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

www.londonpainconsultants.com

Definition


Definition

• Soft tissue injury to the neck

• Sudden Extension-Flexion injury

• Whip-like movement

• Collection of symptoms

Causes


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


Incidence


Incidence

• US National Highway Traffic Safety Administration (1995)

• 53% of 5.5 million RTA victims suffered whiplash injury


Soft Tissue Damage


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)


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


Symptoms and Signs

• Whiplash syndrome-

continual headache

pain

reduced movement

tingling

lumbar pains

fatigue

sleep disturbance

Investigations

Investigations

• X-rays- exclude #

• CT

• MRI

Management


Overall Aim

• Pain-free window

• Rehabilitation


Management

• Medication

• Physical Therapy/ Rehabilitation

• Minimally Invasive Pain Management Procedures


Medication

Medication

• Pharmacological

• WHO ladder (amended from cancer)

Step 1 paracetamol/ NSAID/ COX 2

Step 2 + weak opioids

Step 3 + strong opioids


Medication

• Adequate medication- regularly, prevent breakthrough pain

• Muscle relaxant- Diazepam/ similar


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…..


• Clear red flags – C-spine instability/ #

• Adequate medication- regularly, prevent breakthrough pain



• Keep neck moving as normally as possible!

• Collars not recommended

• Gentle mobilisation


• Avoid ‘stiffening-up’

• Studies- quicker recovery with gentle exercise



• 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


Cervical and Thoracic facet joint injections


Trigger Point Injections


1. Dry Needling


…otherwise known as…

Acupuncture

Any Vets in the Audience?

5. (a) Veterinary practitioners?

2. Local Anaesthetic and Steroid preparations


3. Botulinum Toxin A


Prevention


Prevention

• Head restraints

• 3 in 4 not properly adjusted!


Prognosis

• Overall good in most cases

• Symptoms improve after few days

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


Prognosis

• Up to several months

• 1 in 4 pain n stiffness at 6 months

• Small number persistent beyond 6 months

Any Questions


Health & Medicine

Whiplash Injury Presented To Amled 1.12.06