1- Whiplash (Boesler) Flashcards
Which of the following about “whiplash” is false:
a) it is an acceleration/deceleration injury
b) it is an acute hyperextension/hyperflexion injury of the cervical spine
c) Tissue injury can happy at as low as 7 miles per hour
d) It is an non-inertial injury that extends all the way to the thoracic spine.
d) It is an non-inertial injury that extends all the way to the thoracic spine.
It is an non- inertial injury and it may extend all the way to the lumbar spine (lower back pain)
Whiplash is an insult to the ENTIRE body.
A 66-year-old female presents to your office following an MVA two days prior, where she was rear-ended while at a red light. She was driving, and her daughter was in the passenger seat. She went to the ED that day where X- rays of her cervical spine were taken and read as negative. Today she presents to you complaining of right arm weakness and paresthesias, and episodes of dizziness and vertigo. What problems do you suspect she has?
Thoracic outlet syndrome
Bulging disk
and Carotid artery stenosis
A patient comes in to the clinic complaining of knee pain. the only thing remarkable on their history is a car accident 6 weeks ago. Could the knee pain be related to the car accident? What should you do?
YES. It can be. So… it is IMPORTANT to try to reconstruct the events of the accident AND document them.
Which causes the greatest amount of injury: hyperextension or hyperflexion?
Hyperextension!
Hyperflexion can occur within the anatomical barrier.
A 38 yo patient comes in complaining of torticollis (injury to the SCM) and problems swallowing after they were in the car accident. You notice that they have a retropharyngeal hematoma. What kind of injury is this?
Hyperextension injury!
A 22 yo patient comes into your clinic complaining of tension in their neck and blurry vision after a car accident. You notice that the suboccipital muscles, trapezius, and latissimus mm are tense. What kind of injury is this?
Hyperflexion injury!
Which of the following cannot apply to a hyperextension accident?
a) posterior compression of vertebrae
b) posterior disk herniation
c) spinous process fracture
d) facet impingement
b) posterior disk herniation
[This is a hyperflexion issue]
Which of the following cannot apply to a hyperflexion accident?
a) anterior compression w/ vertebral body fracture
b) posterior disk herniation
c) strain of supraspinous ligament
d) facet impingement
d) facet impingement
Distinguish which of the following belong to hyperextension & hyperflexion:
a) greater and lesser occipital nerves
b) Anterior & Middle scalenes
c) Brachial plexus
d) Suboccipital nerve irritation / headaches
Hyperflexion (Posterior nerve Injury)
a) greater and lesser occipital nerves
d) Suboccipital nerve irritation / headaches
Hyperextension (Anterior nerve injury)
b) Anterior & Middle scalenes
c) Brachial plexus
A 80 yo patient walks in complaining of wanting to pass out every time they turn their head. Other symptoms include vertigo, syncope, and nystagmus on rotation of the head. What do you think is the problem? What test would you do?
Vertebral artery compromised @ C1 - C2
Wallenburg / Decline Test
[don’t hyperextend your head at the salon!]
A patient come in complaining of headache, restlessness, insomnia and crazy mood changes (like serious high to low to high changes). They casually mentioned that they were in a car accident last week. What do you ask them? What should you be worried of?
You need to ask them: DID you hit your head??
You should be worried about CEREBRAL involvement.
Which of the following does not make the type or degree of injury worse?
a) greater force of impact
b) rotating head to talking to child
c) gripping the steering wheel very tightly
d) not being aware of impending accident
e) head rest level at the level of occiput
f) DJD
g) osteoporosis
d) not being aware of impending accident
Generally when people are aware of the accident, they brace themselves, which makes things worse.
What can happen to the thoracic and lumbar spines after a car accident?
The spine can be flattened! You will lose the lordotic and kyphotic curves.
What can happen to the rib cage in a car accident, especially if they were wearing a seat belt? They can get locked down into what position?
Their ribs can get “locked down” into [exhalation].
A 39 yo m patient comes in with acute muscle contraction. He complains about being unable to rotate his neck and pain that radiates throughout his upper back. Upon touch, you notice that the tissues are warm and edematous with slight ecchymosis. If you had to estimate what stage of whiplash the man has, what would you say to impress him? Also, how do you treat him?
Sir, was your accident up to 7 days ago? This is the ACUTE stage!
Treatment: OMT ICE NSAID Analgesic LIMITED ACTIVITY
