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At least 145 records · Page 8Linked to original sources
PubMed1998

Whiplash injuries and the potential for mechanical instability.

Whiplash injury to the cervical spine is poorly understood. Symptoms often do not correlate to the clinical findings. It has been hypothesized that the long-term clinical symptoms associated with whiplash have their basis in mechanical derangement of the cervical spine caused at the time of trauma. Before such a hypothesis can be proven, one needs to document and quantify the soft tissue injuries of the cervical spine in whiplash. The purpose of the study was to quantify the mechanical changes that occur in the cervical spine specimen as a result of experimental whiplash trauma. Utilizing a whiplash trauma model, injuries to human cadaveric cervical spine specimens (C0-T1 or C0-C7) were produced by increasingly severe traumas. The flexibility tests determined the motion changes at each intervertebral level in response to 1.0 Nm pure flexion-extension moment. Parameters of range of motion (ROM) and neutral zone (NZ) were determined before and after each trauma. Significant flexibility increases first occurred in the lower cervical spine after 4.5-g rear-end (anteriorly directed) acceleration of the T1 vertebra. At this acceleration magnitude, extension ROM and NZ at C5-C6 increased (P < 0.05) by 98% and 160% respectively. There was also a tendency (P < 0. 1) for the extension NZ at C0-C1 and C6-C7 levels to increase after the 6.5-g acceleration by 52% and 241% respectively. There were no such tendencies for the ROM parameter. We have identified the threshold and sites of whiplash injury to the cervical spine. This information should help the clinician make more precise diagnoses in the case of whiplash trauma patients.

Cadaver↗
PubMed1997

Ability to reproduce head position after whiplash injury.

STUDY DESIGN: A two-group design with repeated measures. OBJECTIVES: To determine if there is loss of the ability to reproduce target position of the cervical spine individuals who have sustained a whiplash injury. SUMMARY OF BACKGROUND DATA: The ability to sense position is a prerequisite for functional movement. Injury may have a deleterious effect on this ability, resulting in inaccurate positioning of the head and neck with respect to the body coordinates and to the environment. METHODS: Eleven subjects with history of whiplash injury (age, 42 +/- 8.7 years) and 11 age-matched asymptomatic subjects (age, 43 +/- 3.1 years) participated in the study. Effects of whiplash injury on the ability to replicate a target position of the head were assessed. Maximum rotation of the neck and ability to reproduce the target angle were measured using a standard cervical range-of-motion device. Subjects' perception of "neutral" position was also assessed. RESULTS: Analysis of variance indicated the whiplash subjects were less accurate in reproducing the target angle than were control subjects. These whiplash subjects tended to overshoot the target. In addition, the subjects in the whiplash group were often inaccurate in their assessment of neutral position. CONCLUSIONS: Subjects who have experienced a whiplash injury demonstrate a deficit in their ability to reproduce a target position of the neck. These data are consistent with the hypothesis that these subjects possess an inaccurate perception of head position secondary to their injury. This study has implications for the rehabilitation of individuals with whiplash injury.

Adult↗
PubMed1992

Some observations on whiplash injuries.

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Differential↗
PubMed1993

Evaluation of whiplash injuries by technetium 99m isotope scanning.

Despite the frequency with which whiplash injuries present to accident and emergency (A&E) departments, there lacks an objective investigation to define the severity of the initial injury or the morbidity that may ensue. Following reports on the effectiveness of isotope bone scanning for soft tissue and ligament injuries a study was undertaken of isotope scanning of whiplash injuries. The objectives of the study were to isolate the anatomic site of the injury and to quantify the severity of the injury with relation to the concentration of isotope uptake and subsequent morbidity.

Adolescent↗
PubMed1993

Psychological disturbances and an exaggerated response to pain in patients with whiplash injury.

Psychological state, response to pain and style of interpreting everyday experiences were measured in 32 patients who had suffered a whiplash injury 1-84 months before the study. For comparison, measures were also obtained in 15 general practice attenders. Ratings of depression and anxiety were greater in patients than in controls, and patients reported more cold-induced pain during a cold pressor test. Within the patient sample, anxious subjects gave the highest ratings of cold-induced pain. Those with the longest history of pain gave the highest ratings of whiplash injury pain, and were most depressed. Most of these patients were involved in litigation. The findings demonstrate that, like most patients with chronic pain, whiplash injury sufferers are anxious and depressed. Their psychological distress could be aggravated by litigation. Behavioural assessment and treatment of chronic pain syndromes such as whiplash injury could benefit from early evaluation of the patient's psychological state, and response to standard painful stimuli.

Adolescent↗
PubMed2004

Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia.

Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage.

Adult↗
PubMed2003

Occupant- and crash-related factors associated with the risk of whiplash injury.

