WHIPLASH 1996-7

1.AUTHORLord-S-M, Barnsley-L, Wallis-B-J, Bogduk-N.
INSTITUTIONCervical Spine Research Unit, University of Newcastle, Callaghan, Australia.
TITLEChronic cervical zygapophysial joint pain after whiplash. A placebo- controlled prevalence
SOURCESpine 1996 Aug 1, VOL: 21 (15), P: 1737-44; discussion 1744-5, ISSN: 0362-2436.
ABSTRACTABSTRACT 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.

2.AUTHORGarcia-R-Jr, Arrington-J-A.
INSTITUTIONDepartment of Radiology at the University of South Florida College of Medicine, USA.
TITLEThe relationship between cervical whiplash and temporomandibular joint injuries: an MRI study.
SOURCECranio 1996 Jul, VOL: 14 (3), P: 233-9, ISSN: 0886-9634.
ABSTRACTTemporomandibular 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.
3.AUTHORGennis-P, Miller-L, Gallagher-E-J, Giglio-J, Carter-W, Nathanson-N.
INSTITUTIONBronx Municipal Hospital Center, Department of Emergency Medicine, NY 10461, USA. pskm34a@prodigy.com.
TITLEThe effect of soft cervical collars on persistent neck pain in patients with whiplash injury (see comments).
SOURCEAcad-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.
ABSTRACTOBJECTIVE: 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.

4.AUTHOROtte-A, Ettlin-T-M, Fierz-L, Kischka-U, Muerner-J, Hogerle-S, Brautigam-P, Mueller-Brand-J.
INSTITUTIONInstitut fur Nuklearmedizin, Universitatskliniken, Kantonsspital Basel.
TITLE(Cerebral findings following cervical spine distortion caused by acceleration mechanism (whiplash injury). Assessment of current diagnostic methods in nuclear medicine). TT Zerebrale Befunde nach Halswirbelsaulendistorsion durch Beschleunigungsmechanismus (HWS-Schleudertrauma). Standortbestimmung zu neuen diagnostischen Methoden der Nuklearmedizin.
SOURCESchweiz-Rundsch-Med-Prax 1996 Sep 3, VOL: 85 (36), P: 1087-90, ISSN: 0369-8394.
ABSTRACTIn any grade of distortion of the cervical spine as a result of acceleration forces in addition to cervical symptoms cerebral symptoms like headache, vertigo, auditory disturbances, tinnitus, disturbances in concentration and memory, difficulties in swallowing, impaired vision and temporo-mandibular dysfunctions may appear. These symptoms can persist and become invalidating. Cerebral single-photon emission tomography (SPECT) and positron emission tomography (PET) enable new diagnostic horizons for neurotraumatology. In this article we summarize the actual findings of these nuclear medical methods in neuropsychologically deficient patients with distortion of the cervical spine as a result of acceleration forces. Especially the latest results of the group of Basle (University Hospital Basle, Clinic of Rehabilitation Rheinfelden, Switzerland) are illustrated. This group found parieto-occipital hypoperfusion by relative quantitation using SPECT and bicisate (Neurolite, ECD). A first pilot study using PET and F-18-fluoro-deoxyglucose (FDG) could verify the above observation. The group's working hypothesis is that parieto- occipital hypoperfusion may be caused by activation of nociceptive afferences from the upper cervical spine. A critical approach to interpreting new functional methods and, on the other hand, openness in new scientific findings may contribute to answering the lasting controversial medico-legal discussion with more objectivity. Author.
5.AUTHORRadanov-B-P, Dvorak-J.
INSTITUTIONDepartment of Psychiatry, University of Berne, Inselspital, Switzerland.
TITLESpine update. Impaired cognitive functioning after whiplash injury of the cervical spine. 
SOURCESpine 1996 Feb 1, VOL: 21 (3), P: 392-7, ISSN: 0362-2436 26 Refs.
ABSTRACTTo 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.
6.AUTHORMayou-R, Bryant-B.
INSTITUTIONUniversity Department of Psychiatry, Warneford Hospital, Oxford, UK.
TITLEOutcome of 'whiplash' neck injury
SOURCEInjury 1996 Nov, VOL: 27 (9), P: 617-23, ISSN: 0020-1383.
ABSTRACTPsychological 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.

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