Suissa S, Harder S, Veilleux M.
The relation between initial symptoms and signs and the prognosis of whiplash.
Eur Spine J. 2001 Feb;10(1):44-9. doi: 10.1007/s005860000220.
Abstract/Text
Whiplash, a common injury following motor vehicle crashes, is associated with high costs and a prognosis that is variable and difficult to predict. We studied the profile of recovery from whiplash and assessed whether presenting signs and symptoms directly after the crash were predictive of whiplash prognosis. We formed a population-based incident cohort of all 2627 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the province of Québec, Canada, in 1987, and followed these patients for up to 7 years. The data on signs and symptoms were obtained from the medical charts kept by the universal automobile insurance plan (Société de l'assurance automobile du Québec), which covers all 7 million residents of the province, while data on the outcome--the recovery time from whiplash--was obtained from their databases. The median recovery time was 32 days, and 12% of subjects had still not recovered after 6 months. The signs and symptoms that were found to be independently associated with a slower recovery from whiplash, besides female gender and older age, are neck pain on palpation, muscle pain, pain or numbness radiating from the neck to arms, hands or shoulders, and headache. Together, these factors in older females (age 60) predicted a median recovery time of 262 days, compared with 17 days for younger males (age 20) who do not have this profile. In contrast, using a classification of injury severity previously proposed by the Québec Whiplash Associated Disorders Task Force, the median recovery time varied from 17 to only 123 days. We conclude that whiplash patients presenting with several specific musculoskeletal and neurological signs and symptoms will have a longer recovery period. These patients can easily be identified and closely monitored and targeted for the evaluation of early intervention programmes aimed at managing whiplash patients with a poor prognosis.
Scholten-Peeters GG, Verhagen AP, Bekkering GE, van der Windt DA, Barnsley L, Oostendorp RA, Hendriks EJ.
Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.
Pain. 2003 Jul;104(1-2):303-22. doi: 10.1016/s0304-3959(03)00050-2.
Abstract/Text
We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However, there is some inconsistency in the literature and there have been no systematic attempts to analyze the level of evidence for prognostic factors in whiplash recovery. Studies were selected for inclusion following a comprehensive search of MEDLINE, EMBASE, CINAHL, the database of the Dutch Institute of Allied Health Professions up until April 2002 and hand searches of the reference lists of retrieved articles. Studies were selected if the objective was to assess prognostic factors associated with recovery; the design was a prospective cohort study; the study population included at least an identifiable subgroup of patients suffering from a whiplash injury; and the paper was a full report published in English, German, French or Dutch. The methodological quality was independently assessed by two reviewers. A study was considered to be of 'high quality' if it satisfied at least 50% of the maximum available quality score. Two independent reviewers extracted data and the association between prognostic factors and functional recovery was calculated in terms of risk estimates. Fifty papers reporting on twenty-nine cohorts were included in the review. Twelve cohorts were considered to be of 'high quality'. Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed. Strong evidence was found for high initial pain intensity being an adverse prognostic factor. There was strong evidence that for older age, female gender, high acute psychological response, angular deformity of the neck, rear-end collision, and compensation not being associated with an adverse prognosis. Several physical (e.g. restricted range of motion, high number of complaints), psychosocial (previous psychological problems), neuropsychosocial factors (nervousness), crash related (e.g. accident on highway) and treatment related factors (need to resume physiotherapy) showed limited prognostic value for functional recovery. High initial pain intensity is an important predictor for delayed functional recovery for patients with whiplash injury. Often mentioned factors like age, gender and compensation do not seem to be of prognostic value. Scientific information about prognostic factors can guide physicians or other care providers to direct treatment and to probably prevent chronicity.
Yelland M.
Review: high initial pain intensity is associated with persisting symptoms after whiplash.
ACP J Club. 2004 Mar-Apr;140(2):49.
Abstract/Text
Hartling L, Pickett W, Brison RJ.
Derivation of a clinical decision rule for whiplash associated disorders among individuals involved in rear-end collisions.
Accid Anal Prev. 2002 Jul;34(4):531-9. doi: 10.1016/s0001-4575(01)00051-3.
Abstract/Text
A prospective study was used to: (1) quantify potential risk factors for whiplash associated disorder following a rear-end motor vehicle collision; and (2) develop a simple clinical decision rule for the early identification of patients at risk for long-term whiplash associated disorder. Between 1 October 1995 and 31 March 1998, 446 adults involved in rear-end collisions presented to the only two emergency departments serving Kingston, Ontario. Eligible and consenting subjects (n = 353) were contacted by telephone soon after the collisions then at multiple occasions up to 2 years post-collision. Bivariate and multiple logistic regression analyses were used to identify potential risk factors for persistent symptoms. A software package that uses Chi-squared automatic interaction detection and classification and regression trees was used to develop a simple clinical decision rule for the identification of patients at high and low risk for persistent whiplash associated disorder. Risk factors identified by regression analyses included: increased age, number of initial physical symptoms, and early development of the following symptoms: upper back pain, upper extremity numbness or weakness, or disturbances in vision. A simple clinical decision rule that requires asking up to three basic questions of each patient was derived and would have identified the 118 cases of persistent whiplash associated disorder with a sensitivity of 91.5% (95% confidence interval: 86.5, 96.6) and a specificity of 51.4% (44.7, 58.1). This study confirmed the importance of several risk factors for whiplash associated disorder following rear-end motor vehicle collisions.
