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Whiplash (medicine)

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Whiplash (medicine)
SpecialtyEmergency medicine, orthopedic surgery Edit this on Wikidata

Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck.[1]

Whiplash is commonly associated with motor vehicle accidents,[2] usually when the vehicle has been hit in the rear;[3] however, the injury can be sustained in many other ways, including falls from bicycles[2] or horses[2] or headbanging.[2] It stands out as one of the main injuries covered by the car insurers. In UK, 430,000 people made a claim for whiplash in 2007 (75% of the UK's motor insurance claims), accounting for 14% of every driver's premium[4].

Cause

The exact injury mechanism that causes whiplash injuries is unknown. A whiplash injury may be the result of impulsive stretching of the spine, mainly the ligament: anterior longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a whiplash injury.[5]

Whiplash may be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster [6]or other rides at an amusement park, sports injuries such as skiing accidents, other modes of transportation such as airplane travel, or from being hit, kicked or shaken.[7] Shaken baby syndrome can result in a whiplash injury.[5]

Whiplash symptoms might not always have any pathological (injury) explanation. "Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms", which can not be attributed to any pathogenic effect on the subjects neck.[8]

Symptoms

Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms & legs and headaches. Symptoms can appear directly after the injury, but often are not felt until days afterwards.[3] Whiplash is usually confined to the spinal cord, and the most common areas of the spinal cord affected by whiplash are the neck, and the mid-back (middle of the spine).

Diagnosis

Diagnosis occurs through a patient history, head and neck examination, X-rays to rule out bone fractures and may involve the use of medical imaging to determine if there are other injuries.[9]

Québec Task Force

The Québec Task Force (QTF) was a task force sponsored by the Société de l'assurance automobile du Québec, the public auto insurer in Quebec, Canada. The QTF submitted a report on whiplash-associated disorders in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. These recommendations have become the base for Guideline on the Management of Claims Involving Whiplash-Associated, a guide to classifying WAD and guidelines on managing the disorder.[10] The full report titled Redefining "Whiplash" was published in the April 15, 1995 issue of Spine.[11] An update was published in January 2001.[12]

Québec Task Force grades of disorder

Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs):

  • Grade 0: no neck pain, stiffness, or any physical signs are noticed
  • Grade 1: complaints of neck pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
  • Grade 2: neck complaints and the examining physician finds 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 injury to the spinal cord.[10]

Treatment

First aid

In the first 24 hours after the injury, an ice bag applied to the neck will help to relieve inflammation. Bags of frozen peas make particularly good ice packs because they mould to the body. An ice bag should first be wrapped in a towel or cloth to avoid direct contact between the skin and the ice. The patient should lie in bed with their head resting on the ice bag for 20 minutes at a time, with the head also supported by a pillow.

Medication

Treatment for individuals with whiplash may include pain medications, nonsteroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and a cervical collar (usually worn for 2 to 3 weeks). Range of motion exercises, physical therapy, and cervical traction may also be prescribed. Supplemental heat application may relieve muscle tension.

Exercise

  • Stand against a door or a wall with your head facing forward and move your eyes so you look towards the two, four, eight, and 10 o'clock positions. Repeat this a few times. This eye movement causes a slight movement in some deep muscles in the back of the head.
  • Next, take a step forward and perform the following movements.
  • Bend the back of the head carefully forward as if taking a bow. Return to the starting position with your head straight and facing forward.
  • Draw the chin in towards your neck and bend the head carefully forward. Return to the starting position. Bend the head backwards far enough to look at the ceiling. Return to the starting position.
  • Tilt the head sideways, so the right ear is near the right shoulder. If possible try to maintain the glance at a fixed point at eye level. Return to the starting position. Repeat this action with the head tilted to the other side.
  • Turn the head as if trying to look backwards over the shoulder, first to the left and then to the right. Imagine following a horizontal line on the wall at eye level.
  • You can also use a beach ball or a soft ball to exercise the head and neck muscles. Place the ball between the wall and the forehead and then try to move it around on the wall in circles or figures of eights. Repeat the exercise, this time placing the ball between the back of the head and the wall.

