Whiplash Associated Disorders
|
Original Editor - Your name will be added here if you created the original content for this page. Lead Editors - Your name will be added here if you are a lead editor on this page. Read more. |
Clinically Relevant Anatomy
[edit | edit source]
Whiplash and whiplash associated disorders (WAD) affects variable areas of the cervical spine, depending on the force and direction of impact as well as many other factors. In a whiplash injury, bony structures, ligamentous structures, muscles, neurological structures, and other connective tissue may be affected. Anatomic causes of pain can be any of these structures, with the strain injury resulting in secondary edema, hemorrhage, and inflammation.
Mechanism of Injury / Pathological Process
[edit | edit source]
The mechanism of injury is variable, usually involving a motor vehicle accident but also including causes such as sports injury, child abuse, blows to the head from a falling object, or similar accelleration-decceleration event.
Clinical Presentation[edit | edit source]
The most common presentation will be sub-occipital headaches and/or neck pain that is constant or motion-induced. There may be up to 48 hrs delay of symptom onset from the initial injury. Other signs include neurologic signs, dizziness, tinnitus, visual disturbances, UE radicular pain, difficulty sleeping due to pain, and difficulty concentrating/poor memory. (eMedicine) It is important to provide a thorough spinal exam and neurologic exam in patient with WAD to screen for delayed-onset of cervical spine instability or myelopathy. [1]
QTFC (Quebec Task Force Classification)
[edit | edit source]
| QTFC Grade |
Clinical presentation |
| 0 |
No complaint about neck pain No physical signs |
| I |
Nec complaints of pain, stiffness or tenderness only No physical signs |
| II |
Neck complaint Musculoskeletal signs including
|
| III |
Neck complaint Musculosceletal signs Neurological signs including:
|
| IV |
Neck complaint and fracture or dislocation |
MQTFC (Modified Quebec Task Force Classification) [2]
|
Proposed classification grade |
Physical and psychological impairments present |
| WAD 0 |
No complaints about neck pain No physical signs |
| WAD I |
No complaints of pain, stiffness or tenderness only No physical signs |
| WAD IIA |
Neck complaint Motor impairment
Sensory Impairment
|
| WAD IIB |
Neck complaint Motor impairment
Sensory Impairment
Psychological impairment
|
| WAD IIC |
Neck complaint
Motor impairment
Sensory Impairment
Psychological impairment
|
| WAD III |
Neck complaint Motor impairment
Sensory Impairment
Neurological signs of conduction loss including:
Psychological impairment
|
| WAD IV |
Fracture or dislocation |
Diagnostic Procedures[edit | edit source]
Canadian C-Spine Rule (CCR): algorithm to determine the necessity for cervical spine radiography in alert and stable patients presenting with trauma and cervical spine injury. [3]
Management / Interventions
[edit | edit source]
Management approaches for patients with WAD are poorly researched. These patients often do not fit into treatment categories as defined for other cervical pain problems due to multiple factors, and even within the WAD group there are multiple variances which warrant individualized treatment approaches. The most recent evidence supports the use of Sterling's classification system for WAD. [4]
Differential Diagnosis
[edit | edit source]
Cervical radiculopathy
Facticious disorder
Polymyalgia Rheumatica
Traumatic Brain Injury
Cervical herniated disk
Cervical myelopathy
Cervical osteoarthritis
Infection or osteomyelitis
Inflammatory rheumatologic disease
Malingering
Psychogenic pain disorder
Referred pain from cardiothoracic structures
Tumor or malignancy of cervical spine
Vascular abnormality of cervical structures
Key Evidence[edit | edit source]
Resources
[edit | edit source]
www.som.uq.edu.au/whiplash
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Delfini R, Dorizzi A, Facchinetti G, Faccioli F, Galzio R, Vangelista T. Delayed post-traumatic cervical instability. Surg Neurol. 1999;51:588-95.
- ↑ Sterling M., Man Ther. 2004 May;9(2):60-70. A proposed new classification system for whiplash associated disorders--implications for assessment and management.
- ↑ Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holoroyd B, Lesiuk H, Wells GA. The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26): 2510-2518.
- ↑ Sterling M, Jull G, Kenardy J. Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. Pain. 2006;122:102-108.