小谷善久：外傷性頚部症候群の病態解析に関するmultidisciplinary approach、整形災害外科 52: 139-43, 2009.
Obelieniene D, Schrader H, Bovim G, Miseviciene I, Sand T.
Pain after whiplash: a prospective controlled inception cohort study.
J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):279-83. doi: 10.1136/jnnp.66.3.279.
Abstract/Text
OBJECTIVES: In Lithuania, there is little awareness of the notion that chronic symptoms may result from rear end collisions via the so-called whiplash injury. After most such collisions no contact with the health service is established. An opportunity therefore exists to study post-traumatic pain without the confounding factors present in western societies.
METHODS: In a prospective, controlled inception cohort study, 210 victims of a rear end collision were consecutively identified from the daily records of the Kaunas traffic police. Neck pain and headache were evaluated by mailed questionnaires shortly after the accident, after 2 months, and after 1 year. As controls, 210 sex and age matched subjects were randomly taken from the population register of the same geographical area and evaluated for the same symptoms immediately after their identification and after 1 year.
RESULTS: Initial pain was reported by 47% of accident victims; 10% had neck pain alone, 18% had neck pain together with headache, and 19% had headache alone. The median duration of the initial neck pain was 3 days and maximal duration 17 days. The median duration of headache was 4.5 hours and the maximum duration was 20 days. After 1 year, there were no significant differences between the accident victims and the control group concerning frequency and intensity of these symptoms.
CONCLUSIONS: In a country were there is no preconceived notion of chronic pain arising from rear end collisions, and thus no fear of long term disability, and usually no involvement of the therapeutic community, insurance companies, or litigation, symptoms after an acute whiplash injury are self limiting, brief, and do not seem to evolve to the so-called late whiplash syndrome.
Obelieniene D, Bovim G, Schrader H, Surkiene D, Mickeviàiene D, Miseviàiene I, Sand T.
Headache after whiplash: a historical cohort study outside the medico-legal context.
Cephalalgia. 1998 Oct;18(8):559-64. doi: 10.1046/j.1468-2982.1998.1808559.x.
Abstract/Text
Headache is frequently reported as a chronic complaint after whiplash traumas. Criteria have been presented, but it has not been validated whether any specific headache type emerges after a trauma with whiplash mechanism. In a questionnaire-based historical cohort design, 202 adult Lithuanian individuals were interviewed 1-3 years after experiencing a rear-end car collision. The questionnaire was designed so that a diagnosis of migraine and tension-type headache in accordance with the International Headache Society criteria could be made. "Possible cervicogenic headache" was diagnosed according to Sjaastad et al.'s minimal criteria. The diagnostic panorama in those with traumas was compared with that of an age- and sex-matched control group. The introductory questions did not reveal differences in headache frequencies between the traumatized and control groups (p = 0.60). The prevalence of migraine and tension-type headache (both episodic and chronic) was also similar. A higher frequency of possible cervicogenic headache was observed in the traumatized group (10 vs 5), but the difference was not statistically significant (p = 0.28). Sixteen patients in the accident group had headache > 15 days per month, 11 of the 16 had similar complaints before the trauma, while 5 had worsened headache as compared to (the recollected headache) before the trauma. None of the patients with possible cervicogenic headache reported increased headache after the accident. Accordingly, the present results obtained outside the medico-legal context do not confirm that a specific headache pattern emerges 1-3 years after a rear-end car collision.
Pearce JM.
Headaches in the whiplash syndrome.
Spinal Cord. 2001 Apr;39(4):228-33. doi: 10.1038/sj.sc.3101128.
Abstract/Text
STUDY DESIGN: A prospective clinical analysis of headaches in whiplash injury.
OBJECTIVES: To provide a detailed clinical account of the nature, characteristics and natural history of headaches, and to examine their possible relation to the neck injury.
SETTING: One medicolegal practice in UK.
METHODS: This study consists of a prospective clinical analysis of headache symptoms in consecutive patients referred to the author for medicolegal assessment of whiplash injury, with no special reference to headaches.
RESULTS: All 80 patients noted neck pain. Headaches were related as a consequence of the accident by 48 patients (60% of the total). The circumstances of injury did not differ from whiplash victims who did not have prominent headache. The headache onset was maximum in the first 24 h after injury. The failure to recall well documented pre-accident headaches in almost one fifth of patients is significant. The common types of headaches were non-specific, generalised, dull, aching pain (25 patients), a mixtures of aching and tightness, and tension type headache. Only three (6%) had migraine without aura.
