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PubMed1997

Reflex jaw motions and jaw stiffness pertaining to whiplash injury of the neck.

Because a so-called mandibular whiplash injury requires the absence of short-latency jaw-closing reflexes in order to explain the postulated mechanism of injury (excessive jaw opening); the authors studied the presence and absence and more importantly, the kinematics (duration, displacement, velocity, acceleration) of monosynaptic and possibly, polysynaptic myotatic (stretch) reflexes in the jaw elevator muscles. In six healthy adults jaw jerk maneuvers were elicited through a brisk tap on the chin, and surface electromyography identified elevator reflexes while translational electrognathography identified the kinematics of the reflexes. The maneuvers were done while maintaining the rest position (3% MVC) and moderate clenching of the teeth (30% MVC). Electromyography was also used to identify phasic elevator excitations during a passive brisk neck extension maneuver. A sudden and unexpected elongation of the jaw elevators released autogenic reflex responses that, in conjunction with augmented tissue elasticity (stiffness), elevated the mandible into centric occlusion within approximately 150 milliseconds. In 86% of trials, the responses occurred regardless of the prevailing resting and clenching contractile activities. There was no evidence of a depressor force that consistently would and could anchor the mandible in a position of extreme or moderate depression, the theoretical linchpin of the mandibular whiplash injury. It was concluded that the mandibular locomotor system is very efficient in maintaining the rest and intercuspal positions of the mandible. This study found no evidence corroborating the mechanism claimed to release a so-called mandibular whiplash injury.

Acceleration↗
PubMed1996

Ocular injuries in battered women.

PURPOSE: The purpose of this article is to examine the occurrence of battered women seen by ophthalmologists in an eye emergency department, and to make ophthalmologists aware that these women are not a rarity but often go unrecognized. METHODS: This retrospective study reviews a large urban eye center's emergency room charts over a 6-month period for documentation of injuries to women as a result of domestic violence. Seventy-nine charts were selected as part of this study. In 18 of these charts, battered women definitely were identified, and in 61 charts abuse was suspected but the abuser was not specifically identified. RESULTS: The patients ranged in age from 15 to 90 years. The abuser was most commonly a boyfriend using a fist as the means of inflicting the injury. Injuries ranged from lacerations and contusions to more serious injuries, including three hyphemas and three ruptured globes. Six patients were hospitalized because of their injuries. Substance abuse was documented in 5 of 79 patients. CONCLUSIONS: Many of these female victims of intentional violence in their homes go unrecognized or uncharted by physicians. Ophthalmologists see many of these women because of the high frequency of head and neck injuries in these cases, and should therefore maintain a high index of suspicion and be prepared to act appropriately with recognition and documentation of the injury and provision of social service referrals.

Adolescent↗
PubMed2004

Delayed traumatic occlusion of the extracranial internal carotid artery after earthquake: report of two cases.

We report on two patients with head and neck injuries, who remained asymptomatic after the earthquake for 1 and 2 years, respectively. They developed late transient ischemic neurological signs and eventually presented with complete occlusion of the internal carotid artery. They made a good recovery with medical treatment. Focal cerebral ischemic symptoms may develop months or even years after the head or neck trauma, and internal carotid artery occlusion should be considered in differential diagnosis as a late complication.

Adolescent↗
PubMed2006

Is there a relationship between whiplash-associated disorders and concussion in hockey? A preliminary study.

PRIMARY OBJECTIVE: To examine the relationship between the occurrence of whiplash-associated disorders and concussion symptoms in hockey players. RESEARCH DESIGN: Prospective cohort observational study to examine the relationship between whiplash associated disorders and concussion in actual hockey play. METHODS AND PROCEDURES: Twenty hockey teams were followed prospectively for one season. Team therapists completed acute and 7-10 day follow-up evaluation questionnaires for all of the players who received either a whiplash mechanism or a concussion. MAIN OUTCOMES AND RESULTS: 183 players were registered for this study; 13 received either a whiplash mechanistic injury or a concussion injury. Initial injuries ranged from WAD I to WAD III and all subjects reported concussion symptoms. Only three subjects reported full resolution of both WAD and concussion symptoms at the 7-10 day follow-up evaluation. CONCLUSIONS: There is a strong association between whiplash induced neck injuries and the symptoms of concussion in hockey injuries. Both should be evaluated when dealing with athletes/patients suffering from either injury.

