Whiplash: Fact not Fiction

Automobile collisions are notorious for creating cervical sprain/strain or whiplash injuries. This is a severe medical problem. While people generally heal from neck pain in a month or two, more than 15 million Americans currently complain of chronic whiplash symptoms. It is common for whiplash symptoms to be mild initially and then intensify or the course of several days.

How can you tell if I have a cervical sprain/strain?
Because x-rays are meant to reveal problems with bones, diagnosis is primarily based on the patient history. The most accurate exam test for whiplash is the patients inability to to hold their head up to an applied load in the neutral and lateral rotated positions.

What’s the most common complaint after a whiplash-type injury?
Neck and upper back pain with associated decreased range of motion, headaches, shoulder pain, dizziness, arm paresthesias, as well as visual and auditory disturbances – which may indicate concussion type brain injury.

Soft tissues like the sternocleidomastoid and scalenes are disrupted followede by deeper muscles including the longus capitus and lngus colli.

Cervical sprain/strain injuries are rated at follows:

  • Grade 0: Patient has no subjective complaints and no objective signs.
  • Grade 1: Patient complains of neck pain only, but has no objective signs.
  • Grade 2A: There is neck pain with objective anterior and posterior point tenderness on palpation and no neurological findings
  • Grade 2B: Neck pain with objective point tenderness AND decreased range of cervical motion, without neurological findings.
  • Grade 3: Here the patient has neck pain, objective point tenderness, decreased range of motion and any of the following: absent deep tendon reflexes, sesnory deficit, and/or objective weakness on motor-proprioceptive testing.
  • Grade 4: Has an associated fracture/dislocation

What are the consequences of having this kind of injury?
Whiplash injured patients have 3 times the incidence of neck and/or shoulder pain 7 years POST-accident compared to a normal population.

An amazing 84% of patients who sustained a second whiplash injury reported recurrence and/or worseing of previously resolved neck and arm symptoms. Of those patients reporting a recurrence, 97% were symptom-free before the second accident.

When patients complain of headaches along with their neck and shoulder pain it indicates injury to the C2-C3 facet joint more than 1/2 the time.

In cases with severe acute symptoms of numbness and tingling, including increased dermatomal pain and weakness there is an increased likelyhood of damage to C3-4 through C6-7. The increased nerve injury and symptom severity such as pain and paresthesias in the periclavicular region, anterior and posterior neck, deltoid and trapezius muscles, as well as the dorsal arm, forearm, and hand make for a worse clinical prognosis.

What condition make a Cervical Sprain/Strain injury worse?
Any rotation of the head or neck at the time of impact increases the forces imparted to the cervical facet joints and capsular structures which increases pain that leads to degenerative changes and a poor prognosis for recovery.

Patients who were surprised by the collision, who didn’t see or hear it coming, are particularly vulnerable for damage to critical ligaments and membranes.

Front end impacts cause injury to the upper cervical ligaments and membranes and are now included in the definition of whiplash trauma, along with rear-end and side impact collisions.

Indicators that you might have had a concussion; even if you didn’t blackout
There’s a good chance that you suffered from a concussion if you develop chronic headaches, have blurred vision, ringing in the ears, dizziness and vertigo-balance disturbances.

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