Manifestations of Whiplash Injury
The symptoms stemming from a whiplash injury span various body regions and can display a delayed onset, taking weeks to manifest after the initial incident.
The most prevalent symptoms following a whiplash incident include:
Neck discomfort: The most frequently reported symptom.
Headaches: Reported in 50% to 75% of cases as the second most common symptom. These headaches typically originate at the base of the skull (occiput) and tend to spread toward the head's top and frontal regions. (44)
Jaw discomfort: Temporomandibular Dysfunction, or TMJ, is a common issue following a vehicular incident.
Facial discomfort: This could be direct or referred to as facial pain.
Shoulder discomfort: Often perceived as a rotator cuff injury.
Pain between the shoulder blades: Also known as inter-scapular pain.
Arm Discomfort: Arm discomfort could involve muscles, tendons, and ligaments or be due to nerve compression. It might also be referred spinal pain from an injured facet joint or spinal disc.
Further Symptoms of Whiplash
Paresthesia: These abnormal sensations in the neck, shoulders, upper back, and arms are common, appearing in 33% to 100% of whiplash patients.
Balance issues: Often associated with the upper cervical area.
Sleep disturbances: Between 39-89% of whiplash victims report disruptions in their sleep patterns.
Dizziness: Frequently connected to the upper cervical area, dizziness is prevalent in up to 70% of patients with chronic symptoms. Approximately 34% of whiplash patients suffer from benign paroxysmal positional vertigo (BPPV), potentially leading to genuine vertigo.
Fatigue: The level of fatigue can be extremely severe in some instances.
Lower back pain: This is a common occurrence in whiplash cases.
Concentration and memory: Concentration and memory issues could result from a concussion sustained during the accident.
Psychological changes: Depression and anxiety are common psychological alterations.
Tinnitus: Perceiving ringing, buzzing, whistling, or other noises in one or both ears.
Visual disturbances: For instance, sensitivity to light (related to adrenal stress).
Weakness: After a whiplash injury, 80% to 90% of patients report neck or upper extremities weakness.
Assessment Process After Motor Vehicle Injury
Conducting a comprehensive physical examination following any motor vehicle injury is crucial. Any delay could have severe implications, both for the injury resolution and potential legal compensation if litigation is necessary.
Orthopaedic Assessment
Cervical Examination
This video provides a detailed walkthrough of the examination process, including inspection and observation, palpation techniques, assessment of active and passive ranges of motion, and an orthopaedic examination focusing on the cervical region.
Key Elements of Peripheral Vascular
Examination A peripheral vascular examination is crucial in identifying indications of vascular-related disorders. Recognizing and treating Peripheral Vascular Disease (PVD) can help prevent cardiovascular and cerebrovascular health complications. This video highlights routine procedures we incorporate into our everyday clinical practice.
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.
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.
Effective Concussion Evaluation - VOMS
VOMS, or Vestibular Ocular Motor Screening, is a method specifically formulated to identify indicators of a concussion, whether from sports, impact tests, or general concussions. It investigates the coordination of balance, vision, and movement systems. VOMS examines five distinct domains of vestibular (balance) and ocular (vision) motor impairment.
HINTS Exam
The HINTS Exam serves as a diagnostic tool to distinguish benign peripheral disorders from central nervous system conditions, such as strokes. HINTS is an acronym for Head Impulse-Nystagmus-Test of Skew. The 'Head Impulse' component involves testing the function of the vestibulo-ocular reflex. A normal result on this test (HIT) strongly suggests that the cause of Acute Vestibular Syndrome is situated within the central nervous system.
Dix HallPike Maneuver - Vertigo
BPPV (Benign Paroxysmal Positional Vertigo) is among the leading causes of vertigo, characterized by a sudden feeling of spinning or the internal sensation of the head spinning. While BPPV vertigo can cause significant discomfort, it seldom poses a serious threat unless it heightens the risk of falls. This video will walk you through the Dix Hallpike maneuver, a fundamental step in diagnosing vertigo (BPPV).