Adolescent↗
PubMed1997

An unusual mechanism of burn injury due to flaming drinks.

Bars and cocktail lounges serve various forms of flaming drinks, usually made with very high-proof alcohol. The drinks are lit and then served. If additional alcohol from the bottle is added to a still-burning drink, flames may spread up the stream of alcohol into the bottle and cause a flash of flame out the bottle's neck. Injuries can require grafting. Three cases are reported. A 32-year-old white female sustained burns covering 10 per cent of her body surface, including the face. Surgery with split-thickness grafts were required. Pressure garments were prescribed for 6 months. A 34-year-old black female was burned by a "volcano" drink. Burns covered 20 per cent of her body surface, including the face. Split-thickness grafts were required on multiple occasions. Infected wounds healed slowly. Reconstructive surgery has so far required eight procedures. A 39-year-old white male sustained severe burns to 10 per cent of his body, including the face. Grafting was carried out. Pressure garments were required. Permanent visible facial scarring is present in all three cases. This type of accident is readily preventable.

Accident Prevention↗
PubMed1990

Enzyme-linked immunoabsorbent assay for plasma thyroglobulin following compression of the neck.

A highly sensitive enzyme-linked immunosorbent assay (ELISA) for determination of plasma thyroglobulin (Tg) which we devised was applied to the postmortem diagnosis of external compression of the neck. The coefficients of variation within and between assays were 2.4-6.6% and 6.8-12.0%, respectively. A significant correlation was observed between Tg levels measured by our ELISA and those measured by radioimmunoassay (r = 0.996, P less than 0.001). Plasma Tg levels in all 36 cadavers without external compression of the neck or neck injuries were lower than 200 ng/ml (73.6 +/- 51.9 ng/ml, M +/- S.D.) although these levels were a little higher than those in living bodies (16.7 +/- 11.8 ng/ml). On the other hand, plasma Tg levels in most of 42 victims of asphyxia due to external compression of the neck were higher than 200 ng/ml (2190 +/- 4300 ng/ml), and the highest one was 24,600 ng/ml. Plasma levels of the other thyroid hormones and thyroid-stimulating hormone were determined in some cases, and the cervical conditions in certain cases of strangulation were analyzed. Present results suggest that Tg was released by mechanical force on the thyroid gland added at the agonal stage. The determination of plasma Tg level in a cadaver using our ELISA would seem to be useful for the postmortem diagnosis of the presence of external compression of the neck. Although thyroid diseases causing elevated Tg levels are rare in forensic cases, they should be excluded by routine histology of the thyroid at autopsy, so that the finding of a high Tg level would thus carry more weight when given in evidence.

Adolescent↗
PubMedDate not supplied

Cervical spinal stenosis and stingers in collegiate football players.

We evaluated the relationship of cervical spinal stenosis with the occurrence of "stingers" in collegiate football players who participated at our institution from 1987 through 1991. Preparticipation cervical spine radiographs of 266 players were used to measure Torg ratio. Forty players with stingers were identified: 34 had an extension-compression mechanism; 6 had a brachial plexus stretch mechanism. Time-loss neck injuries occurred in 31 players; the remaining 195 players were asymptomatic. The mean Torg ratio was significantly smaller for the stinger group (P = 0.02). The Torg ratio was less than 0.8 at 1 or more levels in 47.5% of the stinger group, 32.3% of the time-loss neck pain group, and 25.1% of the asymptomatic group. No player with a brachial plexus stretch mechanism had a mean Torg ratio less than 0.8, but 20.6% of the players with an extension-compression mechanism had a mean Torg ratio less than 0.8. Players with a Torg ratio less than 0.8 had 3 times the risk of incurring stingers. We conclude that cervical spinal stenosis increases the risk for having stingers with complicated clinical courses.

Adult↗
PubMed2000

Traumatic carotid artery dissection: a significant incidental finding.

