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Whiplash Injury

  1. It is the acceleration, deacceleration injury of the cervical spine caused usually by rear end collision, in which occupants body is thrown forwards and the head jerked backwards with hyperextension of the lower cervical spine. However it can also occur with flexion and rotation injuries.
  1. It commonly affects cervical column and rarely Lumbo- dorsal columns.
  2. It most commonly presents as soft tissue sprain & strain (wrenching injuries) of the neck usually causing restriction of range of all movements of the cervical spine with pain and spasm. But rarely radicuiar signs, neurological deficit and fracture.
  3. Etio - Pathology
    Hyperextension of lower cervical spine causing - anterior longitudinal ligament sprain ± rupture,sprain of the capsular fibres of the facet joints. and rarely disc disruption at epiphyseal plate, minor posterior longitudinal ligament sprain, extradural haemorrhage, fracture of spinous processes and petechial haemorrhage in spinal cord.
  4. Clinical Presentation
    1. Pain is typically the one unifying feature, usually appears with the next 12 - 48 hrs, or occasionally only several days later. It sometimes radiates to the shoulder or interscapular area.
    2. Stiffness of the neck, local tenderness and decreased range of motion
    3. Headache (typically occipital), dizziness, blurring of vision, temporomandibular discomfort (jaw pain), tinnitus, difficulty in balance, and even vertigo
    4. Paresthesias in ulnar distribution d/t nerve root compression secondary to scalenus muscle spasm.
    5. Hoarseness and dysphagia secondary to retrophaiyngeal hematoma.
    6. The cervical zygapophyseal joint and facet joint capsule have been implicated as a source of chronic pain.
    7. Neurological deficits, fractures and dislocations are uncommon.
    8. Quebec Task Force is the severity grading system of whiplash associated disorders
  5. Investigations
    1. X-ray appearances are usually normal
    2. Straightening out or reversal of the normal cervical lordosis, a sign of muscle spasm and subtle signs of instability may also be present.
    3. Neurological signs (muscle weakness, wasting, loss of sensibility and depressed reflex) is an indication for MRI
  6. Treatment
    1. Initial bed rest, NSAIDs, & soft collar immobilization.
    2. Gradual exercise - Gradual increment in range of motion in all directions.
    3. Posterior fusion of one or two level for unstable spine.

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