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  • Cervical acceleration–deceleration injury (CAD)

  • Neck sprain

  • Neck strain

  • Whiplash associated disorders (WAD)


  • 847.0 Sprain of neck


  • S13.4XXA Sprain of ligaments of cervical spine, initial encounter

  • S13.8XXA Sprain of joints and ligaments of other parts of neck, initial encounter


  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, And Range Of Motion Associated with Connective Tissue Dysfunction1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation


A 43-year-old male presents with reports of generalized neck pain and stiffness 9 days post motor vehicle accident. The patient was traveling approximately 30 miles per hour when his vehicle collided with another vehicle. The patient received cervical spine and open mouth radiographs in the hospital emergency department revealing no abnormalities. Currently, cervical range of motion is limited in all directions with axial cervical spine pain. Hypertonicity is noted in the cervical musculature particularly bilateral sternocleidomastoid and scalenes. Instability testing is negative but craniocervical flexion testing reveals impaired longus colli and capitis control with movement generated by anterior scalene and sternocleidomastoid. Encouragement and education appears to help the patient increase cervical spine movement.



  • WAD: Injury dysfunction and symptoms

  • Cervical acceleration–deceleration injury (CAD): Mechanism of injury

  • Traumatic neck pain from being hit from behind

  • Quick movement through a S curve causing upper cervical flexion and lower cervical hyperextension2

  • Post-traumatic mechanism of injury to the head/neck, most commonly secondary to motor vehicle accident3

  • Injury to the soft tissues, joint capsule and ligaments, zygapophyseal joint, central or peripheral neurologic systems, intervertebral disk, posterior (dorsal) root ganglia, vascular structures (verterbrobasilar arteries), and visceral structures (secondary to ruptures or contusions)3

FIGURE 144-1

Extension injury (Whiplash) of the cervical spine. Violent impact from behind produces rapid translation between three sequential positions, causing rupture of the ligamentum nuchae. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

FIGURE 144-2

The outstanding feature of this sagittal section T2-weighted MR image is the increased signal intensity consistent with edema from soft tissue injury. The presence of such findings warrants particular caution to examine scrupulously for the presence of fractures. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

FIGURE 144-3

Algorithm for management of patients with cervical strain. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. Copyright © The McGraw-Hill ...

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