PURPOSE: Given that a motor vehicle crash (MVC) had occurred, to evaluate whether occupant- and crash-related factors, such as age, gender, seating position and type of MVC are associated with the risk of whiplash injury. METHODS: A study of occupants in cars covered by motor insurance at one of the largest insurance companies in Sweden, was undertaken during a one-year period. The study population comprised all occupants in cars exposed to an MVC in which at least one occupant was injured (n = 7120). Adjusted estimates of the relative risk of whiplash injury, associated with the different factors, were calculated by means of binomial regression analysis. RESULTS: Considering different MVCs, rear-end collisions were associated with the highest relative risk of whiplash injury when compared with side impacts (1.82; 95% CI 1.68-1.96), while drivers showed the strongest association with respect to seating position when compared with passengers in the rear seat (1.78; 95% CI 1.60-1.97). Females had a somewhat higher relative risk of whiplash injury than males (1.20; 95% CI 1.16-1.25). Regarding age, the relative risk was moderately increased across the different age groups when compared with the oldest age group. No interaction was observed on the additive scale. CONCLUSIONS: Given that an MVC had occurred, subjects exposed to a rear-end collision and drivers had a substantial increased risk of whiplash injury, while age and gender were of minor importance.

Accidents, Traffic↗
PubMed1996

Cervicocephalic kinesthetic sensibility in patients with whiplash injury.

This study investigated cervicocephalic kinesthetic sensibility in patients with whiplash injury and the effects of a rehabilitation programme. Fourteen patients with a whiplash injury and 34 healthy subjects participated in this study. The ability to appreciate both movement and the position of the head with respect to the trunk was investigated. Active head repositioning was significantly less precise in the whiplash subjects compared to the control group. Repositioning was more precise in whiplash subjects after the 5-week rehabilitation programme. There was no correlation between error of repositioning in patients and pain intensity. It is probable that cervicocephalic kinesthesia is linked to sensory information from the extensive muscular and articular proprioceptive system. A flexion-extension injury to the neck may result in dysfunction of this system.

Adult↗
PubMed1998

Cervical curvature in acute whiplash injuries: prospective comparative study with asymptomatic subjects.

The cervical curvature of 488 patients with acute whiplash injury was prospectively studied by comparison with 495 asymptomatic healthy volunteers. Plain radiography of the cervical spine in the neutral position was evaluated qualitatively. No significant difference was noted in frequencies of non-lordotic cervical curvature and local angular kyphosis between acute whiplash injury patients and asymptomatic subjects. No significant association was apparent between clinical symptoms and cervical curvature. These results suggest that non-lordotic cervical curvature and angular kyphosis in acute whiplash injury patients constitute normal variants rather than pathological findings.

Acute Disease↗
PubMed2002

Perceived cognitive deficits, emotional distress and disability following whiplash injury.

OBJECTIVES: To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury. PARTICIPANTS: A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work-related soft-tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups. METHODS: Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain-related disability. RESULTS: Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain-related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits. DISCUSSION: The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.

Adult↗
PubMed1983

[Treatment of whiplash injuries of the cervical spine with acupuncture].

30 patients with whiplash injuries were treated with aural-acupuncture. The points were chosen according to a special programme. Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation.

Acupuncture Therapy↗
PubMed1982

[The mechanics of whiplash injury of the cervical spine (author's transl)].

Despite many attempts it has so far not been possible to establish a uniform application of the term "whiplash injury" either for diagnostics, therapy, or medical reports. To obtain a clear, functionally based definition, the most frequently used formulations are compared, taking into account anatomic and mechanical aspects in addition. Whiplash injury is separated from hyperextension injury ("snap" trauma of the cervical spine), even though overlaps in the lesion picture are possible. In the definition suggested, invariable linkage to rear-end collision is dispensed with. Instead, it is emphasized that this accident mechanism is frequent, but can also be substituted. In contrast to other definitions, special emphasis is laid on the biphasic course since a substantial traumatization is to be assumed to occur from the secondary movement. This second movement does not by any means proceed with low energy, but its determined by the mass contraction of the muscle group subject to primary abrupt overextension with their synergists. On the basis of the analysis of the mechanical course and the investigation of a actual accidents, the monosegmental cervical spine injury cannot, therefore, be seen as the characteristic type of damage due to a whiplash injury. Instead of this, the frequent occurrence of multiple injuries is pointed out.

Biomechanical Phenomena↗
PubMed1992

Whiplash injury: misconceptions and remedies.

Misconceptions about whiplash injury and its common course are discussed. Different patient populations appear to suffer to varying degrees and social copying is evident in certain groups--features shared with the Australian 1983 to 1985 'epidemic' of 'repetitive strain syndrome'. Psychosocial factors and overtreatment delay recovery. Family physicians have the opportunity to properly assess and manage most patients. Wasteful therapy must be discouraged, and self care and patient responsibility encouraged.

Causality↗
PubMed2004

Quantification of acute neck pain following whiplash injury by computer-aided pressure algesimetry.

