Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas Whiplash definition: neck pain experienced as a result...

Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas

Whiplash

definition: neck pain experienced as a result of a motor

vehicle collision or similar trauma


Whiplash


Whiplash

whiplash injury: any structural damage sustained because of

the whiplash forces


Whiplash

whiplash injury: it is the abnormal motion between individual motion segments that has

the potential to injure facets, disks, and ligaments


Whiplash

whiplash associated disorder: variety of clinical symptoms other than head, neck , and arm pain that occur after a whiplash type

of trauma


Whiplash

The Quebec Classification for Whiplash Associated Disorders

Grade 0 No Complaint about the neck No physical signs


Whiplash


Grade 1 Neck Complaint of pain , stifness or tenderness only

No physical signs


Whiplash


Grade 2 Neck Complaint and musculoskeletal signs

(including decreased ROM and point tenderness)


Whiplash


Grade 3 Neck Complaint and neurological signs

(including decreased or absent deep tendon reflexes, weakness,

and sensory deficit)


Whiplash


Grade 4 Neck Complaint and fracture or dislocation


Whiplash

annual incidence ranges from 0,1 to 7 per 1000

financial burden results from the small number of injuries that become chronicpatients with disabilities of more than 6

months account for 46% of the total cost


Whiplash

15% to 40% of patients with acute neck pain after MVC develop chronic pain

5% to 7% of patients become permanently

partially or totally disabled


Whiplash

Natural history:In +/- 80% pain after MVC begins the day

of the collisioncomplete recovery occurs in 60 to 85% of

patients 5% to 12 % experience chronic moderate

to severe pain 5% to 10% have permanent partial or total

disability


Whiplash

Prognostic factors:strongest indicator of poor outcome is

high initial intensity of painconflict in results regarding older age and

female sex no prognostic differences in preinjury psychological factors , work related

factors , litigation


Whiplash

Prognostic factors:consulting a lawyer results in lesser

chance on early claim settlement, longer treatment and slightly worse functionin a no-fault no-tort system there is a

shorter time to case closure


Whiplash

Clinical symptoms :

acute vs chronic neck pain (i.e. Pain that persists beyond 6 months)

location: midline, uni- or bilateral , trapezius, shoulder, interscapular , arm or

face


Whiplash

Clinical symptoms :

Headache is the second most common symptom

involves the base of the skull and radiates to the crown of the head and the frontal

region


Whiplash

Clinical symptoms :

WAD including LBP , visual disturbances, dizziness, tinnitus, weakness , fatigue ,

poor concentration , poor memory , difficulty sleeping , secondary

psychological changes


Whiplash

structural etiologyfacet joint

49%-54% facet joints in chronic neck pain 60% facet joints in chronic neck pain and

headache53% C2/C3 facet joint pain in case of

cervicogenic headache


Whiplash

structural etiologydisk ?

craniocervical ligaments?


Whiplash

Treatment:acute neck pain

explanation, education, reassuranceno orthosis

« act as usual » as good as any other treatmentactive excercises

conflicting results of SMTNSAIDs


WhiplashTreatment:

chronic neck pain rehabilitation

injections

medication

spinal manipulative therapy

cervical orthosis

surgery


WhiplashTreatment:

chronic neck pain rehabilitation

strength training and endurance training

intensive excercises are more effective than light excercises but not more effective than ordinary activity

behavior modification : overcoming fear avoidance


WhiplashTreatment:

chronic neck pain

injectionslevel 1 evidence for efficacy of RFN for pain arising from facet

joints

Complete pain relief is possible with pure facet joint pain and in 86% of patients with facet-joint mediated cervicogenic

headache

Median of 270-400 days pain relief

Corticosteroid injection of facet joints only short term relief

No place for epidural infiltrations


WhiplashTreatment:

chronic neck pain

medicationUp to 3 trials of different NSAIDs (2wks), when response is

meaningful drug should be continued

Opioid analgesics

No evidence for the use of TCA nor anticonvulsants


WhiplashTreatment:

chronic neck pain

spinal manipulative therapy

No evidence concerning efficacy


WhiplashTreatment:

chronic neck paincervical orthosis

No evidence for efficacy


WhiplashTreatment:

chronic neck pain surgery

Surgery may be considered for the patient wih severe pain, significant impairment and good psychological health who has

not improved with high quality non-surgical care

Diskography?

? Science , pff !


Whiplashkey references

spitzer wo, skovron ml, salmi lr et al: scientific monograph of the Quebec Task Force on whiplash-associated disorders: redifining

whiplash and its managementSpine 1995;20:1S-73S

schofferman j, bogduk n, slosar p:chronic whiplash and whiplash-associated disorders: an evidence based approach

Journal of the AAOS;vol 15, October 2007,No 10, pp 596-606

Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas Whiplash definition: neck pain experienced as a result...

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