Whiplash (medicine): Difference between revisions
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In this case an adequate operation for stabilization can help. The patients with an instability at the passage from head to neck often show the symptoms already mentioned like headache, decrease of memory, partial signs of paralysis, prickle in the arms or legs, frequent dizziness, ringing in the ears, dysfunctions and pain in the area of the jaw joints, of the ears and eyes. These symptoms confirm the suspicion of a structural instability of the passage from head to neck. In order to judge these symptoms better, we have developed a form in which the patient can describe his disorders. |
In this case an adequate operation for stabilization can help. The patients with an instability at the passage from head to neck often show the symptoms already mentioned like headache, decrease of memory, partial signs of paralysis, prickle in the arms or legs, frequent dizziness, ringing in the ears, dysfunctions and pain in the area of the jaw joints, of the ears and eyes. These symptoms confirm the suspicion of a structural instability of the passage from head to neck. In order to judge these symptoms better, we have developed a form in which the patient can describe his disorders. |
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* [http://www.whiplash-connection.com/wiki/index.php/Overview:_Head-neck-joint_instabilities Summary document about head-neck-joint instabilities] |
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*[http://www.whiplash-connection.com/wiki/index.php/The_Multitude_of_Problems_Occurring_after_Whiplash_Injury._Instability_of_the_Upper_Cervical_Joints_-_Booklet The multitude of problems occurring after whiplash injury] |
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*[http://www.whiplash-connection.com/wiki/index.php/Overview:_Head_neck_joint_stabilization_therapy Therapy of head-neck-joint instabilities after whiplash injury] |
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* [http://www.hnjdonline.de/site/content/view/74/50/1/2/ Diagnosis of head neck joint instability] |
* [http://www.hnjdonline.de/site/content/view/74/50/1/2/ Diagnosis of head neck joint instability] |
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Revision as of 22:13, 8 March 2007
Whiplash is the common name for a hyper extension/flexion injury to the cervical, thoracic or lumbar spines. The injury is referred to as "whiplash" due to the neck or back being thrown forwards and/or backwards at a rapid speed. This causes the fibres of the neck muscles to tear, resulting in pain and often a decreased range of movement.
Whiplash is a commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear, [1] however the injury can be sustained in many other ways.
Cause
A whiplash injury is 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.[2] The Insurance Institute for Highway Safety defines whiplash as: "a range of neck injuries that are related to sudden distortions of the neck."[citation needed] It takes about 100 milliseconds for an occupant's body to catch up to the car when it is hit, and it is during this time that the damage occurs.[citation needed]
Whiplash can be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster 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 or shaken.[3] Shaken baby syndrome can result in a whiplash injury.[2]
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 crash, but often are not felt until days afterwards.[1]
Diagnosis
Reliably diagnosing a whiplash injury or disorder is not difficult for a trained doctor. If a patient cannot achieve the full motion, or has excessive range of motion, the probable ultimate cause is the whiplash motion.[citation needed]
Québec Task Force
The Québec Task Force (QTF) was a task force sponsored by Société d'assurance automobile du Québec (SAAQ), the public auto insurer in the province of Quebec, Canada. The QTF submitted a report on Whiplash-associated disorders (WAD) in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. The 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. The full report titled Redefining "Whiplash" was published in the April 15, 1995 issue of Spine.[4]
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 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.[4]
Consequences
The consequences of whiplash range from mild pain for a few days (which is the case for most people)Cite error: A <ref>
tag is missing the closing </ref>
(see the help page). This helps prevent the neck being forced backwards, and decreases the risk of whiplash.
