on neck disability index, range of motion[19]
- Other proposed but unstudied treatments
- Temperomandibular joint treatment
- Cervical traction
- Intraarticular corticosteroids
- Botulinim toxin
Rehab and Return to Play
Rehabilitation
- Emphasis on cervical range of motion
- Strengthening peri-scapular and scapular muscles
- Neck stabilization exercises
Return to Play
- Needs to be updated
Complications
- Chronic neck pain
- Inability to return to work
See Also
- Internal
- External
- Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/
References
- ↑ Sanjay Yadla, John K. Ratliff, James S. Harrop. Whiplash: diagnosis, treatment, and associated injuries. (2008) Current Reviews in Musculoskeletal Medicine. 1 (1): 65.
- ↑ Khushnum Pastakia, Saravana Kumar. Acute whiplash associated disorders (WAD). (2011) Open Access Emergency Medicine. 3: 29
- ↑ Barnsley L, Lord SM, Bogduk N. Whiplash injury. Pain 1994;58: 283–307
- ↑ Cote PDC, Hogg-Johnson S, et al. Initial patterns of clinical care and recovery from whiplash injuries. Arch Intern Med 2005; 165:2257–63.
- ↑ Freeman MD. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999;24:86–98.
- ↑ Grauer JN, Panjabi MM, et al. Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine 1997;22:2489–94.
- ↑ Van Geothem JW, et al. Whiplash injuries: is there a role for imaging? Eur J Radiol 1996;22:30–37.
- ↑ James M. Elliott, Sudarshan Dayanidhi, Charles Hazle, Mark A. Hoggarth, Jacob McPherson, Cheryl L. Sparks, Kenneth A. Weber II. Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?. (2016) Journal of Orthopaedic & Sports Physical Therapy. 46 (10): 862-873.
- ↑ Erika Jasmin Ulbrich, Sandra Eigenheer, Chris Boesch, Juerg Hodler, André Busato, Christian Schraner, Suzanne E. Anderson, Harald Bonel, Heinz Zimmermann, Matthias Sturzenegger. Alterations of the Transverse Ligament: An MRI Study Comparing Patients With Acute Whiplash and Matched Control Subjects. (2012) American Journal of Roentgenology. 197 (4)
- ↑ . Ronnen HR, de Korte PJ, et al. Acute whiplash injury: is there a role for mr imaging?—a prospective study of 100 patients. Radiology 1996;201 1:93–6
- ↑ TRACsa: Trauma and Injury Recovery . Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. Adelaide, Australia: South Australian Centre for Trauma and Injury Recovery (TRACsa); 2008.
- ↑ ourse and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD): Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. (2008) Spine. 33 (4S): S83-92
- ↑ Rodriquez AA, Barr KP, Burns SP. Whiplash: pathophysiology, diagnosis, treatment, and prognosis. Muscle Nerve 2004;29:768– 81.
- ↑ Dufton JA, et al. Prognostic factors associated with minimal improvement following acute whiplash-associated disorders. Spine 2006;20:E759–65
- ↑ Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R. Active intervention in patient with whiplash-associated disorder improves long-term prognosis. Spine 2003;28:2491–8.
- ↑ Motor Accidents Authority . Your guide to whiplash recovery in the first 12 weeks after the accident. Sydney, Australia: Motor Accidents Authority; 2007
- ↑ Petterson K, Toolanen G. High-dose methylprednisolone prevents extensive sick leave after whiplash injury. a prospective, randomised, double-blind study. Spine 1998;23:984–9.
- ↑ Vendrig AA, van Akkerveeken PF, McWhorter KR. Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck. Spine 2000;25:238–44
- ↑ Prushansky T, Pevzner E, Gordon C, Dvir Z. Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures. J Neurosurg 2006;4:365–73
Created by:
John Kiel on 17 June 2019 14:30:14
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Last edited:
6 October 2022 23:14:50
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