Role of Diagnostic Imaging in Whiplash Assessment
Diagnostic imaging plays a crucial role in assessing the severity of soft-tissue damage and ruling out potential fractures following a whiplash injury. Depending on the specifics of the case, a range of imaging techniques might be employed, including X-rays, CT scans, ultrasound, and MRI.
X-rays
X-rays are typically the first line of imaging used, as they can quickly and effectively identify fractures or dislocations. However, they are less effective for identifying soft tissue injuries.
CT Scans
CT scans provide a more detailed image than X-rays and can better visualize both bone and soft tissues. These are useful when fractures are suspected but not clearly visible on an X-ray. However, they expose the patient to more radiation.
Ultrasound
Ultrasound imaging, on the other hand, is a safe, non-invasive method that can be used to assess soft tissue injuries. It uses sound waves to produce pictures of the inside of the body and can show movement of the internal tissues and organs, and blood flowing through blood vessels.
MRI
MRI scans offer the most comprehensive view of the body's internal structures. They are particularly useful for visualizing soft tissue damage, including damage to the muscles, ligaments, and intervertebral discs. However, they are more expensive and time-consuming than other imaging techniques.
Please note that while diagnostic imaging is critical, it's important to understand that for Grade 1 and Grade 2 Whiplash Associated Disorders (WAD), CT scans and MRIs are typically not employed.
It's crucial to remember that any signs of fracture or dislocation warrant immediate referral to an emergency medical department for further evaluation and treatment."
Classification and Rating of Whiplash Associated Disorders (WAD)
The classification of Whiplash Associated Disorders (WAD) is based on the criteria set forth by the Quebec Task Force. This rating system is utilized by insurance companies to ascertain the extent of coverage provided to an individual who has sustained an injury.
Here's a breakdown of the WAD grading system:
Grade 0: There are no complaints or physical signs related to the neck. Essentially, the individual does not report any neck pain, stiffness, or discomfort, and there are no observable physical signs of injury.
Grade 1: The individual complains of neck pain, stiffness, or tenderness, but there are no physical signs of injury. This means that while the individual might express discomfort or pain, a physical examination does not reveal any tangible signs of damage or trauma.
Grade 2: In addition to complaints of neck pain, there are also musculoskeletal signs present. These signs could include a decreased range of motion in the neck (which is a common symptom following a whiplash injury), as well as point tenderness. Point tenderness refers to a localized, sharp pain that occurs when a specific area is touched or pressure is applied.
Grade 3: At this level, the individual experiences neck discomfort and shows neurological signs. These neurological signs might include decreased or absent deep tendon reflexes, muscle weakness, and various sensory deficits, such as numbness or tingling in certain areas.
Grade 4: This is the most severe grade of WAD. It involves neck complaints and the presence of a fracture or dislocation. This means that the whiplash injury has led to significant structural damage in the neck, necessitating immediate and potentially intensive medical intervention.
The above classification is not just essential for insurance purposes but also guides the treatment approach and prognosis. Understanding the grade of WAD helps healthcare providers develop a tailored treatment plan to address the specific symptoms and injuries of the individual."
Conclusion
In conclusion, understanding the complexity and wide range of symptoms associated with whiplash injuries is crucial for effective diagnosis and treatment. From the immediate onset of neck pain to the delayed manifestation of psychological changes, the signs of whiplash are diverse and often interconnected. Moreover, various physical examination methods, from inspection to orthopaedic examination, are instrumental in assessing the severity of the injury.
We've also highlighted the essential role of diagnostic imaging in ruling out possible fractures and determining the extent of soft-tissue damage. Remember, Whiplash Associated Disorders are categorized into grades by the Quebec Task Force criterion, a classification system which helps determine the extent of insurance coverage for the injured party. In the following instalment, we will take a closer look at the conservative treatment approaches for managing these disorders. Stay tuned to learn more about addressing both soft-tissue and joint injuries resulting from whiplash.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.
As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
Please Note: References for all five sections of this article can be found at the end of Part Five.
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