Until now the clinical investigation of cervical pain due to whiplash injury is mainly based on finger palpation. The present study introduces a PC-interactive pressure algesimetry to standardize cervical pain measurement. Pressure pain scores of the splenius and trapezius muscles of 23 patients with an acute cervical syndrome after whiplash injury were compared to those of 24 healthy subjects. The pressure painfulness of neck and shoulder muscles was significantly increased in whiplash patients. The splenii muscles showed an equally increased muscle pain whereas the trapezii muscles showed a left-sided preponderance of painfulness, possibly due to the seat belt position in this group of motor vehicle drivers. The computer-interactive pressure algesimetry enables a standardized and rater-independent quantification of the cervical syndrome with neck and shoulder pain caused by whiplash injury.

Adolescent↗
PubMed1997

A prospective study of 39 patients with whiplash injury.

INTRODUCTION: The acute symptoms after whiplash traumas can be explained by the neck sprain, but the pathogenesis of the "late whiplash syndrome" and the reason why only some people have persistent symptoms more than 6 months is still unknown. MATERIAL AND METHODS: Thirty-four consecutive cases of whiplash injury were examined clinically three times; within 14 days, after 1 month and finally 7 months postinjury. In addition, MRI of the brain and the cervical spine, neuropsychological tests and motor evoked potentials (MEP) were done one month postinjury and repeated after 6 months, if abnormalities were found. RESULTS: The total recovery rate (asymptomatic patients) was 29% after 7 months. MRI was repeated in 6 patients. The correlation between MRI and the clinical findings was poor. Cognitive dysfunction as a symptom of brain injury was not found. Stress at the same time predicted more symptoms at follow-up. All MEP examinations were normal. CONCLUSION: In this study, long-lasting distress and poor outcome were more related to the occurrence of stressful life events than to clinical and paraclinical findings.

Adult↗
PubMed1998

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts.

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

Accidents, Traffic↗
PubMed1997

Do "whiplash injuries" occur in low-speed rear impacts?

A study was conducted to find out whether in a rear-impact motor vehicle accident, velocity changes in the impact vehicle of between 10 and 15 km/h can cause so-called "whiplash injuries". An assessment of the actual injury mechanism of such whiplash injuries and comparison of vehicle rear-end collisions with amusement park bumper car collisions was also carried out. The study was based on experimental biochemical, kinematic, and clinical analysis with volunteers. In Europe between DM 10 and 20 billion each year is paid out by insurance companies alone for whiplash injuries, although various studies show that the biodynamic stresses arising in the case of slight to moderate vehicle damage may not be high enough to cause such injuries. Most of these experimental studies with cadavers, dummies, and some with volunteers were performed with velocity changes below 10 km/h. About 65% of the insurance claims, however, take place in cases with velocity changes of up to 15 km/h. Fourteen made volunteers (aged 28-47 years; average 33.2 years) and five female volunteers (aged 26-37 years; average 32.8 years) participated in 17 vehicle rear-end collisions and 3 bumper car collisions. All cars were fitted with normal European bumper systems. Before, 1 day after and 4-5 weeks after each vehicle crash test and in two of the three bumper car crash tests a clinical examination, a computerized motion analysis, and an MRI examination with Gd-DTPA of the cervical spine of the test persons were performed. During each crash test, in which the test persons were completely screened-off visually and acoustically, the muscle tension of various neck muscles was recorded by surface electromyography (EMG). The kinematic responses of the test persons and the forces occurring were measured by accelerometers. The kinematic analyses were performed with movement markers and a screening frequency of 700 Hz. To record the acceleration effects of the target vehicle and the bullet vehicle, vehicle accident data recorders were installed in both. The contact phase of the vehicle structures and the kinematics of the test persons were also recorded using high-speed cameras. The results showed that the range of velocity change (vehicle collisions) was 8.7-14.2 km/h (average 11.4 km/h) and the range of mean acceleration of the target vehicle was 2.1-3.6 g (average 2.7 g). The range of velocity change (bumper car collisions) was 8.3- 10.6 km/h (average 9.9 km/h) and the range of mean acceleration of the target bumper car was 1.8-2.6 g (average 2.2 g). No injury signs were found at the physical examinations, computerized motion analyses, or at the MRI examinations. Only one of the male volunteers suffered a reduction of rotation of the cervical spine to the left of 10 degrees for 10 weeks. The kinematic analysis very clearly showed that the whiplash mechanism consists of translation/extension (high energy) of the cervical spine with consecutive flexion (low energy) of the cervical spine: hyperextension of the cervical spine during the vehicle crashes was not observed. All the tests showed that the EMG signal of the neck muscles starts before the head movement takes place. The stresses recorded in the vehicle collisions were in the same range as those recorded in the bumper car crashes. From the extent of the damage to the vehicles after a collision it is possible to determine the level of the velocity change. The study concluded that, the "limit of harmlessness" for stresses arising from rear-end impacts with regard to the velocity changes lies between 10 and 15 km/h. For everyday practice, photographs of the damage to cars involved in a rear-end impact are essential to determine this velocity change. The stress occurring in vehicle rear-end collisions can be compared to the stress in bumper car collisions.

Accidents, Traffic↗