CONCLUSION: Post-whiplash headache is a genuine common but short lived affair, constant headaches disappearing within 3 weeks in 85% subjects. In the minority complaining of headache after that period there was no evidence of persisting physical injury, nor of inability to work or other disability caused by headaches.
Radanov BP, Sturzenegger M, Di Stefano G, Schnidrig A, Aljinovic M.
Factors influencing recovery from headache after common whiplash.
BMJ. 1993 Sep 11;307(6905):652-5. doi: 10.1136/bmj.307.6905.652.
Abstract/Text
OBJECTIVE: To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash.
DESIGN: Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months.
SETTING: Patients referred from primary care.
SUBJECTS: 117 patients (mean age 30.8 (9.5) years.
MAIN OUTCOME MEASURES: Prevalence of trauma related headache and the predictive relation by multiple logistic regression between different somatic and psychological variables and trauma related headache at each examination.
RESULTS: Prevalence of trauma related headache decreased from 57% to 27%. History of pretraumatic headache proved a significant risk factor for presenting with trauma related headache. A significant relation between trauma related headache and the following variables was found: at seven days the initial wellbeing score, early onset of neck pain, depression scale from the personality inventory, and the initial intensity of neck pain; at three months, intensity of neck pain, and history of pretraumatic headache; and at six months neck pain, pain intensity, and history of pretraumatic headache.
CONCLUSIONS: History of pretraumatic headache significantly increases the likelihood of presenting with trauma related headache but only in combination with findings indicative of clinically important injury to the cervical spine.
Schrader H, Stovner LJ, Obelieniene D, Surkiene D, Mickeviciene D, Bovim G, Sand T.
Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study.
Eur J Neurol. 2006 Nov;13(11):1226-32. doi: 10.1111/j.1468-1331.2006.01481.x.
Abstract/Text
Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical features and have the same prognosis compared with headaches in a control group.
Balla JI.
The late whiplash syndrome.
Aust N Z J Surg. 1980 Dec;50(6):610-4. doi: 10.1111/j.1445-2197.1980.tb04207.x.
Abstract/Text
A condition commonly seen after motor vehicle accidents is studied. This is the "late whiplash" syndrome, which is defined as a collection of symptoms and disabilities seen more than six months after a neck injury occurring in a motor vehicle accident. A series of 300 cases is examined. With the use of factor analysis the syndrome is defined as consisting of headache, neckache, neck stiffness, and depression, as well as anxiety, all of which are strongly correlated with each other. There is, on the other hand, a poor correlation with physical or radiological abnormalities. The condition is common in women, especially in the 21 to 40 years' distribution. It is shown that social variables may be relevant n the production of the syndrome.
Mulhall KJ, Moloney M, Burke TE, Masterson E.
Chronic neck pain following road traffic accidents in an Irish setting and it's relationship to seat belt use and low back pain.
Ir Med J. 2003 Feb;96(2):53-4.
Abstract/Text
Chronic neck pain following road traffic accidents is a highly prevalent condition in developed societies. It constitutes the main element of chronic whiplash syndrome, and is often used synonymously with that term. It is also a highly controversial condition, with debate in the extensive literature as to the nature of the complaint. We performed an analysis of 100 consecutive patients presenting for treatment of chronic neck pain following road traffic accidents. The mean duration of neck pain was 15.5 months and 90% of patients reported wearing a seatbelt at the time, a significantly greater proportion than the general population (p<0.001). All patients in the study were involved in litigation related to the accident. The mean time off work due to the injury was 4.9 months (range 1 week-3 years). 60 patients also complained of accident related low back pain, a statistically significant association with whiplash syndrome (p<0.001). Our study demonstrates a significantly high incidence of reported seatbelt use in patients presenting with chronic neck pain and whiplash syndrome. We also found a significant association between whiplash and chronic lumbar pain, an association having important medico-legal implications and requiring further analysis.
Guez M, Hildingsson C, Nasic S, Toolanen G.
Chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin: a population-based study.
Acta Orthop. 2006 Feb;77(1):132-7. doi: 10.1080/17453670610045812.
Abstract/Text
BACKGROUND: It is unclear whether the prevalence of chronic low back pain is higher in chronic whiplash patients than in the general population. In a population-based study, we evaluated the prevalence of chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin, with special emphasis on whiplash injury.
SUBJECTS AND METHODS: Additional questions concerning the patient's experience of neck and low back pain were added to the questionnaire of the MONICA health survey. 4,415 subjects aged 25-64 years were randomly selected from a geographically well-defined area in northern Sweden.
