Cervical, Whiplash - Medical Research Abstracts - Causation

1. AUTHOR	Seckmeyer-M.
INSTITUTION	Abteilung Kraftschaden, Wiesbaden.
TITLE	(Detection of so-called "cervical whiplash trauma"). TT Zum Nachweis des sogenannten "HWS-Schleudertraumas".
SOURCE	Versicherungsmedizin 1997 Apr 1, VOL: 49 (2), P: 48-51, ISSN: 0933-4548.
ABSTRACT	For the evidence of causality of an accident for a cervical injury without any contact with the interior, it is necessary to provide a interdisciplinary expert's opinion. According to the state of experts knowledge for reconstruction of accidents a slight cervical injury can be precluded if the alteration of speed of the pushed car is less than 15 km/h. Medical diagnoses are only valid if they have been proved by objective results. A diagnose based only on a subjective information is to be considered as a suspicious diagnose. Author.

2. AUTHOR	Olson-V-L.
INSTITUTION	Health East-St John's Hospital, Maplewood, Minn, USA.
TITLE	Whiplash-associated chronic headache treated with home cervical traction.
SOURCE	Phys-Ther 1997 Apr, VOL: 77 (4), P: 417-24, ISSN: 0031-9023.
ABSTRACT	The subject of this case report was a 56-year-old woman who sustained a whiplash-associated disorder as a result of a motor vehicle accident. Within a few hours after the accident, she developed a headache, which became chronic, creating disability and hindering the quality of her life. In the following year, a variety of diagnostic tests, medications, and physical therapy were unsuccessful in determining the cause of her complaints or in relieving them. After this year, she expressed anger, frustration, and a reluctance to undergo additional physical therapy. By listening to her explain how she coped with her problem and observing that she lacked the ability to reduce her cervical lordosis, the therapist developed and implemented a home program of supine cervical traction and exercise. After 30 days of treatment, she was able to reduce and control her headache. This treatment and the approach used to develop the treatment may benefit other patients who have whiplash-associated chronic headache. Author.

3. AUTHOR	Garcia-R-Jr, Arrington-J-A.
INSTITUTION	Department of Radiology at the University of South Florida College of Medicine, USA.
TITLE	The relationship between cervical whiplash and temporomandibular joint injuries: an MRI study.
SOURCE	Cranio 1996 Jul, VOL: 14 (3), P: 233-9, ISSN: 0886-9634.
ABSTRACT	Temporomandibular joint (TMJ) symptoms are a common finding in motor vehicle accident (MVA) patients with hyperextension/hyperflexion injuries of the cervical spine (cervical whiplash). The relationship between cervical whiplash and TMJ injuries was documented with magnetic resonance imaging (MRI) in 87 consecutive MVA cervical whiplash patients who presented with TMJ symptoms and had sustained no direct trauma to the face, head or mandible and had no TMJ complaints prior to the MVA. One hundred sixty-four TMJ patients were evaluated for internal derangement, effusion and inflammation, utilizing T1 and T2 weighted images. A high percentage of the TMJ patients demonstrated abnormal findings: disk displacement with reduction (DDR), 118/164 (72%); disk displacement without reduction (DDNR), 25/164 (15%); effusion, 113/164 (69%); inflammation or edema, 84/164 (51%); total TMJ abnormalities, 156/164 (95%). The high percentage of TMJ abnormalities in this study significantly illustrates the proximate relationship between cervical whiplash and TMJ injuries. Author.

4. AUTHOR	Mayou-R, Bryant-B.
INSTITUTION	University Department of Psychiatry, Warneford Hospital, Oxford, UK.
TITLE	Outcome of 'whiplash' neck injury.
SOURCE	Injury 1996 Nov, VOL: 27 (9), P: 617-23, ISSN: 0020-1383.
ABSTRACT	Psychological factors have been alleged to be important in the course and outcome of 'whiplash' neck injury but there is little quantitative evidence. This study uses quantitative methods involving a prospective interview assessment to describe psychological and quality of life predictors, and 3 and 12 month outcome. Consecutive attenders to the Accident and Emergency department of a teaching district hospital with a clinical diagnosis of 'whiplash' neck injury were included and there were follow-up interviews at home. Neck symptoms were recorded, and there was a standard mental-state interview with added questions about post-traumatic symptoms and a semi-structured interview for disability and consequences for quality of life. There was a wide individual variation in course and outcome; the majority of subjects complained of persistent neck symptoms and a sizeable minority reported specific post-traumatic psychological symptoms (intrusive memory, phobic travel anxiety), similar to those described by patients suffering multiple injuries. Social impairment, including effects on travel, were considerable in one-quarter. Reports of persistent neck symptoms were not associated with any baseline psychological variables or with compensation proceedings; psychological factors appeared to be more important in determining the extent of social impairment. We conclude that travel, social and psychological morbidity is substantially greater than previously recognized. Author.

5. AUTHOR	Lord-S-M, Barnsley-L, Wallis-B-J, Bogduk-N.
INSTITUTION	Cervical Spine Research Unit, University of Newcastle, Callaghan, Australia.
TITLE	Chronic cervical zygapophysial joint pain after whiplash. A placebo- controlled prevalence study.
SOURCE	Spine 1996 Aug 1, VOL: 21 (15), P: 1737-44; discussion 1744-5, ISSN: 0362-2436.
ABSTRACT	STUDY DESIGN: The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. OBJECTIVE: To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury. SUMMARY OF BACKGROUND DATA: The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. METHODS: Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection. RESULTS: Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%). CONCLUSION: Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance. Author.

