Whiplash

• Neck sprain
• Neck strain

• 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

Description

• Whiplash-associated disorders (WAD): injury dysfunction and symptoms
• Cervical acceleration-deceleration injury (CAD): mechanism of injury
• Traumatic neck pain from being hit from behind
• Quick movement through an 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

Essentials of Diagnosis

• Symptoms may be delayed for 24 hours2
• Quebec task force grade levels
• Diagnosis made by clinical examination and patient history

General Considerations

• More common in women than men, possibly from neck muscle strength and stability
• Pain may become chronic if musculature strength not regained

Demographics

• Women appear to be at greater risk secondary to less stiffness of the cervical structures4

Signs and Symptoms

• Neck pain5
• Muscle pain5
• Stiffness
• Headaches, 50% to 60%5
• Dizziness
• Generalized neck and upper back pain, typically absent of radiculopathy
• Ringing in the ears
• Blurred vision
• Sleep disturbance
• Guarded and limited active motion of the cervical spine
• Hypertonic surrounding musculature
• Compensatory neck motion initiated by global cervical musculature, including sternocleidomastoid and scalenes
• Potential sympathetic symptoms
• Post-traumatic psychosocial impairments

Functional Implications

• Difficulty maintaining sustained sitting postures

Possible Contributing Causes

• Occupation that requires prolonged sitting postures including desk work, driving, horseback riding falls, and overhead activities
• Trauma from auto accident, physical abuse, contact sports

Differential Diagnosis

• Cervical fracture including C2 hangman fracture
• Odontoid process fracture
• Examine for complete loss of neck movement, pain with gentle compression/traction, and severe muscle spasm
• Subcranial instability
• Cervical radiculopathy

Imaging

• Plain film open mouth radiograph essential to rule out odontoid fracture
• CT Imaging essential to rule out odontoid fracture
• Radiograph and CT helpful to rule out c-spine factures
• MRI often negative in the presence of clinical impairments and significant pain with the absence of neurologic involvement6

• Severe muscle spasm, muscle weakness, or pain upon gentle compression of the cervical spine may indicate fracture1

Medication

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids

• For imaging and surgical consult if fracture/instability is suspected
• For pain medication if self-care measures insufficient
• For psychological consult if post traumatic stress suspected

• Guarded active cervical spine motion secondary to hypertonic musculature
• Hypermobile ...