For those who have been in a rear-end auto collision, the word whiplash may mean a lot. It’s a common injury that has become a household name. Each year there are about 2.5 million rear end auto collisions. So what exactly is whiplash?
Whiplash is a non-medical term that implies injury to the soft tissues of the neck, specifically ligaments, tendons and muscles.
It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension or flexion from extreme motions pushing neck muscles and ligaments beyond their normal range of motion.
Injuries can range from minor tears of the sternocleidomastoid Muscle ( Figure 1) to partial avulsions of the longus coli (Figure 2) and retropharyngeal hematomas.
Other common findings include:
- Invertebral disc failures
- Tears of one or both of the anterior longitudinal ligaments
- Soft tissue injury of the facet joints
- Dorsal root ganglia contusions
- Damage to the vertebral arteries.
Whiplash is most commonly caused or associated with motor vehicle accidents (Figure 3). However, contact sport injuries, blows to the head, repetitive stress injuries, and chronic strain are also common whiplash causes.
Whiplash Child abuse, particularly the shaking of a child, can also result in this injury as well as in more serious injuries to the child’s brain or spinal cord.
Whiplash may be difficult to diagnose as it may occur immediately or minutes to hours after the initial injury. Patients may experience:
- Diffuse neck pain, tenderness and stiffness
- Muscle spasms as a result of injuries to the muscles or ligaments
- Headache, dizziness, nausea and blurred vision (symptoms of a concussion)
- Difficulty swallowing and chewing and hoarseness (could include injury to the esophagus and larynx)
- Abnormal sensations such as burning or prickling (this is called paresthesias)
- Shoulder and/or arm pain
- Back pain
Examination of the patient begins with a detailed patient history which should include:
- Mechanism and velocity of the injury;
- Delay between the injury and onset of symptoms;
- Additional related symptoms; and
- Review of previous neck injury
Radiographs or other imaging may also be utilized to determine if a fracture exists and to assess the condition of the cervical spine’s soft tissue. The physical examination should include palpation for areas of tenderness, cervical spinous processes, cervical paraspinal muscles, cervical nerve roots, and anterior cervical soft tissues. Lastly, the examiner should provide a neurologic examination to access cranial nerves, cervical nerve-root, upper extremity function and reflex evaluation of the upper extremity.
To manage these injuries, doctors will usually immobilize the neck with a soft cervical collar (Figure 4) which may need to be worn for two to three weeks. Other ways to manage whiplash include ice therapy, pain medications, muscle relaxants and possible surgical intervention.