Whiplash injury

whiplash injury

1. Whiplash injury Dr. Santosh Batajoo Orthopedic

2. introduction Harold Crowe in 1928, first used term to describe movement of neck in accident. First coined as railroad spine in 1919 following train collisions. Also known as sprained neck, neck strain, acceleration injury, soft tissue neck. Occupant’s body is forced against the car seat while his or her head flips backwards and then recoils in flexion.

3. mechanism Cervical acceleration and deceleration. Any impact or blow that causes your head to jerk forward or backward. The sudden force stretches and tears the muscles and tendons.

4. causes Motor vehicle accidents (common) Head banging Falls Sports injury Shaken baby syndrome

5. After impact, the cervical spine undergoes S-shaped curve. The lower part into extension and the upper part into flexion. The lower part of the cervical spine moves beyond its normal range. Whip like movement.

6. pathology Anterior longitudinal ligament of the spine and the capsular fibres of the facet joints are strained and intervertebral disc may be damaged.

7. Grading (WAD) grade Clinical pattern No neck symptoms or signs. 1 Neck pain, stiffness and tenderness. No physical sign. 2 Neck symptoms and musculoskeletal signs. 3 Neck symptoms and neurological signs. 4 Neck symptoms and fracture and dislocation.

8. Possible injuries Joint dysfunction Disc herniation Facet joint cartilage damage Disc tear Nerve root impingement Muscle tear Ligament tear

9. Medullary overstretch Dura overstretch Dislocation Fracture Spinal cord injury Brain injury (coup-contra-coup)

10. Clinical features Often the victim is unaware immediately. Pain and stiffness of the neck. Neck muscles are tender. Skew neck. Temporomandibular discomfort neurological : headache, dizziness, blurring of vision, paraesthesia in the arms, tinnitus.

11. Psychological- memory loss, cognitive impairment, sleep disturbance, fatigue, depression, PTSD.

12. Differential diagnosis Vertebral fracture Acute disc lesion Seat-belt injuries

13. investigations X-ray Straightening out of the cervical lordosis . MRI CT scan

14. treatment Must be immobilized as soon as possible. Collars Analgesic, muscle relaxants. Ice then moist heat after 2-3 days. Postural adjustments. Isometric muscle contractions. Others - Ultrasound, Traction, massage

15. Injection – local anaesthetic , steroid, botulinum toxin A prevention - top of the head restraint as high as the top of the head, and as close to the rear of your head as possible.

16. Severe case may require surgery.

17. progress Some patients start improving within a few weeks and in most patients symptoms diminish gradually after about 3 months and go on improving over the next year. Negative prognostic indicators are- increasing age, severity of symptoms at the onset, prolonged duration of symptoms, pre-existing intervertebral disc degeneration, psychological dysfunction.

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