Exam 2: Whiplash Flashcards
Whiplash describes a mechanism in which
Neck is whipped in one direction and recoils in opp direction
____% of those involved in rear-end accidents experience neck injury
25-33%
Most likely group to be injured by whiplash
Females, 20-24
1 month post accident, __% had residual neck pain
6%
2 years post accident, ___% had residual neck pain
66%
Identifying the mechanism of injury is crucial:
- Direction of force
- Patients position
- Relationship of head/spine
- State of tension in neck muscles
Most important factor in mechanism of whiplash injury
Patient’s position
For an object w/ multiple segments, distal end moves at _____ than prox end
Greater velocity
The more segments, the ____ of the distal end
Greater the velocity
Likely sites of injury from whiplash
Facet joints/capsules Vertebral endplates Spinal ligs IVDs Neck muscles Vertebral arteries
Facet joints mechanisms of injury
Pinching of synovial fluid
Strain of capsule
When subject to compressive load, first structure to fail is the
Endplate
25% reduction in bone mass causes ___% decrease in strength in vertebral endplate
50%
Ligaments more vulnerable during rear impacts
ALL (C3/4-C7/T1)
Alar and transverse ligs
Alar and transverse lig injuries are more severe when
Head is turned
Disc more vulnerable in rear impacts
C5-6 disc
Vulnerable at lower speeds
Ligaments more vulnerable to front impacts
Supraspinous
Ligamentum nuchae
Interspinous
Lig flavum
Discs vulnerable during front impacts
C2/3 — C7/T1
C5/6 = most vulnerable
Superficial muscles damaged w/ whiplash injury
SCM
Trapezius
SCM damaged during
Hyperextension
Trapezius damaged during
Hyperflexion
Deeper muscles damaged during whiplash injuries
Splenius Semispinalis Longissimus Scalenes Longus
Vertebral artery _____ is one explanation for some of the CAD injury symptoms
Insufficiency
Abnormal pressure or tractional stresses may impede
Circulation
Vertebral arteries are most susceptible to injury at
Posterior AO membrane
Space btw occ and posterior arch
Btw lateral mass and TP of C2
Space between occiput and posterior arch most susceptible during
Extension
Between lateral mass and TP of C2 most susceptible during
Rotation and extension
Grading system of whiplash injury
5 point grading system
WAD-0
No signs/symptoms
WAD-1
Complaints of:
-pain
-stiffness/tenderness
No physical signs noted
WAD-2
Complaints
Dec ROM
Point tenderness
WAD-3
Complaints + neuro signs
- dec deep tendon reflexes
- weakness/sensory deficits
WAD-4
Fracture/dislocation
Cord injury
Imaging guidelines
Candian C-Spine rules
NEXUS C-Spine Criteria
Concussion and subdural hematoma can occur with or without
Head strike