Blunt traumatic carotid artery dissection remains controversial in terms of diagnostic screening, reported incidence, and management. Treatment options include observation, anticoagulation and endovascular stenting, and aggressive surgical repair of the carotid artery injury. Blunt traumatic carotid artery dissections were reviewed through a retrospective study of trauma registry records. Seven patients were identified from 3342 patients over 3 years. Six patients were identified incidentally during magnetic resonance imaging (MRI) cervical spine/brain screening and one patient during angiographic evaluation for possible penetrating neck injury without MRI/magnetic resonance angiography (MRA). A total of 189 patients underwent MRI screening over this 3-year period, demonstrating a relative incidence of 3.7 per cent, contrasting with the reported incidence of 0.08 to 0.4 per cent for all trauma patients. All seven patients suffered severe head injuries (mean Glasgow Coma Score = 4.7) requiring mean intensive care unit and hospital stays of 15.6 and 23.7 days, respectively. None of the patients showed evidence of stroke with CT scanning on presentation. None of the patients demonstrated clinical focal neurologic signs or symptoms indicating carotid injury or stroke. Six patients survived their acute trauma and were discharged to rehabilitation after initiation of observation (one patient) or anticoagulation (five patients). All six patients showed neurological improvement without deterioration clinically or radiographically. In conclusion we propose early aggressive screening through MRI/MRA of severely injured patients to detect occult carotid artery dissections. Conservative medical treatment for this occult injury has been effective in this series of patients.

Adolescent↗
PubMed1959

The painful neck.

Explore the source record for details and available documents.

Accidents↗
PubMedDate not supplied

[Soft tissue injuries of the neck].

Thirty five patients were examined. All had soft tissue spinal cord injury and were not treated in a hospital. Complete diagnostic and therapeutical protocol was carried out only for 13 patients. The goal was to compare their initial condition with condition after the control examination after the therapy. Results showed that 8 patients (23%) suffered from pain in the neck, 25 (72%) had limited neck mobility, and 17 (49%) manifested neurological symptoms. Signs of osteochondrosis at isolated spinal levels and dyscoligamental instability were noted in one fifth of the observed patients. In 24 patients (69%) the condition was defined as "serious". Although soft tissue spinal cord injuries are considered as "light" injuries, they can cause serious consequences that reduce the quality of patient's life due to inadequate treatment. From that point of view, a serious approach to diagnosis and treatment is necessary.

Adolescent↗
PubMed2002

An exploration of the occurrence of pressure ulcers in a British spinal injuries unit.

Spinal cord injury (SCI) is associated with increased risk of pressure ulcers, but there are few published data about this in the United Kingdom (UK). This article represents a quantitative exploration of the occurrence of pressure ulcers in a UK spinal injuries unit (SIU). The technique used is a retrospective review of records: details of 144 completed first admissions for SCI between 1998 and 2000 were entered on to a database (SPSS) for analysis. Thirty-two per cent of patients already had pressure ulcers on admission to the SIU, while a total of 56% experienced an ulcer at some stage between injury and discharge from the SIU. Four pressure ulcer risk assessment scales were used (Waterlow, Braden, Norton and SCIPUS-A). These appeared to have moderate predictive power in this population. Pressure ulcers were found to be associated with increased length of hospital stay, density of lesion, surgical stabilization of neck injury before transfer to the SIU, tracheostomy on admission to the SIU and delayed transfer to the SIU after injury. Implications for practice are discussed.

Adolescent↗
PubMed1978

[Trauma to the cervical spine (author's transl)].

Thirty-five occupants fatally injured (despite the use of seat belts) in head-on collisions suffered severe injuries to the craniocervical junction (ring fractures of the base of the skull, fractures of the upper cervical vertebrae, or disruptions between the cervical vertebrae) if there was extensive trauma against the head or if submarining under shoulder belts took place. If three-point belts were used, few or no neck injuries were observed if there was only a slight impact between the head and some part of the car, and there was no instability of the cervical spine due to pathologic changes.

Accidents, Traffic↗
PubMed1999

Endovascular stent placement for cervical internal carotid artery aneurysm causing cerebral embolism: usefulness of neuroradiological evaluation.

We present a case of a cervical internal carotid artery aneurysm that caused cerebral embolism. This lesion was supposed to be a dissecting aneurysm due to blunt neck injury. The large aneurysm with intramural thrombus was treated with endovascular placement of a balloon-expandable stent. Both CT and MRI were useful for evaluating the size and characteristics of the aneurysmal wall. Intravascular ultrasound imaging was also useful for evaluation of the satisfactory stent deployment and identification of the neck of the aneurysm. We discuss effectiveness of endovascular stenting for cervical internal carotid artery aneurysm with intramural thrombus and the usefulness of a combination of the neuroradiological imaging before, during and after the interventional procedure.

