Whiplash injury: a reappraisal.

Few topics provoke so much controversy or heated opinion, based on so little fact as whiplash injuries. In emergency departments, orthopaedic, neurological and rheumatological clinics, and not least in the Courts, this common syndrome is shrouded in mystery and creates clinical insecurity in those who attempt to explain its mechanism, its prognosis and treatment. These problems are compounded in medico-legal practice where the potential rewards of successful litigation may colour the clinical picture.     

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.     

Whiplash following rear end collisions: a prospective cohort study

OBJECTIVE: The purpose of this study was to investigate the factors which predict neck pain initially and at 1 year following a rear end collision. METHODS: All people who reported a rear end collision to the Devon and Cornwall Constabulary were identified and formed the basis of the cohort. People were excluded if they were under 18 years of age or had suffered a head injury. The main outcome measures were neck pain lasting for more than a week after the accident and neck pain at least 1 day a week at 1 year. Logistic regression was used to investigate associations between demographic and accident related variables and outcomes. RESULTS: A total of 1147 people reported rear end collisions to the police during the study period and 503 (44%) agreed to take part in the study. Of the respondents, 78% had neck pain lasting for more than a week and 52% still had pain at 1 year. Age (odds ratio, 95% confidence interval: 0.957, 0.942-0.972) and prior history of neck pain (8.32, 2.89-23.89) were the most important predictors of early neck pain. The most important predictors of pain at 1 year were the initial neck visual analogue scale (VAS) score (1.03, 1.01-1.05) and the presence of a compensation claim (4.09, 1.62-10.32). There was only weak evidence that measures of the severity of the impact were associated with outcomes. CONCLUSION: Demographic variables and the presence of a compensation suit show the strongest correlation with acute and chronic neck pain following rear end collisions.     

Whiplash: pathophysiology, diagnosis, treatment, and prognosis

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.     

颈髓挥鞭样损伤的诊治

目的 :探讨颈髓挥鞭样损伤的诊治。方法 :对 71例颈髓挥鞭样损伤伴急性颈椎间盘突出症患者的手术疗效作随访 ,其中绝大部分为信访。随访时间为 4～ 13 2个月 (平均 5 5 4个月 )。所有病人手术前后作颈椎MRI检查。结果 :手术优良率为 85 92 %。手术有效率为 91 5 5 %。结论 :颈椎MRI对诊断此病有重要价值。对保守治疗效果不佳者 ,颈前路手术是一种良好的选择     

The Effectiveness of Infrared Thermography in Patients with Whiplash Injury

Objective

This study aims to visualize the subjective symptoms before and after the treatment of whiplash injury using infrared (IR) thermography.

Methods

IR thermography was performed for 42 patients who were diagnosed with whiplash injury. There were 19 male and 23 female patients. The mean age was 43.12 years. Thermal differences (ΔT) in the neck and shoulder and changes in the thermal differences (ΔdT) before and after treatment were analyzed. Pain after injury was evaluated using visual analogue scale (VAS) before and after treatment (ΔVAS). The correlations between ΔdT and ΔVAS results before and after the treatment were examined. We used Digital Infrared Thermal Imaging equipment of Dorex company for IR thermography.

Results

The skin temperature of the neck and shoulder immediately after injury showed 1-2℃ hyperthermia than normal. After two weeks, the skin temperature was normal range. ΔT after immediately injuy was higher than normal value, but it was gradually near the normal value after two weeks. ΔdT before and after treatment were statistically significant (p<0.05). VAS of the neck and shoulder significantly reduced after 2 week (p=0.001). Also, there was significant correlation between ΔdT and reduced ΔVAS (the neck; r=0.412, p<0.007) (the shoulder; r=0.648, p<0.000).

Conclusion

The skin temperature of sites with whiplash injury is immediately hyperthermia and gradually decreased after two weeks, finally it got close to normal temperature. These were highly correlated with reduced VAS. IR thermography can be a reliable tool to visualize the symptoms of whiplash injury and the effectiveness of treatment in clinical settings.     

"Whiplash"-injury of the 2nd cervical ganglion and nerve

Amongst the many patients with persisting neck pain and headache following cervical injuries are a small number in whom the mechanism is compression of the second cervical nerve root and ganglion. This paper describes the clinical features in 14 patients seen by the author. The main features are unilateral pain in the upper cervical and occipital region, tenderness in the suboccipital region, and diminished sensation in the C2 dermatome. The anatomical basis for this syndrome is discussed and illustrated with dissections from a cadaver.     

Disturbed Eye Movements after Whiplash Due to Injuries to the Posture Control System

Abstract

Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n =26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.