Whiplash Injury Presented To Amled 1.12.06

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Whiplash Injury

Presented To AMLED (Association of Medicolegal Doctors) in London

1st December 2006.

Tour de force of the main topics regarding Whiplash injury

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Whiplash Injury Presented To Amled 1.12.06

  1. 1. Whiplash Injury. Dr. Christopher A. Jenner MB BS, FRCA Consultant in Pain Medicine, St Mary’s Hospital, W2 Director, London Pain Consultants 1 st December 2006
  2. 2. Agenda <ul><li>Definition </li></ul><ul><li>Clinical findings </li></ul><ul><li>Management </li></ul><ul><li>Prognosis </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  3. 3. Definition www.londonpainconsultants.com
  4. 4. Definition <ul><li>Soft tissue injury to the neck </li></ul><ul><li>Sudden Extension-Flexion injury </li></ul><ul><li>Whip-like movement </li></ul><ul><li>Collection of symptoms </li></ul>
  5. 7. Causes www.londonpainconsultants.com
  6. 8. Causes <ul><li>RTA commonly- front/ back/ side </li></ul><ul><li>Contact sport injuries </li></ul><ul><li>Accidental/ intentional blows to head </li></ul>
  7. 9. Causes <ul><li>Repetitive stress injuries to neck (eg: phone) </li></ul><ul><li>Child abuse- shaking, hitting </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  8. 10. Incidence www.londonpainconsultants.com
  9. 11. Incidence <ul><li>US National Highway Traffic Safety Administration (1995) </li></ul><ul><li>53% of 5.5 million RTA victims suffered whiplash injury </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  10. 12. Soft Tissue Damage www.londonpainconsultants.com
  11. 13. Soft Tissue Damage <ul><li>Ligaments </li></ul><ul><li>Tendons </li></ul><ul><li>Muscles </li></ul><ul><li>Intervertebral discs </li></ul><ul><li>Facet Joints </li></ul><ul><li>Nerve roots </li></ul>
  12. 14. Serious <ul><li>Spine injuries </li></ul><ul><li>Spinal Cord injury </li></ul>
  13. 15. Clinical
  14. 16. Symptoms and Signs <ul><li>Pain </li></ul><ul><li>Stiffness </li></ul><ul><li>↓ ROM </li></ul>
  15. 17. Symptoms and Signs <ul><li>Nervous system- local </li></ul><ul><li>abnormal sensations arms (burning/ paraesthesia) </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  16. 18. Symptoms and Signs <ul><li>Nervous system- general </li></ul><ul><li>dizziness </li></ul><ul><li>headache </li></ul><ul><li>blurred vision </li></ul><ul><li>pain on swallowing </li></ul><ul><li>ringing in ears </li></ul><ul><li>irritability </li></ul><ul><li>tinnitus </li></ul>
  17. 19. Symptoms and Signs <ul><li>Psychological- </li></ul><ul><li>memory loss </li></ul><ul><li>cognitive impairment </li></ul><ul><li>sleep disturbance </li></ul><ul><li>fatigue </li></ul><ul><li>depression </li></ul><ul><li>PTSD </li></ul>
  18. 20. Symptoms and Signs <ul><li>Secondary Myofacial Pain Syndrome (Fibromyalgia) </li></ul><ul><li>Lower Back Pain </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  19. 21. Symptoms and Signs <ul><li>Whiplash syndrome- </li></ul><ul><li>continual headache </li></ul><ul><li>pain </li></ul><ul><li>reduced movement </li></ul><ul><li>tingling </li></ul><ul><li>lumbar pains </li></ul><ul><li>fatigue </li></ul><ul><li>sleep disturbance </li></ul>
  20. 22. Investigations
  21. 23. Investigations <ul><li>X-rays- exclude # </li></ul><ul><li>CT </li></ul><ul><li>MRI </li></ul>
  22. 24. Management www.londonpainconsultants.com
  23. 25. Overall Aim <ul><li>Pain-free window </li></ul><ul><li>Rehabilitation </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  24. 26. Management <ul><li>Medication </li></ul><ul><li>Physical Therapy/ Rehabilitation </li></ul><ul><li>Minimally Invasive Pain Management Procedures </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  25. 27. Medication
  26. 28. Medication <ul><li>Pharmacological </li></ul><ul><li>• WHO ladder (amended from cancer) </li></ul><ul><li>Step 1 paracetamol/ NSAID/ COX 2 </li></ul><ul><li>Step 2 + weak opioids </li></ul><ul><li>Step 3 + strong opioids </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  27. 29. Medication <ul><li>Adequate medication- regularly, prevent breakthrough pain </li></ul><ul><li>Muscle relaxant- Diazepam/ similar </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  28. 30. Physical Therapy/ Rehabilitation
  29. 31. Physical Therapy/ Rehabilitation <ul><li>Chris Pinches- Specialist Spinal PxTx at Central Health PxTx…. </li></ul><ul><li>Deep stability muscles </li></ul><ul><li>Inhibitory interneurones and ascending nociceptor inputs </li></ul><ul><li>EMG studies </li></ul><ul><li>Retraining dysfunctions….. </li></ul>
  30. 32. Physical Therapy/ Rehabilitation <ul><li>Clear red flags – C-spine instability/ # </li></ul><ul><li>Adequate medication- regularly, prevent breakthrough pain </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  31. 33. Physical Therapy/ Rehabilitation <ul><li>Keep neck moving as normally as possible! </li></ul><ul><li>Collars not recommended </li></ul><ul><li>Gentle mobilisation </li></ul>
  32. 34. Physical Therapy/ Rehabilitation <ul><li>Avoid ‘stiffening-up’ </li></ul><ul><li>Studies- quicker recovery with gentle exercise </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  33. 35. Physical Therapy/ Rehabilitation <ul><li>Pacing activities </li></ul><ul><li>Fear avoidance </li></ul><ul><li>Catastrophising- not torn muscle/ severe </li></ul>
  34. 36. Other <ul><li>• Physical- heat/ cold/ TENS/ hydro/ supports/ US/ IR/ firm supportive pillow/ good posture </li></ul><ul><li>• Manipulation- PxTx/ chiropracter/ osteopathy/ deep tissue massage </li></ul>
  35. 37. Minimally Invasive Pain Management www.londonpainconsultants.com
  36. 38. Cervical and Thoracic facet joint injections www.londonpainconsultants.com
  37. 42. Trigger Point Injections www.londonpainconsultants.com
  38. 43. 1. Dry Needling www.londonpainconsultants.com
  39. 44. … otherwise known as…
  40. 45. Acupuncture
  41. 46. Any Vets in the Audience?
  42. 47. 5. (a) Veterinary practitioners?
  43. 49. 2. Local Anaesthetic and Steroid preparations www.londonpainconsultants.com
  44. 51. 3. Botulinum Toxin A www.londonpainconsultants.com
  45. 54. Prevention www.londonpainconsultants.com
  46. 58. Prevention <ul><li>Head restraints </li></ul><ul><li>3 in 4 not properly adjusted! </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  47. 60. Prognosis <ul><li>Overall good in most cases </li></ul><ul><li>Symptoms improve after few days </li></ul><ul><li>6 in 10 much better/ gone by 1-4 weeks </li></ul><ul><li>www.londonpainconsultants.com </li></ul>
  48. 61. Prognosis <ul><li>Up to several months </li></ul><ul><li>1 in 4 pain n stiffness at 6 months </li></ul><ul><li>Small number persistent beyond 6 months </li></ul>
  49. 62. <ul><li>Any Questions </li></ul>
  50. 63. www .londonpainconsultants. com

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