RESULTS: The prevalences of chronic low back pain and chronic neck pain were 16% and 17%, respectively. 51% of subjects had both back and neck pain. Of the patients with neck pain, one quarter had a history of neck injury, which was related to whiplash injury in almost one-half of the cases. The prevalence of chronic low back pain in individuals with chronic non-traumatic neck pain was 53%, and it was 48% in those with chronic neck pain and a history of neck trauma. There was no difference in the prevalence of chronic low back pain between whiplash injury and other types of neck trauma. Confounding factors such as sex, age, marital status, BMI, smoking status and level of education were not significantly different between traumatic and non-traumatic groups.
INTERPRETATION: Independently of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic muskuloskeletal pain syndromes, may be important in evaluation of these cases.
Berglund A, Alfredsson L, Jensen I, Cassidy JD, Nygren A.
The association between exposure to a rear-end collision and future health complaints.
J Clin Epidemiol. 2001 Aug;54(8):851-6. doi: 10.1016/s0895-4356(00)00369-3.
Abstract/Text
Different symptoms, together with neck pain, have been attributed to persons with persistent complaints after a previous motor vehicle crash (MVC) and are sometimes referred to as the "late whiplash syndrome." A cohort study was conducted to determine whether exposure to a rear-end collision, with or without whiplash injury, is associated with future health complaints. The results regarding future neck or shoulder pain have previously been described, and the objective of the present report was to focus on outcomes other than neck pain. Included in the study were persons 18 to 65 years of age and covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups: those with reported whiplash injury (n = 232) and those without reported whiplash injury (n = 204). For comparison, 3688 subjects who were unexposed to MVCs were selected, with consideration taken to the age and gender distribution in the exposed subgroups. The prevalence of different health complaints among the study subjects was estimated according to a mailed questionnaire at follow-up in 1994, 7 years after the rear-end collision. When exposed subjects with whiplash injury were compared to unexposed subjects, increased relative risks in the range of 1.6-3.7 were seen for headache, thoracic and low back pain, as well as for fatigue, sleep disturbances and ill health. No corresponding increased risks were found among the exposed subjects without reported whiplash injury. We conclude that rear-end collisions resulting in reported whiplash injuries seem to have a substantial impact on health complaints, even a long time after the collision. There is a need to identify factors that predict a non-favorable outcome in order to improve clinical management.
Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A.
Management of posttraumatic vertigo.
Otolaryngol Head Neck Surg. 2005 Apr;132(4):554-8. doi: 10.1016/j.otohns.2004.09.034.
Abstract/Text
OBJECTIVE: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction (without fractures) with vertigo and to report the results of treatment after extensive diagnostics.
STUDY DESIGN: Prospective study of consecutive new cases with vertigo after trauma at different periods of onset. During 2000-2002, 63 patients were examined and treated.
SETTING: Regional trauma medical center for the greater Berlin Area, tertiary referral unit.
RESULTS: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorders (5), delayed endolymphatic hydrops (12), and canalolithiasis (9). The patients were free of vertigo symptoms (except cervicogenic and otolith disorder) after treatment, which consisted of habituation training, medical and surgical therapy options. The follow-up was 1 year.
CONCLUSION: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery determines the precision and quality of diagnostics. Surgical measures should be an integral part of treatment modalities if conservative treatment is not effective.
SIGNIFICANCE: Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma.
BRAAF MM, ROSNER S.
Meniere-like syndrome following whiplash injury of the neck.
J Trauma. 1962 Sep;2:494-501. doi: 10.1097/00005373-196209000-00008.
Abstract/Text
Burke JP, Orton HP, West J, Strachan IM, Hockey MS, Ferguson DG.
Whiplash and its effect on the visual system.
Graefes Arch Clin Exp Ophthalmol. 1992;230(4):335-9. doi: 10.1007/BF00165941.
Abstract/Text
Whiplash or indirect injuries to the neck as a consequence of motor vehicle collisions are a common occurrence in which the frequency of ocular complications is largely unknown. Ophthalmic and oculomotor function was investigated in a longitudinal study of 39 cases who had their initial ophthalmological assessment within one week of the whiplash injury. Ten of 39 cases had ocular symptoms and signs which developed shortly after the accident. The principal abnormality in 6 of these was decreased convergence and accommodation, superior oblique muscle paresis in 2, decreased stereoacuity in 1 and bilateral vitreous detachments in 1 patient. All but 2 had complete resolution of their symptoms within 9 months. Four other patients were asymptomatic but had ophthalmic signs which resolved within 3 months. Oculomotor abnormalities following whiplash injuries are generally mild, have a good prognosis, and would appear from this study to be commoner than hitherto expected.
Roca PD.
Ocular manifestations of whiplash injuries.
Ann Ophthalmol. 1972 Jan;4(1):63-73.
Abstract/Text
Gibson WJ.
The eye and whiplash injuries.
J Fla Med Assoc. 1968 Oct;55(10):917-8.
Abstract/Text
Häggman-Henrikson B, Osterlund C, Eriksson PO.
Endurance during chewing in whiplash-associated disorders and TMD.
J Dent Res. 2004 Dec;83(12):946-50. doi: 10.1177/154405910408301211.
