Whiplash - acute cervical spinal conditions

Question 1

How is whiplash defined?

Answer 1

NIH - “An acceleration-deceleration mechanism of energy of transfer to the neck”

May result from front rear-end or side-impact motor vehicle collisions but can also occur during diving/mishaps.

Results in bony or soft-tissue injuries which can lead to Whiplash-Associated Disorders.

Question 2

How is a whiplash injury classified?

Answer 2

WAD → no pain complaints + no findings
WAD 1 → neck pain, tenderness + stiffness, no signs on examination.
WAD 2A → neck pain, loss of ROM, abnormal muscle activity patterns, very sensitive to movement and pressure
WAD 2B → 2A plus psychological distress
WAD 2C → 2B plus lowered awareness of neck pos, increased sensitivity to cold, heat and movement. Potential changes in heating, reactions to cold + heat. PTS syndrome
WAD 3 → As 2c plus neurological signs
WAD 4 → Fracture or dislocation of the neck, which is an outside diagnosis of whiplash - requires emergency medical attention

Question 3

Mechanism of whiplash?

Answer 3

• upper and lower spine experience - increased cervical lordosis
• flexion of lower vert. gradually leads to flexion in upper vertebrae
• neck is completely flexed with shearing force causing potential damage to IVD and joints

Question 4

What anatomical structures can be injured in a rear-end collision and why?

Answer 4

→ Anterior longitudinal ligament + discs
- strains in annulus fibrosis of lower cervical discs
- apical legs. cx flexion + extension occurs mainly at the A-O joints

→ Dorsal root ganglion
- rapid changes in canal pressure which are caused due to rapid head motions from impact

→ Vertebral artery
- intimal tear
- most often at C1-2
- suggested cause = cervical spine extension combined with axial rotation beyond physical limit

→ Muscles (sternocleidomastoid, semispinalis capitis etc.)
- impact induced lengthening caused by reflex neck muscle activation

Question 5

What structures are stretched during hyperextension?

Answer 5

sternomastoid, ALL, anterior muscle structures

Question 6

What structures are compressed during hyper extension?

Answer 6

IV disc, lig. flav, interspinous lig, zygapophyseal facet joints, could lead to fracture

Question 7

What structures are stretches in hyper flexion?

Answer 7

Nuchal lig, PLL, levator scap, erector spinae, interspinous lig. , trapezius

Question 8

What structures are compressed during hyeprflexion?

Answer 8

anterior disc structures - could lead to herniation