RESOLVING WHIPLASH INJURIES PART 3 – SYMPTOMS, EXAMINATION & WAD CATEGORIZATION

Updated: 3 hours ago


Symptoms of a Whiplash Injury


The symptoms of a whiplash injury are varied, covering large regions of the body. Many of these symptoms do not come on immediately, often taking weeks to develop after the initial accident.

The most predominant symptoms after a whiplash accident are: (16)

  • Neck pain – This is the most commonly reported symptom.

  • Headaches – The second most commonly reported symptom, occurs in 50% to 75% of cases. These headaches usually manifest on one side of the head, and often begin at the base of the skull (occiput). The pain often radiates to the top of the head and frontal regions of the skull. (44)

  • Jaw painTMJ Temporomandibular Dysfunction commonly occurs after a vehicular accident.

  • Facial pain – This can be either direct or referred pain to the face.

  • Shoulder pain – This often presents as a rotator cuff injury.

  • Shoulder blade pain – This is pain between the shoulder blades - interscapular pain.

  • Arm pain – Arm pain can involve muscles, tendons and ligaments or it can be due to nerve compression. It can also result from referred spinal pain from an injured facet joint or spinal disc.


Additional Whiplash Symptoms


  • Paresthesia’s - Paresthesia’s (abnormal sensations) of the neck, shoulders, upper back, and arms are common in 33 to 100% of whiplash patients. (49)

  • Balance problems – This is often upper cervical related.

  • Sleep disturbances – 39-89% of whiplash report disturbances in their sleeping patterns. (45)

  • Dizziness – Often related to the upper cervical area (48), dizziness can appear in up to 70% of patients who have chronic symptoms. (46) About 34% of patients with whiplash injury suffer from benign paroxysmal positional vertigo (BPPV), which can eventually lead to true vertigo. (47)

  • Fatigue – The degree of fatigue (in some cases) can be very severe.

  • Low back pain is common in whiplash cases.

  • Poor concentration, loss of memory - These could possibly be due to a concussion resulting from the accident.

  • Psychological changes - Depression and anxiety are common psychological changes .

  • Tinnitus - Ringing, buzzing, whistling, or other noises that are heard in one or both ears.

  • Visual disturbances – An example would be sensitivity to light (Adrenal stress). (48)

  • Weakness – 80 to 90% of patients experience weakness in the neck or upper extremity after a whiplash injury. (51)

 

PHYSICAL EXAMINATION PROCESS

It is imperative to perform a thorough physical examination after any motor vehicle injury. Delaying this could have significant consequences, both for resolving the injury, and if required, for seeking future compensation in cases of litigation.


Orthopaedic Assessment

Cervical Examination

This video goes through inspection and observation, palpation, Active and Passive Ranges of motion, and orthopaedic examination of the cervical region.




Peripheral Vascular Examination - Key Points


A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video we go over some of the common procedures we perform in daily clinical practice. This video is available for the public on November 14/2022.


 

Neurological Assessment


Cranial Nerve Examination - 12 Cranial Nerves

The Cranial Nerve examination is one of the ways that we assess sensory and motor dysfunction. We commonly perform this examination on all new patients. (Available Sept 2/2022)



Upper Limb Neuro Exam

The upper limb neurological examination is part of the over all neurological examination process, and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool. (Available Oct 7/2022)


Effective Concussion Evaluation - VOMS

VOMS is a tool designed to detect signs and symptoms of a concussion (sports, impact concussion testing, general concussions). VOMS stands for vestibular ocular motor screening and looks at the systems integrating balance, vision, and movement. VOMS tests for five areas of vestibular (balance) and ocular (vision) motor impairment.


HINTS Exam

The HINTS Exam is used to differentiate benign peripheral conditions from a problem in the central nervous system, lesions like a stroke. HINTS stands for Head Impulse-Nystagmus-Test of Skew. Head Impulse: test of vestibulo-ocular reflex function. A normal Head Impulse test (HIT) strongly indicates a central localization for the Acute Vestibular Syndrome.


Dix HallPike Maneuver - Vertigo

BPPV (Benign Paroxysmal Positional Vertigo) is one of the most common causes of vertigo (Benign Vertigo). Vertigo is the sudden sensation that you're spinning, or that the inside of your head is spinning. Although BPPV vertigo can be very troublesome, it is a condition that is rarely serious unless there is an increased risk of falling. In this video, we will review the Dix HallPike maneuver. This maneuver is a great starting point for diagnosing vertigo (BPPV).

 

Diagnostic imaging

Diagnostic imaging is also very important to rule out possible fractures, and to diagnose the degree of soft-tissue damage. Depending on the case, this may include X-rays, CT scans, ultrasound and MRI.


Note:

  • Fracture or dislocation warrants immediate referral to an emergency medical department.

  • CT scans and MRI are typically not used for Grade 1 and Grade 2 WAD.



 


WAD RATING CRITERION


Whiplash Associated Disorders are rated according to the Quebec Task Force criterion. The rating given is used by insurance companies to determine the extent of coverage provided to the injured party. (27)


Grade of WAD - Classification

  • 0 - No complaint about the neck. No physical signs.

  • 1 - Complaint of neck pain, stiffness or tenderness only. No physical signs of injury.

  • 2 - Neck complaint and musculoskeletal signs. Musculoskeletal signs include decreased range-of-motion and point tenderness.

  • 3 - Neck complaint and neurological signs. Neurological signs include, decreased or absent deep tendon reflexes, muscle weakness, and various sensory deficits.

  • 4 - Neck complaint and fracture or dislocation.

 

Part Four: In Part Four of “Resolving Whiplash Injuries” I will discuss conservative treatment of WAD and provide demonstration videos about how to address both soft-tissue and joint injuries.



Note: All references are at the end of RESOLVING WHIPLASH INJURIES Part 5

 

DR. BRIAN ABELSON DC.

Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.

Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.


 

Make Your Appointment Today!

Make an appointment with our incredible team at Kinetic Health in NW Calgary, Alberta. Call Kinetic Health at 403-241-3772 to make an appointment today, or just click the MSR logo to right. We look forward to seeing you!





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