Whiplash protection
The focus of preventive measures has been on the design of car seats, primarily through the introduction of headrests. So far the injury reducing effects of head restraints has been relatively 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 increases 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.[1]
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
- Mercedes-Benz A-Class Active Head Restraint (AHR)[5] [1],
- Ford, Nissan, Opel, Peugeot and Saab - Active Head restraint (SAHR)[6] [1],
- Volvo and Jaguar - Whiplash Protection System/Whiplash Prevention System (WHiPS)[7], and
- Toyota - Whiplash Injury Lessening (WIL).[1]
Whether or not such devices offer any 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.[8]
Biomechanical aspects of whiplash injury
Probably the best-known and most controversial injury nowadays is the whiplash injury. The collision forces do not necessarily have to leave external damages on the head, rather they lead to compact brain injuries. In lethal cases, which appear seldom, greater bleedings of the head callosity can be found during the post mortem examination, even though no injuries can be seen from the outside. Then a whiplash injury by a rear impact accident with a compact brain injury is not an absolute whiplash injury. But also an absolute whiplash injury without head impact can lead to cerebral injuries. This could be proved in 1968 by Ommaya et al. in an experiment with monkeys. So a whiplash injury is a distortion of the cervical spine with or without cerebral involvement. According to the Quebec Task Force on Whiplash-Associated Disorders (Spitzer et al. 1995), peripheral disorders such as pain or stiffness in the neck and cerebral disorders such as headache, dizziness, tinnitus, concentration and memory disorders, deglutition dysfunctions and temporomandibular dysfuncions (functional disturbances in the area of the lower jaw at the passage to the temple) are symptomatic. A fibrillating or blurred sense of vision also appear frequently. These symptoms appear with a characteristic latency (time delay) of 0 to 72 hours. The cerebral symptoms mentioned above are relevant in order to chronify a disease. Unfortunately just these symptoms provoke heavy controversies among physicians during the assessment of the connection with the accident (causality). A whiplash injury can emerge almost everywhere: During a traffic accident, while doing sports or at work. Yes, it can even happen while skiing or in an airplane, although it has to be said that car accidents are by far the most frequent reason for a whiplash injury. The critical factor for the occurrence of a whiplash injury is not the place, but the mechanism of the accident, i.e. the body has to perform the movement of a whip stroke. The exact course of such a whip movement during a rear-end collision can be seen in the subchapter. The common diagnostic method with a whiplash injury of the cervical spine is shown in the adjacent diagram and can be looked up in appropriate medical literature. But there are examinations that are generally less known in the emergency departments of hospitals: First, the determination of the brain’s state is mostly missing, even though the appearance of the symptoms mentioned above indicate a damage. Second, the examination of the passage from head to neck is missing. And also the next problem appears here: The possible injuries of the brain, of the passage from head to neck and also of the jaw area (see above) need an interdisciplinary treatment. Thus, depending on the severity of the case specialists from orthopaedics, neurology, ENT medicine, maxillary surgery and neurosurgery would have to cooperate in the creation of a diagnosis and the corresponding treatment. Mostly a whiplash injury is only treated from the point of view of an orthopaedist. This may be sufficient in light cases of the whiplash injury. However, if the patient’s discomfort does not ease, examinations by the specialists mentioned above to clarify the circumstance would immediately have to be ordered. And this is mostly not done, with fatal consequences for the patient, so that irreparable damage can possibly result.
