Whiplash injuries and associated disorders: new insights into an old problem

Abstract

SummaryThe Medical Task Force of the Swedish Society of Medicine and the Whiplash Commission has come to the following main conclusions:The term ''whiplash'' is so generally accepted that it should continue to be used, but the term ''whiplash trauma'' should only be used to refer to indirect cervical spine trauma. By deleting WAD grades 0 and IV from the classification system introduced in 1995 by the Quebec Task Force (QTF), the diagnosis of whiplash injury will be more exact and more realistically defined, which will reduce the risk of misunderstanding.The reported incidence of whiplash injuries in Sweden varies depending on the particular investigation cited, and ranges between 1.0 and 3.2/1000 per year. Whiplash injuries represent approximately 1/3 of all claims submitted after traffic injuries to insurance companies in Sweden, and give rise to a medical disability rate of 10% or more. Various studies of how the possibility of an insurance claim influences the course of a whiplash injury have produced quite different results, but generally there is no evidence of significant differences in outcome between those who have and have not sought claim.Ligament injuries can rarely be demonstrated acutely after whiplash trauma, and radiologically verified instability later in the course of the injury is also rare. Experimental studies have shown that whiplash trauma can lead to loads on discs and facet joints that might result in injury of these structures, but there is no scientific evidence to verify such injuries in patients with whiplash injury. Certain studies indicate that a dysfunction in the nervous system may exist in a small proportion of patients with whiplash injury.A series of physiological changes occurs in both the peripheral and the central nervous systems after whiplash injury, comprising peripheral as well as central sensitisation. There is no scientific evidence that such physiological changes are specific to the pain associated with whiplash injury; similar changes have been shown to occur in association with various other pain conditions, acute as well as long-term.It is likely that any previous mental ill-health and the patient's current mental state are both important for the clinical development and course of whiplash injury. To minimise the risk of long-term problems among people with acute whiplash injury, concurrently occurring acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) should be diagnosed and treated. It is also important to diagnose and adequately treat possible sleep disorder, depression, or anxiety among people with whiplash injury.Neck problems in terms of pain and stiffness, either with or without objective clinical findings such as decreased range of motion and tenderness at palpation (WAD grades I and II), are most common. Symptoms usually appear within the first day and up to a few days after whiplash trauma. Headache commonly occurs, along with pain in the shoulders and the thoracic spine. Neurological symptoms are present in approximately 20% of pat...

Joint position sense error in people with neck pain: A systematic review

“…In nine out of 14 included studies JPSE was assessed in participants with traumatic neck pain (Heikkil€ a and Wenngren, 1998;Kristjansson et al, 2003;Sterling et al, 2003;Treleaven et al, 2003;Armstrong et al, 2005;Feipel et al, 2006;Grip et al, 2007;Sjolander et al, 2008;Woodhouse and Vasseljen, 2008). Seven of those nine studies used the classification of the Quebec Task Force on Whiplash-Associated Disorders (WAD) (Spitzer et al, 1995;Rydevik et al, 2008). In this classification system, WAD grade 1 corresponds to complaints of neck pain, stiffness or tenderness only without physical signs that are noted by an examining physician; WAD grade 2 corresponds to complaints of neck pain and musculoskeletal signs, such as a decreased range of motion and point tenderness in the neck; and WAD grade 3 includes additional signs (decreased or absent deep tendon reflexes, weakness, and sensory deficits).…”

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial

“…Following cervical whiplash, neck pain can radiate to the spinal cord roots and has been linked with slight changes in median nerve function [1]. Cervical whiplash may also influence intervertebral discs, muscles, facet joints and ligaments, which may irritate surrounding nerve roots [2]. Therefore, neural responses and dysesthetic pain can appear in the absence of apparent nerve fibre or tissue damage [3].…”

The Enduring Controversy of Cervicogenic Vertigo, and Its Place among Positional Vertigo Syndromes

“…This possibility merits consideration because neck pain and vertigo are each very common human experiences, and even when each symptom results from an independently occurring etiology, the likelihood of temporal overlap (coincidence) by random distribution is not small. Neck pain is common and appears to be increasing; the prevalence among adults aged 25–84 in the US was 14.8% in 2002 and 17.2% in 2018 [ 11 ]; similar demographics are reported in other countries [ 12 ]. In the US, dizziness and vertigo accounted for 20.6 million ambulatory care visits per year in 2013–2015 [ 13 ], and for approximately 4 million emergency department visits in 2011 [ 14 ].…”

“…However, most injuries are not so focal as to affect the neck in isolation; in fact, whiplash—the most common neck injury, in whose context cervicogenic vertigo is suspected—is usually not a “pure neck injury.” Yacovino and Hain note that “Postwhiplash vertigo can combine several mechanisms. At the ear level, the otolith system is prone to suffer inertial damage” [ 6 ], and several authors have noted that benign paroxysmal positional vertigo can result from acceleration-deceleration injuries [ 12 , 17 , 18 ]. More broadly, “Dizziness following neck injury may be due to vestibular system pathologies, brain injury, or cervicogenic dizziness” [ 8 ], including “the ear (labyrinth contusion), the brainstem, the cortical and subcortical structures, and the vertebral arteries (traumatic artery dissection)” [ 6 ].…”

“…Perhaps the most popular theory about CV pertains to cervical proprioception. Note that “Proprioception is not a function of the superficial neck muscles but of the deep short intervertebral neck muscles, which are extensively supplied with muscle spindles” [ 1 ], and in fact, “Of all the muscles in the body, it is the deep neck muscles that have the highest concentration of muscle spindles” [ 12 ]. As a result, “The proprioceptive system of the cervical spine… is extremely well developed, as reflected by an abundance of mechanoreceptors, especially from the gamma-muscle spindles in the deep segmental upper cervical muscles” [ 47 ], and “The dense network of mechanoreceptors in the soft tissues in this region… gives the CNS information about the orientation of the head with respect to the rest of the body via direct neurophysiological connections to the vestibular and visual systems” [ 3 ].…”