What is Whiplash?
Whiplash – a soft tissue injury to the neck – is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion. The disorder commonly occurs as the result of an automobile accident and may include injury to intervertebral joints, discs, ligaments, cervical muscles and nerve roots.
The classical definition of whiplash comes from the sudden “whipping motion” of the head and neck during the rapid deceleration that occurs in a motor vehicle accident. The damaging motion most often occurs in a rear-ended type collision but can occur with other trauma. According to some studies, the amount of damage to the car involved in the accident is inversely proportional to the incidence of whiplash injury.
The name or denomination “whiplash” derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, produced at the moment of a traffic accident, particularly subsequent to collisions from the rear, head-on or side collisions.
Clinical Syndromes of Whiplash
- Spinal Cord Injury
- Occipital Neuralgia
- Tempomandibular Joint Dysfunction
- Cervical Vertigo
- Cervical Radiculopathy
- Cervical Facet Syndromes
- Thoracic Outlet Syndromes
- Shoulder and Arm Pain
Grade 1 – Complaints of neck pain, stiffness or tenderness, but no physical signs are noted on exam.
Grade 2 – Neck complaints, and the examining physician notices decreased range of motion and point tenderness in the neck.
Grade 3 – Decreased range of motion, plus neurological signs such as decreased deep tendon reflexes, weakness, insomnia, and sensory deficits.
Grade 4 – Neck complaints and fracture or dislocation, or spinal cord injury.
Symptoms of Whiplash
- Neck pain occurs in 62-100% of those injured and is the hallmark symptom.
- Headaches occur in 82% of those injured and are often in the suboccipital region.
Imaging Tests & Diagnostics
- Plain radiographs should be obtained early in the evaluation of whiplash injury to exclude fractures or subluxations; findings usually are normal.
- Dynamic X-ray films (flexion and extension views) should be included to exclude abnormalities that suggest instability of the neck.
- MRI abnormalities have included increased signal changes in cervical ligaments (eg, intraspinous) suggestive of tears, disk herniations, tears of the cervical musculature, and annular tears of the disk.
- Physical therapy
- Modalities – Heat, ice, ultrasound, traction, TEN’s
- Active strengthening
- Neutral spine stabilization
- Education of mechanics
- Developing independent home programs
- Steroid Injections
During the management stage of whiplash, it’s important to remember that 90 percent of individuals with whiplash heal with symptomatic (acute) management. Acute management of whiplash includes:
- Evaluating for significant bony or neurologic injury.
- Judiciously use medications for acute pain.
- Keeping the patient moving to strengthen muscles.
10 percent of individuals will not recover within 12 weeks after undergoing acute management. They need subacute management. They should seek out the help of a Interventional Pain Specialist and their multidisciplinary team.
Medications to use
- Nonsteroidal Anti-inflamatory Drugs (NSAIDS)
- Steroids – Prednisone, Medrol Dose Pak
- Muscle Relaxants
- Antispasmotics – Baclofen, Zanaflex
- Antidepressants – TCA’s, SSRI, Cymbalta
- Anticonvulsants – Neurontin, Topomax, Lyrica
- Narcotics – Short Acting vs. Long Acting
Medications To Avoid
- Sleep inducers – Restoril, Ambien
- There are an estimated 13-18 million motor vehicle accidents yearly in the U.S.
- One million people suffer whiplash type injuries.
- The management of these injuries cost about $30 billion dollars annually in terms of diagnosis, treatment, litigation and insurance costs.
- Many studies indicate that 15% of the patients remain significantly symptomatic and require ongoing treatment.
- 26% of patients have intermittent neck pain one year after injury.
- 4% of patients had continuous discomfort.
- 30% of patients lost some work.
- 59% of patients had disruptions of daily routines for many months.
Thomas Cohn, MD
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