Whiplash injuries

The term “whiplash” is not a medical diagnosis, but is the result of soft-tissue trauma to the neck. A whiplash injury occurs as a result of a sudden acceleration or deceleration of the head and neck with respect to the body. This article recommends that patient treatment be individualized.     

颈椎挥鞭伤的MRI诊断

目的：着重探讨颈椎挥鞭伤的MRI特征及诊断价值.方法：搜集经临床诊治并有MRI资料的颈椎挥鞭伤16例,均为交通事故伤,伤后6小时～3天行颈椎常规MRI检查.结果：1.颈椎爆裂性骨折6例.2.椎间盘突出3例.3.椎管变形狭窄6例.4.颈髓损伤4例.5.颈椎管硬膜下血肿1例.6.椎前间隙出血16例.7.项后软组织撕裂伤10例.8.颈椎及椎管内外损伤均有MRI信号改变,16例中12例为长T1和长T2信号;4例为短T1和长T2信号.结论：颈椎挥鞭伤是一种急性过伸过屈性间接暴力伤,常多结构受损,MRI可全面揭示其损伤的MRI特征、范围及程度,对临床诊治可提供重要影像学信息.     

Whiplash: diagnosis, treatment, and associated injuries

Study design Focused review of the current literature. Objective To identify and synthesize the most current data pertaining to the diagnosis and treatment of whiplash and whiplash-associated disorders (WAD), and to report on whiplash-related injuries. Methods A search of OVID Medline (1996–January 2007) and the Cochrane database of systematic reviews was performed using the keywords whiplash and WAD. Articles under subheadings for pathology, diagnosis, treatment, and epidemiology were chosen for review after identification by the authors. Results A total of 485 articles in the English language literature were identified. Thirty-six articles pertained to the diagnosis, treatment, epidemiology of whiplash, and WAD, and were eligible for focused review. From these, 21 primary and 15 secondary sources were identified for full review. In addition, five articles were found that focused on whiplash associated cervical injuries. These five articles were also primary sources. Conclusions Whiplash is a common injury associated most often with motor vehicle accidents. It may present with a variety of clinical manifestations, collectively termed WAD. Whiplash is an important cause of chronic disability. Many controversies exist regarding the diagnosis and treatment of whiplash injuries. The multifactorial etiology, believed to underly whiplash injuries, make management highly variable between patients. Radiographic evidence of injury often cannot be identified in the acute phase. Recent studies suggest early mobilization may lead to improved outcomes. Ligamentous and bony injuries may go undetected at initial presentation leading to delayed diagnosis and inappropriate therapies.     

Whiplash injuries from car accidents in a Swedish middle-sized town during 1993-95

OBJECTIVE: To assess the incidence of whiplash associated disorders (WAD) after minor whiplash injuries in car accidents. DESIGN: A cohort defined by means of a health-care-based registration of traffic injuries and followed up by postal questionnaire after 12 months. SETTING: Primary and hospital care in a Swedish middle-sized town (approx. 80,000 inhabitants) during 2 years in the period 1993-1995. MAIN OUTCOME MEASURES: Incidence of WAD, duration of symptoms and sick leave. RESULTS: A total of 485 injured car occupants were identified; 158 had a WAD with no difference between the sexes. The incidence was estimated to be 1/1000 inhabitants and year. The response rate to the questionnaire was 79% (125/158). In 64 cases, symptoms lasted 6 weeks and in 30 cases more than 6 months. Forty individuals (32%) reported sick leave exceeding 4 weeks in 15 cases. Seven persons (5.6%) were still on sick leave at follow-up. The duration of symptoms and sick leave was similar for men and women. CONCLUSION: Relatively few cases of WAD reported long-term sick leave. More cases reported chronic symptoms.     

Whiplash injuries from car accidents in a Swedish middle-sized town during 1993-95

Objective - To assess the incidence of whiplash associated disorders (WAD) after minor whiplash injuries in car accidents. Design - A cohort defined by means of a health-care-based registration of traffic injuries and followed up by postal questionnaire after 12 months. Setting - Primary and hospital care in a Swedish middle-sized town (approx. 80000 inhabitants) during 2 years in the period 1993-1995. Main outcome measures - Incidence of WAD, duration of symptoms and sick leave. Results - A total of 485 injured car occupants were identified; 158 had a WAD with no difference between the sexes. The incidence was estimated to be 1/1000 inhabitants and year. The response rate to the questionnaire was 79% (125/158). In 64 cases, symptoms lasted 6 weeks and in 30 cases more than 6 months. Forty individuals (32%) reported sick leave exceeding 4 weeks in 15 cases. Seven persons (5.6%) were still on sick leave at follow-up. The duration of symptoms and sick leave was similar for men and women. Conclusion - Relatively few cases of WAD reported long-term sick leave. More cases reported chronic symptoms.     

Whiplash Around the World

The term "whiplash" was first used in 1928 by the American orthopedist Crowe, although the earliest use that I can find published was in 1945 by the American orthopedist Davis. Although widely used by the medical profession and public, many physicians find the term objectionable. However, when used appropriately to refer only to the mechanism of injury in a motor vehicle accident, the term can be worthwhile. In any case, "whiplash" is well-entrenched in usage and is here to stay. But what term is used in other languages? Is there a term similar to "whiplash?" To determine terms for whiplash injuries in other languages, members of the American Academy of Neurology living in non-English-speaking countries were contacted by mail. Terms used in 11 other languages are listed. Some comments about whiplash injuries by respondents are excerpted. Further cross-cultural studies may be helpful in studying the influence of physician and popular attitudes, as well as litigation on persistent neck complaints and headaches after motor vehicle accidents.     

