Whiplash Injury Presented To Amled 1.12.06

Whiplash Injury.

Dr. Christopher A. Jenner MB BS, FRCAConsultant in Pain Medicine, St Mary’s Hospital, W2

Director, London Pain Consultants1st December 2006

Agenda

• Definition

• Clinical findings

• Management

• Prognosis

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Definition

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Definition

• Soft tissue injury to the neck

• Sudden Extension-Flexion injury

• Whip-like movement

• Collection of symptoms

Causes

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Causes

• RTA commonly- front/ back/ side

• Contact sport injuries

• Accidental/ intentional blows to head

Causes

• Repetitive stress injuries to neck (eg: phone)

• Child abuse- shaking, hitting

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Incidence

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Incidence

• US National Highway Traffic Safety Administration (1995)

• 53% of 5.5 million RTA victims suffered whiplash injury

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Soft Tissue Damage

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Soft Tissue Damage

• Ligaments

• Tendons

• Muscles

• Intervertebral discs

• Facet Joints

• Nerve roots

Serious

• Spine injuries

• Spinal Cord injury

Clinical

Symptoms and Signs

• Pain

• Stiffness

• ↓ ROM

Symptoms and Signs

• Nervous system- local

- abnormal sensations arms (burning/ paraesthesia)

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Symptoms and Signs

• Nervous system- general

dizziness headache blurred vision pain on swallowing ringing in ears irritability tinnitus

Symptoms and Signs

• Psychological-

memory loss

cognitive impairment

sleep disturbance

fatigue

depression

PTSD

Symptoms and Signs

• Secondary Myofacial Pain Syndrome (Fibromyalgia)

• Lower Back Pain

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Symptoms and Signs

• Whiplash syndrome-

continual headache

pain

reduced movement

tingling

lumbar pains

fatigue

sleep disturbance

Investigations

Investigations

• X-rays- exclude #

• CT

• MRI

Management

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Overall Aim

• Pain-free window

• Rehabilitation

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Management

• Medication

• Physical Therapy/ Rehabilitation

• Minimally Invasive Pain Management Procedures

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Medication

Medication

• Pharmacological

• WHO ladder (amended from cancer)

Step 1 paracetamol/ NSAID/ COX 2

Step 2 + weak opioids

Step 3 + strong opioids

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Medication

• Adequate medication- regularly, prevent breakthrough pain

• Muscle relaxant- Diazepam/ similar

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Physical Therapy/ Rehabilitation

Physical Therapy/ Rehabilitation

• Chris Pinches- Specialist Spinal PxTx at Central Health PxTx….

• Deep stability muscles

• Inhibitory interneurones and ascending nociceptor inputs

• EMG studies

• Retraining dysfunctions…..

Physical Therapy/ Rehabilitation

• Clear red flags – C-spine instability/ #

• Adequate medication- regularly, prevent breakthrough pain

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Physical Therapy/ Rehabilitation

• Keep neck moving as normally as possible!

• Collars not recommended

• Gentle mobilisation

Physical Therapy/ Rehabilitation

• Avoid ‘stiffening-up’

• Studies- quicker recovery with gentle exercise

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Physical Therapy/ Rehabilitation

• Pacing activities

• Fear avoidance

• Catastrophising- not torn muscle/ severe

Other

• Physical- heat/ cold/ TENS/ hydro/ supports/ US/ IR/ firm supportive pillow/ good posture

• Manipulation- PxTx/ chiropracter/ osteopathy/ deep tissue massage

Minimally Invasive Pain Management

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Cervical and Thoracic facet joint injections

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Trigger Point Injections

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1. Dry Needling

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…otherwise known as…

Acupuncture

Any Vets in the Audience?

5. (a) Veterinary practitioners?

2. Local Anaesthetic and Steroid preparations

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3. Botulinum Toxin A

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Prevention

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Prevention

• Head restraints

• 3 in 4 not properly adjusted!

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Prognosis

• Overall good in most cases

• Symptoms improve after few days

• 6 in 10 much better/ gone by 1-4 weeks

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Prognosis

• Up to several months

• 1 in 4 pain n stiffness at 6 months

• Small number persistent beyond 6 months

Any Questions

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