Whiplash

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'Whiplash 'Introduction

• Defined as: traumatic injury in the soft tissue around cervical spine. '
  • Cervical muscles'
  • Ligaments'
  • Discs'
  • Facet joints'
  • Etc.'
• Mechanism: '
  • Hyperflexion'
  • Hyperextension'
  • Rotational injury'
• No fractures, dislocation or disc herniations'
• Most common non-fatal automobile injury'

Symptoms

• May start immediately but more often delayed (hours to days).
• Associated complaints'
  • Headache'
  • Cognitive impairment'
  • Low back pain.'
• May have occipital neuralgia'

Clinical Grading of Whiplash Associated Disorders Severity'(1)''''

Grade	Description
0	No complaints, no signs
1	Neck pain or stiffness or tenderness, no signs
2	Above symptoms with reduced range of motion or point tenderness
3	Above symptom with weakness, sensory deficit, or absent deep tendon reflexes
4	Above symptoms with fracture or dislocation (definition of whiplash excludes these patients)

''''Evaluation of WAD '(1)''''

'Grade 1: Patients with normal mental status and physical exam do not require plain radiographs on presentation. '

Grade 2 & 3: C-spine x-rays, possibly with flexion- extension views. Special imaging studies are not indicated.

Grade 3 & 4: managed as suspected spinal cord injury.

'

Treatment of WAD '(3)' (excluding patients with SCI, fractures or dislocations)

Whiplash is usually benign requiring little treatment and resolves in days to a few weeks

Recommendation	Grade 1	Grade 2	Grade 3
Range of Motion Exercises	Started Immediately	Started Immediately	Started Immediately
Encourage early return to regular activities	Immediately	ASAP	ASAP
Cervical Collars and rest*	No	Not for > 72 hours	Not for > 96 hours
Passive Modality Therapies: heat, ice, massage, TENS, US, relaxation, acupuncture, work alteration	No	Optional if symptoms last > 3 wks	Optional if symptoms last> 3 wks
Medications: optional use of NSAIDs and non-narcotic analgesics (recc for < 3 wks)	No	Yes	Yes. Limited narcotics may also be needed.
Surgery	No	No	Only progrssive neuro deficit or persisting arm pain

Not Recommended: cervical pillows and soft collars, bed rest, spray and stretch exercises, muscle relaxant medication, TENS, reflexology, magnetic necklaces, herbal remedies, homeopathy, OTC medications (except NSAIDs), and inta-articular, intrathecal or trigger point steroid injections.

*soft foam collars are generally discouraged; if they are to be used, the narrow part should be placed in front to avoid extension.

Recovery of Patients with WAD'(2)''''

Time (mos)	Percent Recovered
3	50%
6	70%
12	76%
24	82%

'''' '1. Hirsch SA, Hirsch PJ, Hiramoto H, Weiss A: Whiplash syndrome. Fact or fiction? Orthop Clin North Am 19:791-795, 1988.' '2. Radanov BP, Sturzenegger M, Di Stefano G: Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine (Baltimore) 74:281-297, 1995.' '3. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E: Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine 20:1S-73S, 1995.' ' -edaks'''' '''