Abstract/Text
We have previously shown an association between neck injury and disturbed jaw function. This study tested the hypothesis of a relationship between neck injury and impaired endurance during chewing. Fifty patients with whiplash-associated disorders (WAD) were compared with 50 temporomandibular disorders (TMD) patients and 50 healthy subjects. Endurance was evaluated during unilateral chewing of gum for 5 min when participants reported fatigue and pain. Whereas all healthy subjects completed the task, 1/4 of the TMD and a majority of the WAD patients discontinued the task. A majority of the WAD patients also reported fatigue and pain. These findings suggest an association between neck injury and reduced functional capacity of the jaw motor system. From the results, we propose that routine examination of WAD patients should include jaw function and that an endurance test as described in this study could also be a useful tool for non-dental professionals.
Klobas L, Tegelberg A, Axelsson S.
Symptoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders.
Swed Dent J. 2004;28(1):29-36.
Abstract/Text
The purpose of this study was to compare the prevalence of temporomandibular disorders (TMD) between individuals with chronic whiplash-associated disorders (WAD) and a group of age- and sex-stratified patients attending a Public Dental Service (PDS) clinic. Fifty-four individuals diagnosed with chronic WAD that were referred to a rehabilitation centre constituted the WAD group. The control group consisted of 66 patients at a PDS clinic (C group). Both groups underwent a standardised examination of the masticatory system comprising a questionnaire and a clinical examination. Eighty-nine per cent of the individuals in the WAD group had severe symptoms of TMD according to Helkimo's anamnestic index of dysfunction (A1) compared with 18% in the C group (p < 0.001). The individuals in the WAD group had also more signs of TMD. The maximum mouth opening capacity was 48 mm in the WAD group and 54 mm in the C group (p < 0.001). In the WAD group 17% had a mouth opening capacity < 40 mm compared with 2% in the C group (p < 0.05). Pain on palpation of the jaw muscles and on lateral palpation of the temporomandibular joints was more common in the WAD group (p < 0.001). Pain on mandibular mobility was reported by 30% in the WAD group and by 3% in the C group (p < 0.001). In conclusion, the prevalence of TMD was higher among individuals with chronic WAD compared with an age- and sex-stratified cohort of patients in a general dental practice. The results indicate that trauma to the neck also affects temporomandibular function.
Friedman MH, Weisberg J.
The craniocervical connection: a retrospective analysis of 300 whiplash patients with cervical and temporomandibular disorders.
Cranio. 2000 Jul;18(3):163-7. doi: 10.1080/08869634.2000.11746128.
Abstract/Text
Because the concept of whiplash as a causative factor for temporomandibular disorders (TMD) is highly controversial, we decided to do a retrospective analysis of patients treated in our office who had sustained whiplash injuries and were treated for cervical and temporomandibular disorders. The records of 300 patients with TMD preceded by a motor vehicle accident were examined retrospectively. The most common presenting symptoms, in order, were: jaw pain, neck pain, post-traumatic headache, jaw fatigue, and severe temporomandibular joint (TMJ) clicking. The most common TMD diagnoses were: masseter trigger points, closing jaw muscle hyperactivity, TMJ synovitis, opening jaw muscle hyperactivity, and advanced TMJ disk derangement. Based primarily on the physical examination, we concluded that the TMJ and surrounding musculature should be examined similarly to other joints, with no preconceived notion that TMD pathology after whiplash is unlikely.
Visscher C, Hofman N, Mes C, Lousberg R, Naeije M.
Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?
Clin J Pain. 2005 Jul-Aug;21(4):353-7. doi: 10.1097/01.ajp.0000125264.40304.8c.
Abstract/Text
OBJECTIVES: The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group.
METHODS: From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests.
RESULTS: Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001DISCUSSION: The higher prevalence of widespread pain and psychologic distress in patients with chronic whiplash-associated disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.
Sterling M, Jull G, Vicenzino B, Kenardy J.
Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery.
Pain. 2003 Aug;104(3):509-517. doi: 10.1016/S0304-3959(03)00078-2.
Abstract/Text
Hypersensitivity to a variety of sensory stimuli is a feature of persistent whiplash associated disorders (WAD). However, little is known about sensory disturbances from the time of injury until transition to either recovery or symptom persistence. Quantitative sensory testing (pressure and thermal pain thresholds, the brachial plexus provocation test), the sympathetic vasoconstrictor reflex and psychological distress (GHQ-28) were prospectively measured in 76 whiplash subjects within 1 month of injury and then 2, 3 and 6 months post-injury. Subjects were classified at 6 months post-injury using scores on the Neck Disability Index: recovered (<8), mild pain and disability (10-28) or moderate/severe pain and disability (>30). Sensory and sympathetic nervous system tests were also measured in 20 control subjects. All whiplash groups demonstrated local mechanical hyperalgesia in the cervical spine at 1 month post-injury. This hyperalgesia persisted in those with moderate/severe symptoms at 6 months but resolved by 2 months in those who had recovered or reported persistent mild symptoms. Only those with persistent moderate/severe symptoms at 6 months demonstrated generalised hypersensitivity to all sensory tests. These changes occurred within 1 month of injury and remained unchanged throughout the study period. Whilst no significant group differences were evident for the sympathetic vasoconstrictor response, the moderate/severe group showed a tendency for diminished sympathetic reactivity. GHQ-28 scores of the moderate/severe group were higher than those of the other two groups. The differences in GHQ-28 did not impact on any of the sensory measures. These findings suggest that those with persistent moderate/severe symptoms at 6 months display, soon after injury, generalised hypersensitivity suggestive of changes in central pain processing mechanisms. This phenomenon did not occur in those who recover or those with persistent mild symptoms.