6. AUTHOR	Gennis-P, Miller-L, Gallagher-E-J, Giglio-J, Carter-W, Nathanson-N.
INSTITUTION	Bronx Municipal Hospital Center, Department of Emergency Medicine, NY 10461, USA. pskm34a@prodigy.com.
TITLE	The effect of soft cervical collars on persistent neck pain in patients with whiplash injury (see comments).
SOURCE	Acad-Emerg-Med 1996 Jun, VOL: 3 (6), P: 568-73, ISSN: 1069-6563.
CM	Comment in: Acad-Emerg-Med 1996 Jun; 3(6):563-4.
ABSTRACT	OBJECTIVE: To assess the efficacy of soft cervical collars in the early management of whiplash-injury-related pain. METHODS: A controlled, clinical trial was conducted in an urban ED. Adults with neck pain following automobile crashes indicated their initial degrees of pain on a visual analog scale. Patients with cervical spine fractures or subluxation, focal neurologic deficits, or other major distracting injuries were excluded. Patients were assigned to receive a soft cervical collar or no collar based on their medical record numbers. Pain at > or = 6 weeks postinjury was coded as none, better, same, or worse, and analyzed as 3 dichotomous outcomes: recovered (pain = none); improved (pain = none or better); and deteriorated (pain = worse). RESULTS: Of 250 patients enrolled, 196 (78%) were available for follow-up. Of these patients, 104 (53%) were assigned to the soft cervical collar group, and 92 (47%) to the control group. These groups were similar in age, gender, seat position in the car, seat belt use, and initial pain score. Pain persisted at > or = 6 weeks in 122 (62%) patients. The groups showed no difference in follow-up pain category (p = 0.59). There was no significant difference between the 2 groups in complete recovery (p = 0.34), improvement (p = 0.34), or deterioration (p = 0.60). The study had a power of 80% to detect an absolute difference of at least 20% in recovery, 17% in improvement, and 7% in deterioration (2-tailed, alpha = 0.05). CONCLUSIONS: Most patients with whiplash injuries have persistent pain for at least 6 weeks. Soft cervical collars do not influence the duration or degree of persistent pain. Author.

7. AUTHOR	Radanov-B-P, Dvorak-J.
INSTITUTION	Department of Psychiatry, University of Berne, Inselspital, Switzerland.
TITLE	Spine update. Impaired cognitive functioning after whiplash injury of the cervical spine.
SOURCE	Spine 1996 Feb 1, VOL: 21 (3), P: 392-7, ISSN: 0362-2436 26 Refs.
ABSTRACT	To enhance the awareness of physicians treating whiplash patients, findings from previous research regarding cognitive functioning of these patients are discussed and recommendations for assessment provided. Cognitive disturbances (i.e., deficient attentional functioning and impairment of memory) are frequent complaints in patients after whiplash injury. However, few prospective studies of nonselected patients have been performed. These studies indicate that impaired cognitive functioning relates either to trauma-induced somatic symptoms (i.e., pain) or psychologic symptoms resulting from problems adjusting to trauma-related somatic symptoms. Accordingly, cognitive disturbances after whiplash show a fair rate of recovery, which parallels recovery from trauma-related somatic symptoms. Current research does not indicate disturbances in higher cognitive functions after whiplash. Author.

8. AUTHOR	Barnsley-L, Lord-S-M, Wallis-B-J, Bogduk-N.
INSTITUTION	Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, Australia.
TITLE	The prevalence of chronic cervical zygapophysial joint pain after whiplash.
SOURCE	Spine 1995 Jan 1, VOL: 20 (1), P: 20-5; discussion 26, ISSN: 0362-2436.
ABSTRACT	STUDY DESIGN . A survey of the prevalence of cervical zygapophysial joint pain was conducted. OBJECTIVES. To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA. In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks. METHODS. Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order. RESULTS. A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%). CONCLUSION. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash. Author.

9. AUTHOR	Jonsson-H-Jr, Cesarini-K, Sahlstedt-B, Rauschning-W.
INSTITUTION	Department of Orthopaedic Surgery, Academic University Hospital, Uppsala, Sweden.
TITLE	Findings and outcome in whiplash-type neck distortions.
SOURCE	Spine 1994 Dec 15, VOL: 19 (24), P: 2733-43, ISSN: 0362-2436 116 Refs.
ABSTRACT	STUDY DESIGN. The authors assessed the clinical and imaging findings and late outcome in 50 patients with whiplash-type neck distortions (17 men, 33 women, mean age 33 years). SUMMARY OF BACKGROUND DATA. Early symptoms are neck pain, stiffness, and sometimes radiating pain; later bizarre symptomatology poses intricate clinical and medicolegal problems. Pathoanatomic studies indicate that soft tissue injuries may be overlooked. METHODS. Repeated clinical and radiographic examinations (plain and flexion-extension radiograms and contrast magnetic resonance imaging evaluated with a new grading system); surgical findings; follow-up were performed after 1 and 5 years by an independent observer neurologist. RESULTS. Neck pain persisted in 24 patients; radiating pain developed within 6 weeks in 19 patients. Two patients with segmental instability had posterior fusions and complete pain relief. Eight patients with severe radiating pain and large disc protrusions on magnetic resonance had nine surgically confirmed fresh disc herniations. Discectomy and fusion alleviated pain in these patients, whereas symptoms largely persisted in the conservatively treated patients. CONCLUSIONS. A high incidence of discoligamentous injuries was found in whiplash-type distortions. Most patients with severe persisting radiating pain had large disc protrusions on MRI that were confirmed as herniations at surgery. Neck and radiating pain were alleviated by early disc excision and fusion. Author.

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