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At least 541 records · Page 30Linked to original sources
PubMed2005

A re-examination of the whiplash associated disorders (WAD) as a systemic illness.

OBJECTIVE: To describe the systemic nature of the illness reported after motor vehicle collisions using data from a large, population based cohort of individuals making an injury insurance claim. METHODS: All subjects who submitted a claim or were treated for whiplash injury following a motor vehicle collision in Saskatchewan, Canada during an 18 month period were examined. Demographics of claimants, collision related data, pre-collision health data, symptom prevalence, and scores on the short form 36 item general health survey (SF-36) were obtained on average within one month post-collision. RESULTS: Of 9006 potentially eligible claimants, 7462 (83%) met criteria for whiplash injury and provided information regarding demographics and injury related symptoms; 45% of these consented to complete the SF-36 at baseline. For most subjects, neck pain was only one of many diffuse and intense symptoms, including, often, low back pain. The range of symptoms, including fatigue, dizziness, paraesthesiae, headache, spinal pain, nausea, and jaw pain, could be interpreted as a systemic disorder. SF-36 scores showed low physical and mental functioning one month post-collision. CONCLUSIONS: What is commonly referred to as whiplash associated disorders (WAD) is best appreciated as a syndrome extending well beyond what can be labelled as a neck injury. More research is needed for a better understanding of the underlying mechanisms involved so that treatment can be directed at the broad spectrum of the illness rather than focusing on finding a focal neck injury.

Accidents, Traffic↗
PubMed1997

Evaluation of penetrating injuries of the neck: prospective study of 223 patients.

The objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. "Hard" signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with "soft" signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.

Algorithms↗
PubMed1989

Cervical spine injury in patients with facial skeletal trauma.

The records of 2,555 patients admitted to hospital with facial fractures were reviewed for concomitant neck injury. Cervical spine injury occurred in 1.3% of all patients with facial fractures, the incidence rising to 5.5% with facial fractures resulting only from MVA's. Neck injuries occurred most frequently in the setting of MVA's (85%) and multisystem trauma (70%) and tended to involve two main levels of the cervical spine: C2 (31%) and the two lower cervical vertebrae C6 and C7 (50%). Examination of the pattern of cervical spine injury with respect to the pattern of facial skeletal injury does not support the premise of a direct causal relation between them.

Adult↗
PubMed1985

Rugby football injuries, 1980-1983.

The injuries sustained by the boys at one English public school have been recorded and analysed by age, experience, position, phase, duration of the game and of the season. Few injuries have been serious. Detailed reference is made to concussion, injuries from collapsed scrums and injuries of the cervical spine. The paper emphasises that the tackle leads to most injuries. This paper presents the Rugby football injuries sustained by the boarders of Rugby School in the four seasons 1980-1983. The injury rate was 194 per 10,000 player hours, compared with the rate of 198 per 10,000 player hours for the thirty seasons 1950-1979 (Sparks, 1981). Tables I-VI list the injuries by different criteria. Table VII lists the sites of injury; Table VIII the time off Rugby football after injury; Table IX lists some of the more important injuries; Table XI summarises the playing results of the various school teams; Table XIII compares some of the Rugby School figures with those recorded in the Accident and Emergency Department of Christchurch Hospital during the 1979 New Zealand Rugby football season (Inglis and Stewart, 1981); Table XIV records information on three aspects of Rugby football that have occasioned much recent concern, viz:--Time off playing after concussion, injuries caused by collapsed scrums and neck injuries.

Adolescent↗
PubMed2001

Return to play after cervical spine injury.

