Transcript Whiplash definition: neck pain experienced as a result of a motor vehicle collision or similar trauma Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas.

Whiplash
definition: neck pain experienced as a result of a motor
vehicle collision or similar trauma
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
whiplash injury: any structural
damage sustained because of
the whiplash forces
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
whiplash injury: it is the abnormal motion
between individual motion segments that has
the potential to injure facets, disks, and
ligaments
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
whiplash associated disorder:
variety of clinical symptoms other
than head, neck , and arm pain
that occur after a whiplash type
of trauma
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for
Whiplash Associated Disorders
Grade 0
No Complaint about the
neck No physical signs
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for
Whiplash Associated Disorders
Grade 1
Neck Complaint of pain ,
stifness or tenderness only
No physical signs
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for
Whiplash Associated Disorders
Grade 2
Neck Complaint and
musculoskeletal signs
(including decreased ROM
and point tenderness)
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for
Whiplash Associated Disorders
Grade 3
Neck Complaint and
neurological signs
(including decreased or absent
deep tendon reflexes, weakness,
and sensory deficit)
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for
Whiplash Associated Disorders
Grade 4
Neck Complaint and fracture or
dislocation
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
annual incidence ranges from 0,1 to 7 per
1000
financial burden results from the small
number of injuries that become chronic
patients with disabilities of more than 6
months account for 46% of the total cost
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Natural history:
In +/- 80% pain after MVC begins the day
of the collision
complete 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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Prognostic factors:
strongest indicator of poor outcome is
high initial intensity of pain
conflict in results regarding older age and
female sex
no prognostic differences in preinjury
psychological factors , work related
factors , litigation
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Prognostic factors:
consulting a lawyer results in lesser
chance on early claim settlement, longer
treatment and slightly worse function
in a no-fault no-tort system there is a
shorter time to case closure
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Clinical symptoms :
WAD including LBP , visual disturbances,
dizziness, tinnitus, weakness , fatigue ,
poor concentration , poor memory ,
difficulty sleeping , secondary
psychological changes
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
structural etiology
facet joint
49%-54% facet joints in chronic neck pain
60% facet joints in chronic neck pain and
headache
53% C2/C3 facet joint pain in case of
cervicogenic headache
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
structural etiology
disk ?
craniocervical ligaments?
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
acute neck pain
explanation, education, reassurance
no orthosis
« act as usual » as good as any other treatment
active excercises
conflicting results of SMT
NSAIDs
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
chronic neck pain
rehabilitation
injections
medication
spinal manipulative therapy
cervical orthosis
surgery
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
chronic neck pain
injections
level 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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
chronic neck pain
medication
Up 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
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
chronic neck pain
spinal manipulative therapy
No evidence concerning efficacy
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
chronic neck pain
cervical orthosis
No evidence for efficacy
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
Treatment:
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 !
Dr Gert Van Esbroeck
AZ Nikolaas Sint Niklaas
Whiplash
key references
spitzer wo, skovron ml, salmi lr et al: scientific monograph of the
Quebec Task Force on whiplash-associated disorders: redifining
whiplash and its management
Spine 1995;20:1S-73S
schofferman j, bogduk n, slosar p:chronic whiplash and whiplashassociated 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