Barrett K, Buxton N, Redmond AD, Jones JM, Boughey A, Ward AB.
A comparison of symptoms experienced following minor head injury and acute neck strain (whiplash injury).
J Accid Emerg Med. 1995 Sep;12(3):173-6. doi: 10.1136/emj.12.3.173.
Abstract/Text
The symptoms reported by patients who have experienced minor head or minor neck injury are compared. Symptoms were identified using a questionnaire-based out-patients interview. Rank order correlation analyses were carried out on data obtained at 2 and 6-12 weeks post-injury. Data on 24 head-injured and 29 neck-injured patients are presented. There was a significant rank order correlation at both assessments but neck injured patients reported more phobia (fear of travelling in car) and depression, and head-injured more dizziness. It is likely that neck-injury contributes to the symptomatology experienced after minor head injury, and vice-versa.
Kischka U, Ettlin T, Heim S, Schmid G.
Cerebral symptoms following whiplash injury.
Eur Neurol. 1991;31(3):136-40. doi: 10.1159/000116663.
Abstract/Text
Fifty-two patients suffering from various chronic disturbances after whiplash injury were studied retrospectively. Frequencies and coincidences of the complaints and symptoms were calculated. From those 26 patients who had reported cognitive disturbances 18 were examined with an extensive neuropsychological test battery. The results showed deficits mainly in the attention and concentration tests, to a lesser extent in the memory tests and least in the tests of higher cognitive functions. The findings were discussed as being compatible with damage to frontobasal cerebral structures and the upper brainstem as a consequence of the whiplash injury.
Balla J, Karnaghan J.
Whiplash headache.
Clin Exp Neurol. 1987;23:179-82.
Abstract/Text
This study considers the natural history and characteristics of headache occurring after whiplash injuries. Previous descriptions generally failed to distinguish between the headaches seen at various stages after the injury. In a prospective study of 180 cases of acute whiplash injury, it was demonstrated that 82% suffered from headache. One hundred and twenty-two cases were analysed to describe the type of headache seen and it was shown that in the majority rapid improvement occurred over a matter of some weeks. In a retrospective analysis of over 5000 cases of whiplash injury, about 25% developed chronic disability. Practically all of these had headaches. A retrospective analysis of 100 cases describes a spectrum of headaches different from those seen after the acute illness. The pathogenesis of the two types of headache is likely to be different and this needs to be investigated before rational treatment can be instituted.
Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E.
Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management.
Spine (Phila Pa 1976). 1995 Apr 15;20(8 Suppl):1S-73S.
Abstract/Text
Drottning M, Staff PH, Sjaastad O.
Cervicogenic headache (CEH) after whiplash injury.
Cephalalgia. 2002 Apr;22(3):165-71. doi: 10.1046/j.1468-2982.2002.00315.x.
Abstract/Text
The main objective of the present investigation was to search for cervicogenic headache (CEH) after whiplash injury. Whiplash patients (n= 587), were followed for a year after their emergency service consultation. A total of 222 patients with headache after 1 month went through interview and examinations at 6 weeks, 6 months and 1 year. All included persons received a questionnaire after 1 year. De novo CEH seemed to be present in 8% at 6 weeks and in 3% at 1 year. Previous car accidents, pre-existing headache and neck pain were more frequent in chronic CEH individuals than in those in the cohort without CEH. Range of motion in the neck was reduced in 65% of chronic CEH individuals hours after the accident, compared with 41% in the cohort. Cybex inclinometer, at 6 weeks and 1 year, demonstrated reduced extension in the neck. CEH seems to be present after whiplash injury, particularly in the early phase. It seems similar to, but probably not identical to, non-whiplash CEH.
Atherton K, Wiles NJ, Lecky FE, Hawes SJ, Silman AJ, Macfarlane GJ, Jones GT.
Predictors of persistent neck pain after whiplash injury.
Emerg Med J. 2006 Mar;23(3):195-201. doi: 10.1136/emj.2005.027102.
Abstract/Text
OBJECTIVE: To establish the aetiological influences of persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms.