STUDY DESIGN: A questionnaire survey was mailed to members of the Cervical Spine Research Society, the Herodiuus Sports Medicine Society, and to members of the authors' Department of Orthopaedics. OBJECTIVES: The purpose of our study was to evaluate what influence, if any, factors such as published guidelines, type of sport of the patient, number of years in practice, subspecialty interest, and sports participation of the respondent held in the "return to play" decision-making process after a cervical spine injury. SUMMARY OF BACKGROUND DATA: The consequences of cervical spine injury are potentially catastrophic, and return to play decisions in athletes with a history of neck injury can be agonizing. Although recent publications have addressed some of the concerns regarding cervical spine injuries in the athletic population, many questions remain unanswered. Factors such as published guidelines, type of sport of the patient, number of years in practice, subspecialty interest, and sports participation of the respondent have all been suggested as having a possible role in return to play decisions. METHODS: Representative radiographs and case histories of 10 athletes who had sustained neck injury were mailed to 346 physicians. For each case physicians selected every type of play (of six categories) that they felt comfortable recommending. Type of play was divided into six categories: Type 1, collision sports; Type 2, contact sports; Type 3, noncontact, high velocity sports; Type 4, noncontact, repetitive load sports (e.g., running); Type 5, noncontact, low impact sports; Type 6, no sports. In addition, demographic data regarding board certification, subspecialty interest, number of years in practice, use of guidelines in return to play decisions, and personal participation in sports were queried from all respondents. Statistical analysis was completed with Statview (Berkeley, CA). Basic descriptive statistics, chi2, and ANOVA were used where appropriate. RESULTS: Three hundred forty-six questionnaires were mailed and 113 were returned (response rate 32.7%). One hundred ten (97%) of the respondents who completed the questionnaire were board certified. Seventy-five were subspecialists in spine, 22 were subspecialists in sportsmedicine, and 13 reported interests in both sports medicine and spine. Use of Published Guidelines. Although 49% of respondents reported using guidelines in decision-making, the use of guidelines was statistically significant in only one case (P = 0.04). Hierarchy of Risk. In general, those physicians who participated in the study followed the hierarchy of risk that we established in this study (Type 1 [collision sports; highest level of risk] through Type 6 [no sports; lowest level of risk]). Twelve (10.6%) respondents, however, deviated from it in one or more cases. Years in Practice. In three cases there was a statistically significant association between the number of years a physician was in practice and the type of play selected (P < 0.05). In each case a lower level of play tended to be recommended by more senior physicians. Subspecialty Interest. In three cases those respondents with a spine subspecialty interest recommended returned to a higher level of play (P < 0.05). CONCLUSIONS: There is no consensus on the postinjury management of many cervical spine-injured patients. Further research, education, and discussion on this topic are needed.

Adolescent↗
PubMed2002

[Standardization of diagnosis and therapy in whiplash injuries of the cervical vertebrae].

In this work it is shown a standard diagnostic and therapeutic approach with the patient with stinging neck injury with goal to achieve a protocol for grouping injuries in those categories according to which we will proceed in further diagnostic and treatment, and letting out diagnoses as soon as possible in time period within the rational apply of available diagnostic procedures. The result of installing standardized protocol is the connection of the standard in diagnostic and therapy with safer triage of injured, standard therapy and getting precious time which we could use in treating a patient which will be helped with the treatment itself. In further diagnostic search it is out of most important question to define biomechanical limit of non dangerous in the stinging neck injury which will help to make a line between real injuries and renthal demands. In the therapeutic meaning, the injured patient is to be returned into the activity as soon as possible and certainly not after all the results have been back to normal.

Biomechanical Phenomena↗
PubMedDate not supplied

The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma.

Epidemiologic, pathologic, biomechanical, and cinematographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Preliminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association (NCAA) and National Federation of High School Athletic Associations (NFHSAA) implemented rule changes banning "spearing" and the use of the top of the helmet as the initial point of contact in striking an opponent during a tackle or block. Between 1976 and 1987, as a result of these rule changes, the Registry has documented a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college level. It is suggested that development and implementation of similar preventative measures based on clearly defined injury mechanisms would decrease injury rates in diving, rugby, ice hockey, trampolining, wrestling, and other high-risk sports as well.

Biomechanical Phenomena↗
PubMed1982

Brown-Séquard syndrome associated with brachial plexus injury in neck trauma.

A case of adult cervical trauma that resulted in a clinical picture of Brown-Séquard syndrome and unilateral brachial plexus injury is presented. Rotational hyperflexion of the cervical spine is thought to have resulted in subluxation of C5-6 with root avulsions, leading to this unusual combination of findings.

Brachial Plexus↗
PubMed2006

Spinal injuries in contact sports.

Contact and collision sports such as American football expose the athlete to a wide array of potential injuries. Knee injuries garner much of the attention, but spinal injuries are potentially catastrophic and all levels of medical coverage of football must be knowledgeable and prepared to attend to an athlete with a neck injury. Of the other possible spinal conditions, some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. The spectrum of potential injury is wide, yet the medical team must practice and prepare to treat the possible catastrophic neck injury.

Athletic Injuries↗
PubMed2004

Analysis of fatal injuries to motorcyclists by helmet type.

To clarify the characteristics of injuries of motorcyclists dying in accidents in relation to helmet type, we retrospectively analyzed forensic autopsies of 36 helmeted motorcycle riders. The presence of major injuries and injury severity were evaluated with the injury severity score and the 1990 revision of the Abbreviated Injury Scale. Persons with open-face helmets (19 cases) were significantly more likely to have sustained severe head and neck injuries, especially brain contusions, than were persons with full-face helmets (17 cases). Furthermore, major injuries of the chest or abdomen, rib fractures, lung injuries, and liver injuries were each present in more than one quarter of all cases (26.3% to 70.6%), but their prevalences did not differ significantly between riders with different types of helmet. Because many types of head and neck injuries cannot be prevented and fatal chest and abdominal injuries occur despite the use of full-face helmets, more effective helmets and devices for protecting the chest and abdomen are needed to decrease deaths from motorcycle accidents.

