ChiroACCESS Clinical Review



Acute Whiplash Injuries: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.

  

How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)



Published on

May 1, 2007

Text Size:     
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 so as 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 (1).

Grade Clinical Presentation

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

The author was unable to locate any commonly used clinical tests that are specific for AWI. However there are clinical tests that are often used to evaluate AWI or may be used to quantify the degree of injury. These clinical tests involve standardized scales, proprioception, strength testing, algometry and imaging.

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References

1. 

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.



2. 

Rebbeck TJ, Refshauge KM, Maher CG, Stewart M. Evaluation of the core outcome measure in whiplash. Spine 2007; 32(6):696-702.



3. 

Siegmund GP, Heinrichs BE, Wheeler JB. The influence of head restraint and occupant factors on peak head/neck kinematics in low-speed rear-end collisions. Accid Anal Prev 1999; 31(4):393-407.



4. 

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14(7):409-415.



5. 

Anagnostis C, Gatchel RJ, Mayer TG. The pain disability questionnaire: a new psychometrically sound measure for chronic musculoskeletal disorders. Spine 2004; 29(20):2290-2302.



6. 

Dudgeon D, Raubertas RF, Rosenthal SN. The short-form McGill Pain Questionnaire in chronic cancer pain. J Pain Symptom Manage 1993; 8(4):191-195.



7. 

Kremer E, Atkinson JH, Jr. Pain measurement: construct validity of the affective dimension of the McGill Pain Questionnaire with chronic benign pain patients. Pain 1981; 11(1):93-100.



8. 

Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 2004; 85(5):815-822.



9. 

Clark P, Lavielle P, Martinez H. Learning from pain scales: patient perspective. J Rheumatol 2003; 30(7):1584-1588.



10. 

Boeckstyns ME, Backer M. Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 1989; 38(1):29-33.



11. 

McLain RF. Mechanoreceptor endings in human cervical facet joints. Spine 1994; 19(5):495-501.



12. 

Sandlund J, Djupsjobacka M, Ryhed B, Hamberg J, Bjorklund M. Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders. J Rehabil Med 2006; 38(1):44-49.



13. 

Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med 2003; 35(1):36-43.



14. 

Kasch H, Stengaard-Pedersen K, Arendt-Nielsen L, Staehelin JT. Pain thresholds and tenderness in neck and head following acute whiplash injury: a prospective study. Cephalalgia 2001; 21(3):189-197.



15. 

Stude P, Nebel K, Ludecke C, Wiese H, Diener HC, Keidel M. Quantification of acute neck pain following whiplash injury by computer-aided pressure algesimetry. Cephalalgia 2004; 24(12):1067-1075.



16. 

Kumbhare DA, Balsor B, Parkinson WL, Harding BP, Bedard M, Papaioannou A et al. Measurement of cervical flexor endurance following whiplash. Disabil Rehabil 2005; 27(14):801-807.



17. 

Vernon HT, Aker P, Aramenko M, Battershill D, Alepin A, Penner T. Evaluation of neck muscle strength with a modified sphygmomanometer dynamometer: reliability and validity. J Manipulative Physiol Ther 1992; 15(6):343-349.



18. 

Guideline for the Management of Whiplash-Associated Disorders. 2001. Sidney, NSW, Motor Accident Authority.



19. 

Whiplash. 2007. Alberta, Canada, Workers' Compensation Board.



20. 

Ronnen HR, de Korte PJ, Brink PR, van der Bijl HJ, Tonino AJ, Franke CL. Acute whiplash injury: is there a role for MR imaging?--a prospective study of 100 patients. Radiology 1996; 201(1):93-96.



21. 

Krakenes J, Kaale BR. Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 2006; 31(24):2820-2826.



22. 

Krakenes J, Kaale BR, Nordli H, Moen G, Rorvik J, Gilhus NE. MR analysis of the transverse ligament in the late stage of whiplash injury. Acta Radiol 2003; 44(6):637-644.



23. 

Kaale BR, Krakenes J, Albrektsen G, Wester K. Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 2005; 22(11):1294-1302.



24. 

Kaale BR, Krakenes J, Albrektsen G, Wester K. Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 2005; 22(4):466-475.



25. 

Schroder RJ, Vogl T, Hidajat N, Schedel H, Sudkamp N, Haas N et al. [Comparison of the diagnostic value of CT and MRI in injuries of the cervical vertebrae]. Aktuelle Radiol 1995; 5(4):197-202.