Whiplash injuries in Finland--the possibility of some sociodemographic and psychosocial factors to predict the outcome after one year

Purpose: The aim of our study was to evaluate if there was any relation between the change experienced in the condition of health or the length of the reported sick leaves after one year of whiplash injury and different sociodemographic and psychosocial factors. Method: Our study design is a prospective 1-year-follow-up study. The material was collected in the year 1998 from neck injuries that had been caused by traffic accidents. The insurance companies sent a notice of the accident with medical certificate to the research team. After this we sent questionnaires to the injured and after one year of the accident a new inquiry was done. One hundred and eighty-two persons returned the 1-year-follow-up questionnaire which formed the material of this study. Results: The persons who had the lowest basic education and people over 60 years of age had more health problems after one year of the accident. The other sociodemographic and psychosocial factors had only limited prognostic value when we evaluated the experienced change of health one year after the whiplash injury. Only 71 persons reported that they had been on sick leave because of the whiplash injury and of them only 21 reported sick leave over 1 month. Conclusions: Several sociodemographic and psychosocial factors can have relation to the deterioration of health experienced after whiplash injury but in this prospective study they proved to have only limited prognostic value in the long term symptoms with the exception of the education.     

Whiplash injuries in Finland--the possibility of some sociodemographic and psychosocial factors to predict the outcome after one year

Purpose: The aim of our study was to evaluate if there was any relation between the change experienced in the condition of health or the length of the reported sick leaves after one year of whiplash injury and different sociodemographic and psychosocial factors. Method: Our study design is a prospective 1-year-follow-up study. The material was collected in the year 1998 from neck injuries that had been caused by traffic accidents. The insurance companies sent a notice of the accident with medical certificate to the research team. After this we sent questionnaires to the injured and after one year of the accident a new inquiry was done. One hundred and eighty-two persons returned the 1-year-follow-up questionnaire which formed the material of this study. Results: The persons who had the lowest basic education and people over 60 years of age had more health problems after one year of the accident. The other sociodemographic and psychosocial factors had only limited prognostic value when we evaluated the experienced change of health one year after the whiplash injury. Only 71 persons reported that they had been on sick leave because of the whiplash injury and of them only 21 reported sick leave over 1 month. Conclusions: Several sociodemographic and psychosocial factors can have relation to the deterioration of health experienced after whiplash injury but in this prospective study they proved to have only limited prognostic value in the long term symptoms with the exception of the education.     

Whiplash and post-traumatic stress disorder

Purpose: This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed.

Method: A review of the literature on psychological consequences of motor vehicle accidents and on risk factors associated with developing chronic whiplash complaints is given. A case report is presented to illustrate the treatment strategy.

Results: Traffic accidents lead to psychological complaints more often than is realized in clinical practice. It is estimated that PTSD occurs in at least 25% of traffic accident victims who sustain physical injuries. This number is probably higher in patients with chronic whiplash complaints. The case report shows that improvement in relation with the post-traumatic stress symptoms can have a beneficial effect on coping with the chronic whiplash complaints.

Conclusions: The psychotherapeutic treatment of patients with chronic whiplash complaints and PTSD should be aimed primarily at coping with the trauma and not at the chronic pain complaints.     

Whiplash and Its Relationship to Migraine

SYNOPSIS
Five patients with severely symptomatic cervical injury of the type commonly referred to as 'whiplash' were discovered to also have many migrainous features and all were successfully managed with medications. The relationship of whiplash to migraine is discussed and the argument made that whiplash is trauma-precipitated cervical migraine.     

Whiplash injury prevention with active head restraint

Background

Previous epidemiological studies have observed that an initial head restraint backset greater than 10 cm is associated with a higher risk of neck injury and persistent symptoms. The objective of this study was to investigate the relation between the active head restraint position and peak neck motion using a new human model of the neck.

Methods

The model consisted of an osteoligamentous neck specimen mounted to the torso of a rear impact dummy and carrying an anthropometric head stabilized with muscle force replication. Rear impacts (7.1 and 11.1 g) were simulated with and without the active head restraint. Physiologic rotation was determined from intact flexibility tests. Significant reductions (P < 0.05) in the spinal motion peaks with the active head restraint, as compared to without, were identified. Linear regression analyses identified correlation between head restraint backset and peak spinal rotations (R² > 0.3 and P < 0.001).

Findings

The active head restraint significantly reduced the average peak spinal rotations, however, these peaks exceeded the physiologic range in flexion at head/C1 and in extension at C4/5 through C7/T1. Correlation was observed between the head restraint backset and the extension peaks at C4/5 and C5/6.

Interpretation

Correlation between head restraint backset and spinal rotation peaks indicated that a head restraint backset in excess of 8.0 cm may cause hyperextension injuries at the middle and lower cervical spine. The active head restraint may not be fully activated at the time of peak spinal motions, thus reducing its potential protective effects.     

Basilar Artery Migraine After Uncomplicated Whiplash Injuries

SYNOPSIS
Four female patients with basilar artery migraine (BAM) developing after isolated whiplash neck injuries, uncomplicated by spinal fractures, luxations or by intracranial lesions, are described. BAM constitutes a subtype of posttraumatic migraine headaches, occurring in the absence of direct head trauma, and moderately and variably ameliorated with common anti-migraine medications and physical therapy directed to the injured neck.     

Prolotherapy in Whiplash and Low Back Pain

Relaxation of ligaments and tendons occurs when fibers do not regain their normal tensile strength after having been sprained or torn. This condition causes more chronic whiplash and low back pain, more referred pain and more sciatica than does any other entity.

Diagnosis may be confirmed by intraligamentous injection of a local anesthetic solution.

An incompetent structure may be rehabilitated by intraligamentous injection of a proliferating solution which stimulates the production both of new bone and of fibrous tissue cells.