Sunday, January 30, 2011

RHB of soft tissue and musculoskeletal injury - What is ''Whiplash'' ?

Whiplash was first described by Crowe in 1928 as an acceleration-deceleration mechanism of energy transfer from the relatively immobilized torso to the head. Whiplash can occur at an impact speed of 4-5 mph and affects the Trapezius, Levator Scapula, Paraspinal ( longus colli), Scalene and Sternocleidomastoid muscles. It can commonly affect the zygapophyseal ( facet) joints. Facet dysfunction has a prevalence of 30-60% in chronic spinal conditions, with cervical region having the most frequent symptoms. Severe whiplash to the neck can also include injury of the to the discs, ligaments, cervucal muscles ( including tears), vertebral fractures, as well as neurologic sequelae to the sympathetic trunk ( vertebral fractures), brachial plexus, cervical roots and the spinal cord. Whiplash-associated disorders (WAD) can be considered a syndrome of symptoms and signs that may include fatigue, dizziness, paresthesias, spinal pain, nausea, visual symptoms, and jaw pain and must be treated as a biopsychosocial disease. These symptoms may become persistent in up to 70% of patients, particularly those with headaches and paresthesias.

Symptoms of Whiplash
 - Neck pain and /or stifness (60-95%)
 - Injuries tothe muscles and ligaments (myofascial injuries)
 - Head and fascial pain with fatigue, irritability, blurry vision, dizziness, tinnitus, and nausea (may be related to a concussion or referral from the neck structures) (60-70%)
 - Difficulty swallowing and chewing and hoarseness (may indicate injury to the esophagus and larynx or referral from fascial and neck muscles)
 - Abnormal sensations (numbness or paresthesias)
 - Shoulder and other extremity pain
 - Back pain

WAD classification
In 1995, the Quebec Task Force Classifications for the Severity of Cervical Sprains formulated the following system:
- Grade 0: No neck pain complaints, no physical signs
- Grade 1: Neck pain complaints, stiffness or tenderness only, no physical signs
- Grade 2: Neck complaints, musculoskeletal signs (decreased ROM and tenderness)
- Grade 3: Neck complaints, neurologic signs (weakness, sensory and reflex change)
- Grade 4: Neck complaints with fracture and/or dislocation
Other symptoms for grades 1-4 include hearing, visual and cognitive changes; dysphagia; headache; and temporomandibular joint dysfunction.

The most common diagnostic imaging findings following a cervical trauma



The lateral view of cervical spine x-rays often shows a flattening or reduction of the cervical lordosis, which may indicate a paraspianal spasm (a protective mechanism to restrict cervical spine motion). The C1-C2 (open mouth or Waters view) x ray to image  the odontoid process is used for acute trauma. Lateral flexion/extension xray views identify spinal instability, and oblique x-ray viewa are used to evaluate the neural foramina, particularly if radiculopathy is suspected. In patients with normal x-rays and neurologic examination, cervical magnetic resonance imaging (MRI) scans are usually not required. The clinician must be careful in correlating any minor (or prexisting) abnormalities by diagnostic testing with the patient's presentation.















Bryan J. O'Young MD. Mark A. Young MD. Steven A. Stiens, MD, Physical Medicine and Rehabilitation Secrets Third edition 2008 Philadelphia, PA 19103-2899 MOSBY ELSEVIER. ISBN: 978-1-4160-3205-2

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