DESIGN: Prospective cohort study. Patients recruited from hospital emergency departments were sent a questionnaire to gather information on various exposures. They were followed up at 1, 3, and 12 months to identify those with persistent symptoms.
MAIN OUTCOME MEASURE: Persistent neck pain (pain at 1, 3, and 12 months after collision).
RESULTS: The baseline survey included 765 patients. Subsequently, 480 completed a questionnaire at each follow up time point, of whom 128 (27%) reported neck pain on each occasion. Few collision specific factors predicted persistent neck pain. In contrast, a high level of general psychological distress, pre-collision history of widespread body pain, type of vehicle, whiplash associated symptoms, and initial neck disability best predicted the persistence of symptoms. Furthermore, these factors, in combination, accounted for more than a fivefold increase in the risk of persistent neck pain.
CONCLUSION: The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself. With these factors, and those relating to initial injury severity, it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms. Thus, it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals.
Squires B, Gargan MF, Bannister GC.
Soft-tissue injuries of the cervical spine. 15-year follow-up.
J Bone Joint Surg Br. 1996 Nov;78(6):955-7. doi: 10.1302/0301-620x78b6.1267.
Abstract/Text
Forty patients with a whiplash injury who had been reviewed previously 2 and 10 years after injury were assessed again after a mean of 15.5 years by physical examination, pain and psychometric testing. Twenty-eight (70%) continued to complain of symptoms referable to the original accident. Neck pain was the commonest, but low-back pain was present in half. Women and older patients had a worse outcome. Radiating pain was more common in those with severe symptoms. Evidence of psychological disturbance was seen in 52% of patients with symptoms. Between 10 and 15 years after the accident 18% of the patients had improved whereas 28% had deteriorated.
Radanov BP, Schnidrig A, Di Stefano G, Sturzenegger M.
Illness behaviour after common whiplash.
Lancet. 1992 Mar 21;339(8795):749-50. doi: 10.1016/0140-6736(92)90654-l.
Abstract/Text
厚生労働科学研究費補助金、障害者対策総合研究事業：「脳脊髄液減少症の診断・治療確立に関する研究」総括研究報告書, 2012.
Alexandre A, Corò L, Azuelos A, Pellone M.
Thoracic outlet syndrome due to hyperextension-hyperflexion cervical injury.
Acta Neurochir Suppl. 2005;92:21-4. doi: 10.1007/3-211-27458-8_5.
Abstract/Text
Posttraumatic brachial plexus entrapment in fibrotic scarring tissue is taken into consideration as the cause of complaints for patients who suffered a hyperextension-hyperflexion cervical injury. All 54 patients included in this analysis where symptom-free before the accident and subsequently complained for pain, paresthesia and slight weakness in the arm. In 14 neurological signs of brachial plexus entrapment were observed. Electroneurophysiological, summary index testing was positive for a brachial plexus involvement in all cases. Conservative measures, comprising physical therapy and vasoactive drugs were applied for a period of 6 to 12 (mean 8.4) months; surgical procedure of neurolysis was then proposed in 39 cases to solve the problem. Thirty-two patients were operated on. Twenty of these had a neat improvement on a 6-month to 1-year follow-up. Seven patients had refused surgery; of these 6 patients had clinical worsening at the same follow-up period while 1 remained unchanged. All patients with clinical symptoms not reversed after some time post-injury should be investigated for a possible brachial plexus entrapment.
Kai Y, Oyama M, Kurose S, Inadome T, Oketani Y, Masuda Y.
Neurogenic thoracic outlet syndrome in whiplash injury.
J Spinal Disord. 2001 Dec;14(6):487-93. doi: 10.1097/00002517-200112000-00004.
Abstract/Text
A prospective study of 110 patients was carried out to determine the pathogenic significance of trauma to the upper body in the development of neural compressive irritation at the thoracic outlet. Twenty-nine patients were reviewed as cervical strain injuries (N group), 25 patients as probable neurogenic thoracic outlet syndrome (NTOS) (PT group), 39 patients as definite NTOS (T group), and 17 patients as NTOS associated with cervical disc disease (CD-T group). The time lapse between accident and diagnosis and the duration of treatment were significantly longer in T patients or CD-T patients than those in the N group. Radiography of NTOS patients also showed a higher percentage of cervical spine-length/height ratio. Traumatic NTOS would suggest two types related to direct damage of scalene muscles that included some physical aspects of cervical disc disease. Pathogenesis provided a key to the resolution of more complex posttraumatic problems of whiplash injury.
Ide M, Ide J, Yamaga M, Takagi K.
Symptoms and signs of irritation of the brachial plexus in whiplash injuries.
J Bone Joint Surg Br. 2001 Mar;83(2):226-9. doi: 10.1302/0301-620x.83b2.11094.
