Whiplash injuries

1. WHIPLASH INJURY
Dr SHANAVAS C

2. • Acceleration injury or whiplash injury of the
neck refers to the cluster of symptoms
following application of a propulsive force
to the head and neck complex
• Acceleration injury on the other hand is
called neck sprain, whiplash or soft tissue
neck injury

3. • Sudden hyperextension and hyperflexion
injury to neck
• Whip-like movement - An acceleration/
deceleration mechanism of Energy
transfer to the neck

6. CAUSES
• The typical example is the injury suffered
by a car occupant with a rear-end collision
• RTA commonly- front/ back/ side
• “Railroad spine”
• Contact sport injuries
• Accidental/ intentional blows to head
• Child abuse- shaking, hitting

7. PATHOPHYSIOLOGY
• McNab experiments anesthetised
monkeys
• In a similar study, Clemens and Burrows,
studied the mechanics using embalmed
cadavers

8. • Minor injuries to the sternocleidomastoid,
partial avulsion of the longus colli and
retropharyngeal haematomas. The most
common finding was intervertebral disc
failure and tears of the anterior longitudinal
ligament, found in nearly 90% of cases.

9. • Taylor et al. identified three patterns of
injury to the intervertebral disc: 1. Anterior
rim lesion.
• 2. Posterior contusions and herniation of
intervertebral discs.
• 3. Partial or complete avulsion along the
disc-vertebral interface—usually seen in
children. MRI shows high signal intensity
on T2-weighted images.

10. • Grauer et al - kinematic biphasic
response of the unsupported cervical
spine when it is rear impacted.
• Initially the upper cervical spine as well as
the lower cervical spine hyperextends
converting the cervical spine to an ‘S’.
• Milliseconds later, this is followed by
hyperextension of the entire cervical spine.
Injury is sustained in the first phase

12. • The clinical picture of acceleration injury is
dominated by neck pain, which is
accentuated on movement.

14. SYMPTOM COMPLEX
• Neck and shoulder pain
• occipital headache
• Arm pain/ dysaesthesia
• vertigo
• tinnitus
• TM joint pain
• Depression
• Anxiety

15. • The symptom complex may be aggravated
by various psychosocial factors like anger,
anxiety, depression
• Clinical examination reveals restriction of
neck movements, spasm of paraspinal
neck muscles and tenderness over the
posterior neck muscles

16. Whiplash-Associated Disorders
(WAD)
Given the wide variety of symptoms that are
associated with whiplash injuries the
Quebec Task Force on Whiplash-
Associated Disorders, coined the phrase,
Whiplash-Associated Disorders

17. • Whiplash Associated Disorders (WAD)• Classed by
severity of signs and symptoms- Québec Task Force
(QTF)
• WAD 0 No complaints or physical signs
• WAD 1 Neck complaints but no physical signs
• WAD 2 Neck complaints and musculoskeletal signs
• WAD 3 Neck complaints and neurological signs
• WAD 4 Neck complaints and fracture / dislocation

18. STATISTICS!!!
• Nearly 70% - females.
• Incidence• US National Highway Traffic
Safety Administration (1995)• 53% of 5.5
million RTA victims suffered whiplash
injury

19. • Neurological examination is normal.
Cervical spine radiographs are usually
normal, except for loss of physiological
lordosis.
• The symptoms persist for more than 1
year in about 88%, and more than 2 years
in 64% of patients.

20. • A severe injury in the elderly may rarely be
complicated by oesophageal rupture and
mediastinitis.

21. COGNITIVE DYSFUNCTION
• Cognitive dysfunctions are the least
understood aspect of cervical spine
acceleration injury. Broadly, these
dysfunctions fall in two categories: (1)
cervicocephalic and (2) lower cervical
spine syndrome.

22. • In cervicocephalic syndrome, there is
demonstrable abnormality of auditory and
visual information processing, mood
changes, sleep disturbances,
psychoneurotic reaction, depression and
“litigation neurosis”.

23. • In lower cervical spine type of presentation,
in addition to painful symptoms pertaining
to the cervical spine, there is disturbance
in visual information processing.

24. INVESTIGATIONS
• Cervical Spine Radiographs
• Dynamic radiographs of the cervical spine
show restriction of motion at one level, and
loss of the normal lordotic curve
• Prevertebral swelling is variable.
Degenerative changes pre-existing at the
time of initial presentation

26. TREATMENT
Depends upon the severity of the problem.
Patients with intense symptoms may require
hospitalis
Analgesics, cervical collar, rest, muscle
relaxant and anti-inflammatory medication.
Narcotic analgesics may be required to
interrupt the “pain-spasm” cycle.

27. • Trigger point injections and epidural blocks
may be required in refractory cases.
• Local infiltration with corticosteroids

28. • Surgery is reserved for those with disc
avulsion, especially with pre-existing
degenerative disc disease. These patients
require discectomy with fusion.
• A psychiatric consultation may be required
for patients with chronic persistent pain.

29. Prognosis
• Lower rate of recovery:
• Multiple injuries
• Female
• Older age, every decade increase in age,
likelihood of recovery decreases by 14%

30. PROGNOSIS
Wearing a seatbelt! (Head restraints better
outcome)

31. Rule of thumb
Those with continuing symptoms three
months after the accident are likely to
remain symptomatic for at least two years,
possibly much longer