Cervical Sprain & Strain Injuries Flashcards
Whiplash
Sudden, forceful hyperextension of the neck with flexion recoil
Usually from riding in a wehicle and being struck by another
Acceleration-deceleration injuries
Which groups are likely to obtain a serious injury from whiplash?
Women
Elderly
If there is significant underlying degenerative disc disease
What is the highest force the head and neck can experience in a whiplash injury?
8 Gs
It is better to brace yourself before an impact or not?
Not known, though some evidence says those who were intoxicated (relaxed) seemed to not be injured
The jolt syndrome
When the seat back in a car acts like a spring and magnifies the forward injury
What are the non-neck and shoulder whiplash type injuries?
Pelvis
Spine
Cranium
All segmentally-related structures
What are the biomechanics of whiplash?
Initially, all parts of the body move toward point of impact then recoil away from the point of impact
What are the osteopathic considerations in a whiplash injury?
X-ray and alteration of cervical lordosis Soft tissue warm and boggy Sacrum involvement Occiput and sacrum restriction Temporal bones vulnerable due to SCM
What types of areas may be injured in a whiplash causing accident?
Longitudinal arch of the foot
Ankle and knee
Posterior hip acetabulum
Anterior rotation of the innominate
Superior shear of a public bone unilaterally
Right lower costal cartilage (driver)
Structural and respiratory dysfunctions of lower right ribs
What could happen in a disc is damaged in a whiplash type injury?
Internal derangement of cervical disc architecture leading to late sequel of degenerative disc disease
Potential or disc herniation, most commonly C5-C6 disc
What would be seen in a whiplash injury that involved the brain?
Closed head injury:
Cerebral dysfinction
Cranial somatic dysfunction
Macro trauma
Initial symptoms are present immediately following injury
When would muscle hypertension develop in a whiplash injury?
2 to 3 days
How long might it take for all injuries to fully appear?
Up to one month
Where is pain often felt in the whiplash injuries (ligament)?
Ligamentum Nuchae
Especially C2 and T1
Partial or total ligament rupture
Where is pain often felt in the whiplash injuries (bone)?
Fracture
Avulsion fracture Spinous process of C2
Avulsion fracture Spinous process of T1
Compression fracture most commonly C5
What is posterior neck pain and muscle hypertonicity caused by?
Muscle overstretching (strain)
Reflex from injury to the anterior neck musculature, discs and ligaments
Guarding reaction to direct neural trauma
How can you obtain and significant range of motion loss?
Fracture
Sprain and strain
Disc herniation
Congenital anomalies (klippel-feil, block vertebrae)
What is the stated range of motion for flexion the neck?
60 degrees
45-90?
What is the stated range for extension of the neck?
75 degrees
45-90?
what is the stated range of motion for sidebending of the neck?
45 degrees
What is the stated range of motion for rotaton of the neck?
80 degrees
Where does half of the rotation of the neck occur at?
Atlanto-axial joint
What muscles are active in torticollis and what do they cause?
Sternocleidomastoid - head rotates away from side of injury, sidebends to
Scalene muscles - head rotates and sidebends towards side of injury
How could a pt obtain an occipital headache?
Suboccipital muscle injury
Irritation of greater & lesser occipital nerves
How is the somatovisceral reflex mediated?
Through the upper thoracic cord segments which provide the sympathetic never supply to the head, neck and upper extremities
Distortion of cranium
What is raynaud syndrome?
Vasospasm of the distal blood vessel of the upper extremity in response to a hypersympathecotonia, again emanating from the upper thoracic spinal cord segments
How could painful or difficulty swallowing be caused?
By direct stretching of the esopjagus over the anterior surface of the cervical spine
Potential for formation of retropharyngeal hematoma
(Dysgeusia/Dysphagia)
What causes wallenberg’s syndrome?
Injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis
What are some symptoms of wallenberg syndrome?
Homolateral facial pain or paresthesias Vertigo Vomiting Unilateral paralysis of the palate, pharynx and vocal cords Nystagmus intention tremor Ataxia with a tendency to fall toward the side of lesion Akinetic Mutism
What are some psychiatric repercussion of cervical strain and sprain?
Driving Phobia Depression Withdrawal Panic Attacks Anxiety
What should be measured in vital signs in a neck injury?
Pulse (stretch injury to the vagus n. or cervical sympathetics can alter pulse rate Blood pressure (stretch injury to carotid sinus and/or carotid body can inc or dec BP
What could happen in a cervical injury?
Injury to autonomic nerves can trigger dysrhythmias or coronary vasospasm
What do all pts need in terms of imaging in a neck injury?
X-ray
Cervical AP, lateral, oblique, open mouth views
What should be viewed in an imaging CT of a cervical spine?
Cervical spine - reserved for those with symptoms of nerve root injury and those with pain persisting without significant recovery beyond six weeks
Brain - reserved for neurologic symptoms not just headache
Special studies - retropharyngeal hematoma
When would you use cervical spine x-ray flexion and extension films?
6-12 weeks
Used to diagnose segmental instability
Recurrent segmental somatic dysfunction
What is the treatment for cervical sprain and strain?
Soft/hard collar
OMT adjacent to most severely injured (craium and sacrum)
NSAIDs
After inflam dec treat somatic dysfunction
What should you do if a pt has trigger points?
Inject botulinum toxin - type A
How long do most pts take to recover?
4-6 weeks
What percent of pts have not recovered at 6 months?
12%
What are risk factor for poor recovery?
Being hit by a truck Neck pain on palpation Pain or numbness radiating from neck to arms Headache Significant degenerative disc disease
Which heals better, “forward/lateral flexion” or “extension” injuries?
Extension
Grade 0 whiplash-associated disorder
No neck pain, stiffness, tenderness
Grade I whiplash-associated disorder
Neck pain, stiffness, tenderness (+)
Grade II whiplash-associated disorder
Neck pain, stiffness, tenderness (+), physical signs (+), musculoskeletal signs (+)
Grade III whiplash-associated disorder
Neck pain, stiffness, tenderness (+), physical signs (+), Musculoskeletal signs (+/-), neurological signs (+)
Grade IV whiplash-associated disorder
Neck pain, stiffness, tenderness (+), physical signs (+), neurological signs (+/-), fracture/dislocation (+)
