February 23, 2022
Long-Term Impact of Whiplash Injuries
Whiplash: Definition, Diagnosis, & Management
A Life Care Plan can help quantify the future long term medical and non-medical needs caused by whiplash injuries.
What is Whiplash and How is it Caused?
In laymen terms, a whiplash is a neck injury that happens when the head suddenly gets jerked forward then backwards. Medically it is defined as a neck injury resulting from an acceleration-deceleration mechanism that causes sudden extension and flexion of the neck. This type of injury is often experienced following a motor vehicle collision, slip in fall accident or sports injury.
The extension-flexion mechanism or motion can cause injury to the intervertebral joints, discs, and ligaments (anterior longitudinal ligament, posterior longitudinal ligament, and interspinous ligament); cervical muscles; and/or nerve roots. Injury to the the facet joint (zygapophyseal) joint, is often the most common cause of whiplash-related upper neck pain and headaches. Injury to these areas can require future care and require the assistance of a life care planner.
Symptoms of Whiplash:
Common symptoms include neck pain and stiffness which may present with an onset immediately after the injury or can be delay for several days. Additional symptoms of whiplash include headache (occipital/back of head), limited cervical range of motion, shoulder or back pain, dizziness, paresthesias, fatigue, and sleep disturbances.
Diagnosis of Whiplash:
A whiplash injury is diagnosed based on clinical presentation and findings by a Health Care Providers such as a Physician, Advanced Practice Registered Nurse (APRN), Physicians Assistant.
Initial assessment of patient with neck pain involves identification of any red flags such as neck pain with lower extremity weakness, gait, or coordination difficulties, shock-like paresthesia upon neck flexion, neck pain with fever, neck pain with unexplained weight loss etc. Once red flags have been excluded history and physical examination include observation, range of motion, muscle palpation, neurologic examination, and provocative maneuvers are performed. Diagnostic Imaging is then considered.
In patients with recent trauma, clinical decision rules such as NEXUS Criteria for Cervical Spine Imaging or Canadian C-spine rule can be used to determine the need for cervical spine imaging.
For Individuals who have sustained less severe trauma but have a lower but not negligible risk of cervical spine injury, a history, physical examination, and clinical decision of the clinician are used to determine whether imaging is necessary.
Diagnostic Imaging
Diagnostic Imaging examinations by radiography and MRI of the cervical spine are most commonly used to evaluate neck pain. CT or CT myelography of the cervical spine serves as an alternative if MRI is unavailable or contraindicated. CT is the preferred examination in patients with history of major trauma.
Radiography of the cervical spine or X-Rays typically consists of anterior-posterior (AP) and lateral views. The lateral view demonstrates vertebral alignment; the normal cervical lordotic curve can be replaced by a straightened or even a reversed curve in moderate to severe cases of cervical strain. The lateral view is also used to screen for the degree of osteoarthritis at facet and paravertebral joints, disk space narrowing from osteoarthritis, or other bony pathology (eg, compression fracture).
Additional views may be useful in certain circumstances such as the Odontoid view and/or Flexion extension views. The odontoid view provides an open mouth (odontoid) view and is used to evaluate for atlantoaxial instability or inflammatory arthropathy. Flexion and extension views provide for evaluation of underlying cervical spine instability. They are also used in patients with a history of cervical spine surgery (eg, discectomy and fusion, prosthetic disc) to assess mobility [45-47]. A Computerized Radiographic Mensuration Analysis allows Radiologists measure the exact abnormal intersegmental motion problems that occur with a spinal ligament injury that causes spinal instability.
Magnetic resonance imaging (MRI) of the cervical spine are more sensitive than radiography for detecting most etiologies of neck pain. An MRI enables visualization of the spinal cord and nerve roots, bone marrow, discs and other soft tissues. Additional views to consider based on clinical presentation and symptomatology include additional of flexion and extension with alar protocol.
Computed tomography (CT) such as cervical spine CT or CT myelography for evaluation of a traumatic neck pain is performed only when MRI is not available or contraindicated. Because CT images cortical bone better than MRI, CT is preferred in patients with history of major trauma for fracture detection.
Classifications of Whiplash
Whiplash injuries are classified according to the associated signs and symptoms [11]:
Grade 1 – Complaint of neck pain or stiffness only; no physical signs
Grade 2 – Complaint of neck pain or stiffness with associated musculoskeletal signs (eg, decreased range of motion, point tenderness)
Grade 3 – Complaint of neck pain or stiffness with associated neurologic signs (eg, decreased or absent deep tendon reflexes, weakness, sensory deficits)
Grade 4 – Complaint of neck pain or stiffness with associated fracture or dislocation
The term “whiplash injury” generally refers to grade 1 to 3 injuries; grade 4 injuries (associated with fracture or dislocation) are generally associated with more substantial trauma and are considered a distinct diagnosis.
Treatment of Whiplash Related Injuries
Injury to the intervertebral joints, discs, and ligaments (anterior longitudinal ligament, posterior longitudinal ligament, and interspinous ligament) secondary to whiplash can require treatment including platelet rich plasma, wharton’s jelly, radiofrequency ablations, and or surgical intervention.
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