Consequences

The consequences of whiplash range from mild pain for a few days (which is the case for most people)[13], to severe disability caused by restricted head movement or of the cervical spine, sometimes with persistent pain.

Protection

Protection efforts are hampered by lack of knowledge about the causes of whiplash injuries. The focus of preventive measures to date has been on the design of car seats, primarily through the introduction of headrestraints, often called headrests. This approach is potentially problematic given the underlying assumption that purely mechanical factors cause whiplash injuries - an unproven theory. So far the injury reducing effects of head restraints appears to have been low, approximately 5-10%, because car seats have become stiffer in order to increase crash-worthiness of cars in high-speed rear-end collisions which in turn could increase the risk of whiplash injury in low-speed rear impact collisions. Improvements in the geometry of car seats through better design and energy absorption could offer additional benefits. Active devices move the body in a crash in order to shift the loads on the car seat.[3]

Some car manufacturers have begun to implement various whiplash protection devices in their products in order to reduce the risk for and severity of injury, such as

Whether or not such devices offer a substantial benefit over vehicles without them remains controversial. In a test undertaken by the Swedish National Road Administration and an insurance company (Folksam), one test showed that a whiplash protection device was no guarantee against injury and that the degree of protection varies between vehicles both with and without whiplash protection devices.[17] Yet The Journal of TRAUMA, Volume 51, No 5, November 2001 found that an Active Head Restraint helps reduce the risk of neck injuries by up to 75% in rear-end collisions.

References

Look up Whiplash in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Car accident.
  1. ^ Insurance Institute for Highway Safety. "Q&A: Neck Injury" (html). Retrieved 2007-09-18.
  2. ^ a b c d citation needed
  3. ^ a b c d e f Krafft, M (2005-04-01). "Assessment of Whiplash Protection in Rear Impacts" (pdf). Swedish National Road Administration & Folksam. Retrieved 2008-01-18. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ http://news.bbc.co.uk/1/hi/health/7729336.stm
  5. ^ a b MedlinePlus (2007-06-05). "Whiplash" (html). Retrieved 2007-09-18.
  6. ^ Roller Coaster Neck Pain, from the Spinal Injury Foundation
  7. ^ "Whiplash injury". 2006-08-23.
  8. ^ Castro et al. Int J Legal Med (2001). "No stress--no whiplash?".
  9. ^ "Whiplash - Topic Overview". WebMD. 2006-11-16. Retrieved 2008-01-18.
  10. ^ a b "Guideline on the Management of Claims Involving Whiplash-Associated Disorders" (html). 2005-11-24. Retrieved 2007-09-18.
  11. ^ Freeman MD, Croft AC, Rossignol AM (1998). ""Whiplash associated disorders: redefining whiplash and its management" by the Quebec Task Force. A critical evaluation". Spine. 23 (9): 1043–9. doi:10.1097/00007632-199805010-00015. PMID 9589544.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ "Update Quebec Task Force Guidelines for the Management of Whiplash-Associated Disorders" (pdf). 2001-01-01. Retrieved 2007-09-18.
  13. ^ Ferrari R, Schrader H (2001). "The late whiplash syndrome: a biopsychosocial approach". J. Neurol. Neurosurg. Psychiatr. 70 (6): 722–6. doi:10.1136/jnnp.70.6.722. PMID 11385003.
  14. ^ Long Fibre-Reinforced Polyamide for Crash-Active Car Headrests, August 22, 2006 Template:En icon
  15. ^ Top Safety Ratings For Saab Active Head Restraints, UK Motor Search Engine, August 22, 2006 Template:En icon
  16. ^ Volvo Seat Is Benchmark For Whiplash Protection, Volvo Owners Club, August 22, 2006 Template:En icon
  17. ^ Whiplashskyd inte alltid säkrare (Whiplash protection not always safer), NTF, August 22, 2006 Template:Sv icon

Treatment for Whiplash and Neck Injury

Bibliography

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