Whiplash Injury Evaluation and Treatment
Definition and Mechanism
- Whiplash describes a sudden biphasic movement of the head and cervical spine that typically occurs during motor vehicle accidents, especially rear-end collisions, affecting multiple soft tissue structures in the neck including muscles, ligaments, facet joints, and discs 1
Clinical Presentation
- Common symptoms of whiplash include neck pain and stiffness, point tenderness in the cervical spine, upper extremity pain or paresthesia, and muscle spasm in paraspinal and suboccipital regions 1
Evaluation
Clinical Assessment
- A detailed history focusing on mechanism of injury and symptom progression is necessary for evaluation 1
- Physical examination should assess cervical range of motion, tenderness on palpation of cervical spine, paraspinal and suboccipital muscles, and neurological examination for radicular symptoms 1
- Assessment for signs of cervical instability is crucial 2
Imaging
- Initial imaging should be guided by clinical suspicion for fracture or instability 3, 4
- Plain radiographs have low sensitivity (36%) for identifying cervical injuries, and a minimum of 3 views is recommended when performed 3
- CT scan is significantly more sensitive than radiographs (98% sensitivity) and is recommended when fracture is suspected based on clinical criteria 3
- MRI is most sensitive for detecting soft tissue injuries but has limited value in WAD diagnosis, and tends to overestimate severity of ligament injuries 2, 3, 4
Treatment
Acute Phase
- Early mobilization and return to normal activities are recommended over immobilization with cervical collars 4, 6
- Prolonged immobilization with rigid collars can lead to complications such as pressure sores, increased intracranial pressure, and potential airway problems 7
Chronic Phase
- No cited facts are available for this section