Adult↗
PubMed2000

Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck.

STUDY DESIGN: A descriptive case series pre- and post-treatment design, including a 6-month follow-up. OBJECTIVES: The objective of this study was to document the improvements of patients with chronic symptoms after a "whiplash" injury of the neck, who attended a 4-week multimodal treatment program at the Rug AdviesCentra Nederland. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no studies have been conducted on the effectiveness of multidisciplinary treatment of chronic symptoms after whiplash injury. METHODS: Twenty-six patients who experienced Quebec type 1 or 2 lesions of the neck (whiplash) with persisting symptoms of longer than 6 months' duration participated in the study. The measures included were pain intensity (according to the visual analog scale), number of painful sites (determined by pain drawing), self-reported disability Quebec Back Pain Disability Scale; and symptoms of somatic and psychological distress and cognitive symptoms (according to selected Minnesota Multiphasic Personality Inventory-2 scales). Furthermore, objective outcome criteria were used regarding return to work, medication, and medical and paramedical treatment. Statistical and clinical significance of treatment results were both assessed. RESULTS: The patients' symptoms improved significantly on nearly all self-report measures. Their scores for objective outcome criteria reported during the 6-month follow-up evaluation were: complete return to work (65%); complete or partial return to work (92%); no use of analgesics in the past 6 months (58%); and no medical or paramedical treatments in the past 6 months (81%). CONCLUSION: These early results indicate that a multimodal treatment program has the potential to be an effective treatment for patients with chronic symptoms after a whiplash injury of the neck--a group of patients who have in the past been considered intractable or, at the very least, puzzling.

Activities of Daily Living↗
PubMed1977

Traumatic vertebral arteriovenous fistula associated with cervical spine fracture.

A case of a traumatic vertebral arteriovenous fistula associated with a high cervical fracture-dislocation is reported. The fistula was not suspected clinically but was fortuitously diagnosed by brachial arteriography carried out for a deteriorating level of consciousness. The patient's complex injuries were managed by conservative treatment of the fracture-dislocation and later by ligation of the proximal and distal vertebral artery for trapping of the fistula. The indications and the various surgical procedures for the treatment of vertebral arteriovenous fistula are discussed. The report emphasizes the value of cerebral angiography in head and neck injuries.

Arteriovenous Fistula↗
PubMed2002

Management of traumatic urethral disruption in children: Oman experience, 1988-2000.

BACKGROUND: Traumatic urethral disruptions in children differ anatomically from those of adults. In children, the posterior urethra is not protected by the prostate and may be injured at any level. The management of traumatic rupture of the urethra still a matter of debate, and there is no agreement as to which is the best of 3 options. METHODS: This was a retrospective analysis. Over a 12-year period the authors dealt with 21 urethral disruptions. The authors had detailed follow-up of 20 patients (14 posterior and 6 anterior). Trans-symphyseal urethroplasty (6 early primary repairs and 3 delayed repairs) for complete posterior urethral disruptions was performed. The early repairs were carried out within 7 days of the injury. Primary alignment was performed for 3 of the 4 partial ruptures of the posterior urethra and for all 6 anterior urethral disruptions. Postoperatively, the patients were evaluated for incontinence, penile erectile dysfunction, and stricture formation. RESULTS: In one of the early repairs a stricture developed that responded to dilatations. A second patient with bladder neck injury had incontinence after the repair. She underwent a urethral lengthening procedure and still has stress incontinence. Erections were observed in all 4 boys. One of the delayed repairs developed a stricture postoperatively. Of the 9 partial ruptures (6 anterior and 3 posterior) that underwent primary alignment, 4 had strictures. Some of these strictures required up to 5 dilatations or internal urethrotomy for cure. One patient with complete rupture underwent primary alignment, which broke down, and a long stricture developed. This patient is still awaiting a delayed repair. One posterior partial rupture, repaired primarily at another hospital, had a stricture and an urethrocutaneous fistula that responded to curettage and dilatations. CONCLUSIONS: Primary repairs required less hospitalization and a shorter duration of indwelling catheters. In light of this experience the authors recommend a primary repair in patients with complete posterior urethral disruptions.

Age Factors↗