Injuries at the passage from head to neck
With a whiplash injury, the cervical spine is over-expanded. But not every “whip stroke” happens in the exact “nodding axis of the head”. If you collide with an obstacle e.g. by car in a rather lateral way, or if cars collide on a crossing, then it is absolutely possible that the whip stroke is triggered a little displaced from the normal nodding axis and that it includes a kind of “head shaking”. So it is indeed possible that twists also occur in the cervical spine. And not only this: We know from the cervical spine’s anatomy that the cervical spine has a network of ligaments and arteries. Furthermore there is a joint connection (head joint) between the Atlas (C1) and the Axis (C2). This is the most flexible, but also the most unstable part of the spinal column. The Dens is a kind of “buttress” and prevents the head from over-flexion. All other movements like head shaking, nodding, turning the head etc. are secured by the ligaments and capsules. In a whiplash injury sometimes a rather violent and not consciously controllable over-flexion of the head occurred. That way it is possible that the head joint consisting of Atlas and Axis is “opened” more than its anatomical limits allow. Exactly this opening has to be prevented on the Axis by the three ligaments Ligamenta alaria right and left and Ligamenta cruciforme, as well as the Membrana atlantooccipitalis anterior on the Atlas, and they can now at least be over-expanded, but also be partially or completely torn. There is another ligament that can be abnormally expanded or torn apart: the Ligamenta transversum. This ligament prevents the Dens from touching the spinal cord. A “simple” over-expansion or twist of the cervical spine is normally cured after about six weeks, a ligament injury is not. And this is exactly where in my opinion an unnecessary and sometimes vehement discussion among physicians begins that is too often carried out to the patient’s disadvantage. The latter will hear an opinion from one doctor and from the other one a different opinion again. Why? The solution of the mystery lies in the exact examination of the patient’s passage from neck to head. Some physicians think that a whiplash injury is a rather light injury. If a damage of the cervical spine were existent, it would be visible on the X-ray images. If there is none, then it is just a whiplash injury. The other physicians have the point of view that the cervical spine can not only become injured in the middle section, but that the head joint and/or the ligaments can also be injured and that this has to be examined.
How can an injury at the passage from neck to head be determined then?
The diagnosis and therapy of injuries at the passage from head to neck a bit more closely: Patients with a whiplash injury of the cervical spine that does not involve an osseous injury or the injury of nerval structures face the problem that these patients are examined by accident surgeons, orthopaedists etc. and that normal X-ray images are made for the examination. These images naturally do not indicate changes of the cervical vertebrae resp. of the affected section since normally a static image is taken.
This situation applies also to modern examination, like e.g. computed tomography or magnetic resonance imaging because these are not functional examinations. With a patient lying still, of course no torn ligaments can be detected. This can be compared with a tear-off of the ligaments at the knee-joint. If the knee-joint ligaments are torn, the patient is not capable of walking. But the X-ray images performed while lying do not result in an abnormal statement. If the knee and also the entire leg were examined by a neurologist because the patient could not walk, then no neurological changes at all would be recognizable here either. But if a stress image of this knee-joint, i.e. a functional one, is taken, a dysfunction of the knee-joint, that is, the enlargement of the knee-joint gap in an abnormal form, can immediately be determined and documented. So the conclusion can be drawn that the ligament on the knee-joint or on the ankle must be injured, since otherwise the gap at the joint would not allow such a wide spread. Equally, a ligament injury on the cervical spine cannot be proved because most of the produced X-ray and MRI images are not done functionally.
Head neck joint instability
In this case an adequate operation for stabilization can help. The patients with an instability at the passage from head to neck often show the symptoms already mentioned like headache, decrease of memory, partial signs of paralysis, prickle in the arms or legs, frequent dizziness, ringing in the ears, dysfunctions and pain in the area of the jaw joints, of the ears and eyes. These symptoms confirm the suspicion of a structural instability of the passage from head to neck. In order to judge these symptoms better, we have developed a form in which the patient can describe his disorders.
References
- ^ a b c d e f Assessment of Whiplash Protection in Rear Impacts (PDF), Swedish National Road Administration and Folksam, April 2005 Template:En icon
- ^ a b Cite error: The named reference
Medline
was invoked but never defined (see the help page). - ^ Whiplash injury, August 23, 2006 Template:En icon
- ^ a b Guideline on the Management of Claims Involving Whiplash-Associated Disorders, August 23, 2006 Template:En icon
- ^ Long Fibre-Reinforced Polyamide for Crash-Active Car Headrests, August 22, 2006 Template:En icon
- ^ Top Safety Ratings For Saab Active Head Restraints, UK Motor Search Engine, August 22, 2006 Template:En icon
- ^ Volvo Seat Is Benchmark For Whiplash Protection, Volvo Owners Club, August 22, 2006 Template:En icon
- ^ Whiplashskydd inte alltid säkrare (Whiplash protection not always safer), NTF, August 22, 2006 Template:Sv icon
Further reading
- Whiplash at the MedlinePlus Medical Encyclopedia
- Whiplash injury description