Accidents, Traffic↗
PubMed1992

Physical abuse of children. A retrospective review and an otolaryngology perspective.

Child abuse is a common problem seen by practicing physicians. To further define the incidence and the type of head and neck injury in children referred for evaluation of child abuse, a 5-year retrospective study of 4340 patients was undertaken. Of these patients, 2950 (68%) were victims of sexual abuse, while 1390 (32%) were victims of physical abuse. Forty-nine percent of patients abused physically had evidence of injury to the head and neck region, while only 1% of the sexually abused children had injuries in the head and neck area. The age of the patients ranged from 1 day to 17 years, with a mean of 5.6 years. More than 150 of these children were under the age of 1 year; 180 patients were admitted. The average age of the admitted patients was 2.1 years. The alleged perpetrator, mechanism of injury, and location of injury were tabulated. There were 11 deaths in the series (1.6%). Child abuse has been defined in our institution as any injury inflicted on a child. Identification and reporting of suspected child abuse is required by law and essential for the well-being of the abused child. Recommendations are made concerning the evaluation of these children, their management, and the physician's legal responsibility to report suspected cases of child abuse.

Adolescent↗
PubMed1999

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

PURPOSE: To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. MATERIALS AND METHODS: Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. RESULTS: Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). CONCLUSION: MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Acute Disease↗
PubMed1999

Computed tomographic angiography as a screening modality for blunt cervical arterial injuries: preliminary results.

BACKGROUND: The diagnosis of blunt cervical arterial injury (CAI) is made difficult by its infrequent occurrence and delayed presentation. Beginning in January of 1995, we used computed tomographic angiography (CTA) of the neck to screen for CAI. We hypothesized that CTA could be incorporated into the workup of patients sustaining blunt neck injury as a screening modality for CAI and that CTA would increase the early detection of CAI. METHODS: Retrospective review of all CAI for the years January of 1988 to June of 1997 at a Level I trauma center. CAI diagnosed before introduction of CTA (pre-CTA; January of 1988 to December of 1994) were compared with those after (post-CTA; January of 1995 to June of 1997). RESULTS: The overall incidence of CAI for the entire time period was 0.11%. Motor vehicle crash (53%) was the most common mechanism, with focal neurologic deficit (23%) or seizures (17.6%) the most common presenting clinical symptoms. CTA added only a few additional minutes to the time required for the workup of patients sustaining blunt neck injury in whom CAI was suspected. The incidence of CAI increased from 0.06% pre-CTA to 0.19% post-CTA (p = 0.02; Fisher exact test). CTA was associated with a decrease in mean time to make the diagnosis of CAI (156 hours pre-CTA vs. 5.9 hours post-CTA). In addition, CTA was associated with a decrease in the incidence of permanent neurologic sequelae from CAI (50% pre-CTA vs. 0% post-CTA; p = 0.07; Fisher exact test). CONCLUSION: We conclude that CTA does not significantly increase the time of the diagnostic workup of the patient with injuries caused by blunt trauma. The introduction of CTA at our institution was associated with an increase in the detection rate of CAI. Earlier detection of CAI may allow for more timely therapeutic intervention and potentially prevent permanent neurologic sequelae.

Accidents, Traffic↗
PubMed2002

An unusual case of surgical emphysema in the neck following sport injury.

Surgical emphysema of the neck following sport injury without direct trauma to the neck is uncommon. We report a case of a flexion-hyperextension injury causing an air leak to the soft tissues of the neck. Diagnosis, management and potential mechanisms are discussed. Patients may initially present with minimal symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate.

Adult↗
PubMed2005

Management of neck and head injuries.

The horse, a flight animal that is used extensively by man, frequently receives injuries to its neck or head that result mostly from its management and handling. Better facilities, training of the horse, and horsemanship skills of the handler could prevent many of these injuries. Because many body systems can be involved, with potentially major consequences regarding health, performance, and appearance, early recognition of trauma and competent treatment are crucial. Progress has been made in the treatment of some tracheal and esophageal injuries. Severe tracheal trauma and rupture of the esophagus still represent major challenges for the attending veterinarian, however. Lacerations of the head generally heal well, likely because of an abundant blood supply. Thorough yet conservative debridement is necessary, as is accurate reconstruction of the tissues to maintain normal function and an acceptable cosmetic appearance. Fractures of the facial bones can result in complications, such as sequestrum formation, sinusitis, nasolacrimal duct injury,facial deformity, and injury to or entrapment of the globe. An awareness of the treatment methods available can help to diminish the complication rate and to restore a normal or acceptable appearance.

Animals↗