Acute Whiplash Injuries


Overview

Articles

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Review Sections

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Acute Whiplash Injuries Icon    Acute Whiplash Injuries

There are several terms used to describe acute whiplash injury (AWI). Among them are acceleration-deceleration injury, hyperextension-hyperflexion injury, whiplash associated disorders just to name a few. Regardless of the description, the injury is caused by a rapid change in the position of the head which imparts energy transfer to the structures of the cervical spine, most commonly as a result of an automobile accident. A wide variety of symptoms may result to include cervical pain, headache, light headedness, tinnitus, jaw pain, or vision abnormalities. Long term symptoms are common (1).

Diagnosis of acute whiplash injury (AWI) is primarily based on history, examination and radiographic examination when necessary. The first concern to the physician is to determine the extent of injury to avoid interventions that may be harmful to the patient. Neurological and ligamentous injury resulting in laxity can result in negative outcomes if not recognized early in the intervention process. The following chart represents the commonly used standard of grading for AWI as developed by the Quebec Task Force (2):

GradeClinical Presentation
0No neck complaints, no physical signs
1Complaints of neck pain, stiffness or tenderness. No physical signs.
2neck complaint and musculoskeletal signs
3Neck complaint and neurological signs
4Neck complaint and fracture/dislocation

(1) Krakenes J, Kaale BR. Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 2006; 31(24):2820-2826.; (2) Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine 1995; 20(8 Suppl):1S-73S.

Clinical Reviews

Acute Whiplash Injuries: Prevention



The obvious prevention strategy in acute whiplash injury (AWI) is to avoid being involved in an accident which would lead to AWI. In real world situations, to best serve the patient, the physician is obligated to identify risk factors which may lead to chronicity and attempt to address them early in treatment. One recent study found 50% of AWI patients were still symptomatic at 3 months. Another followed 42 patients for 7.5 years and found 61% had no improvement or worsening of symptoms between the two year and the 7.5 year follow-up. Other studies have found 36% to 78% of AWI patients had residual symptoms at the 1 year follow-up. Regardless of the study referenced, the need to reduce chronicity in this patient population is obvious and essential.

Acute Whiplash Injuries: Diagnosis



Diagnosis of acute whiplash injury (AWI) is primarily based on history, examination and radiographic examination when necessary. The first concern to the physician is to determine the extent of injury to avoid interventions that may be harmful to the patient. Neurological and ligamentous injury resulting in laxity can result in negative outcomes if not recognized early in the intervention process. The following chart represents the commonly used standard of grading for AWI as developed by the Quebec Task Force.

Acute Whiplash Injuries: Therapy



The greatest concern when the physician is confronted with a whiplash injured patient is to rule out serious injury. The second is to manage the patient in such a way to avoid chronicity. When reviewing the natural history of acute whiplash injuries (AWI) one will find 24 to 70% of patients develop long term symptoms with as many as 16% becoming severely impaired. The need to identify and intervene in those patients with tendencies to become chronic is essential. This was clearly demonstrated by a recent review of the literature that found "persuasive evidence that the clinical outcome at two years can be predicted at three months".

Medical Subject Heading (MeSH) Information

MeSH Term: Whiplash Injuries

Scope Note: Hyperextension injury to the neck, often the result of being struck from behind by a fast-moving vehicle, in an automobile accident. (From Segen, The Dictionary of Modern Medicine, 1992)

MeSH Synonyms:
  • Whiplash Injuries
  • Injuries, Whiplash
  • Injury, Whiplash
  • Whiplash Injury
Applicable MeSH Subheadings:
  • analysis
  • anatomy and histology
  • blood
  • cerebrospinal fluid
  • classification
  • complications
  • cytology
  • diagnosis
  • drug therapy
  • economics
  • enzymology
  • epidemiology
  • ethnology
  • etiology
  • history
  • immunology
  • metabolism
  • mortality
  • nursing
  • organization and administration
  • pathology
  • physiology
  • physiopathology
  • prevention and control
  • psychology
  • radiography
  • radionuclide imaging
  • radiotherapy
  • rehabilitation
  • statistics and numerical data
  • surgery
  • therapy
  • ultrasonography

Informative Links

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MayoClinic.com Whiplash Information



Mayo Clinic Health Solutions' award-winning consumer Web site offers health information and self-improvement tools. MayoClinic.com's medical experts and editorial professionals bring you access to the knowledge and experience of Mayo Clinic for all your consumer health information needs, from cancer, diabetes and heart disease to nutrition, exercise and pregnancy.
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MedlinePlus: Neck Injuries and Disorders



MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Current Clinical Trials Relating to  Whiplash Injuries

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

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Preventing Chronic Whiplash Pain


(Status: Completed)

20 Clinical Trials Returned