Abstract/Text
We investigated the incidence of evidence of irritation of the brachial plexus in 119 patients with whiplash injuries sustained in road-traffic accidents. We compared the symptoms, physical signs, autonomic status, psychological status and findings from radiographs of the cervical spine using examination charts and a modified Cornell Medical Index Health questionnaire, in patients in two distinct groups: those with irritation of the brachial plexus and those without. There were 45 patients (37.8%) in the first group. The ratio of women to men was significantly higher in patients with irritation of the plexus as was the incidence of symptoms other than neck pain. There was no significant difference between the two groups with regard to psychological status or findings in radiographs of the cervical spine. Symptoms and signs attributable to stretching of the brachial plexus do occur in a significant proportion of patients after a whiplash injury. Their presence and persistence are associated with a poor outcome.
Capistrant TD.
Thoracic outlet syndrome in cervical strain injury.
Minn Med. 1986 Jan;69(1):13-7.
Abstract/Text
Tishler M, Levy O, Maslakov I, Bar-Chaim S, Amit-Vazina M.
Neck injury and fibromyalgia-- are they really associated?
J Rheumatol. 2006 Jun;33(6):1183-5. Epub 2006 May 1.
Abstract/Text
OBJECTIVE: To investigate whether whiplash injury may be a trigger for the onset of fibromyalgia (FM).
METHODS: One hundred fifty-three patients presenting to the emergency room with the diagnosis of whiplash injury were examined. The control group included 53 patients hospitalized with fractures of the limbs, spine, and ribs due to road accident. The study and control groups were interviewed shortly after presenting and then followed prospectively. Patients complaining of musculoskeletal symptoms during followup were examined and a count of 18 tender points was conducted. FM was diagnosed if the patient fulfilled currently accepted 1990 American College of Rheumatology criteria.
RESULTS: The mean followup period for the study and control groups was 14.5 months (range 12-18) and 9 months (range 6-14), respectively. There were no differences between the groups with regard to age, sex, marital, education, or employment status. During the followup period only one patient in the study group and no patients in the control group developed signs and symptoms of FM. Three patients in the study group (2%) and 15 patients in the control group (16%) filed insurance claims; none was associated with FM.
CONCLUSION: Whiplash injury and road accident trauma were not associated with an increased rate of FM after more than 14.5 months of followup.
Sterling M, Jull G, Vicenzino B, Kenardy J.
Characterization of acute whiplash-associated disorders.
Spine (Phila Pa 1976). 2004 Jan 15;29(2):182-8. doi: 10.1097/01.BRS.0000105535.12598.AE.
Abstract/Text
STUDY DESIGN: An experimental study of motor and sensory function and psychological distress in subjects with acute whiplash injury.
OBJECTIVES: To characterize acute whiplash injury in terms of motor and sensory systems dysfunction and psychological distress and to compare subjects with higher and lesser levels of pain and disability.
SUMMARY OF BACKGROUND DATA: Motor system dysfunction, sensory hypersensitivity, and psychological distress are present in chronic whiplash associated disorders (WAD), but little is known of such factors in the acute stage of injury. As higher levels of pain and disability in acute WAD are accepted as signs of poor outcome, further characterization of this group from those with lesser symptoms is important.
MATERIALS AND METHODS: Motor function (cervical range of movement [ROM], joint position error [JPE]; activity of the superficial neck flexors [EMG] during a test of cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, and responses to the brachial plexus provocation test), and psychological distress (GHQ-28, TAMPA, IES) were measured in 80 whiplash subjects (WAD II or III) within 1 month of injury, as were 20 control subjects.
RESULTS: Three subgroups were identified in the cohort using cluster analysis based on the Neck Disability Index: those with mild, moderate, or severe pain and disability. All whiplash groups demonstrated decreased ROM and increased EMG compared with the controls (all P < 0.01). Only the moderate and severe groups demonstrated greater JPE and generalized hypersensitivity to all sensory tests (all P < 0.01). The three whiplash subgroups demonstrated evidence of psychological distress, although this was greater in the moderate and severe groups. Measures of psychological distress did not impact on between group differences in motor or sensory tests.
CONCLUSIONS: Acute whiplash subjects with higher levels of pain and disability were distinguished by sensory hypersensitivity to a variety of stimuli, suggestive of central nervous system sensitization occurring soon after injury. These responses occurred independently of psychological distress. These findings may be important for the differential diagnosis of acute whiplash injury and could be one reason why those with higher initial pain and disability demonstrate a poorer outcome.
Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R.
Development of motor system dysfunction following whiplash injury.
Pain. 2003 May;103(1-2):65-73. doi: 10.1016/s0304-3959(02)00420-7.
Abstract/Text
Dysfunction in the motor system is a feature of persistent whiplash associated disorders. Little is known about motor dysfunction in the early stages following injury and of its progress in those persons who recover and those who develop persistent symptoms. This study measured prospectively, motor system function (cervical range of movement (ROM), joint position error (JPE) and activity of the superficial neck flexors (EMG) during a test of cranio-cervical flexion) as well as a measure of fear of re-injury (TAMPA) in 66 whiplash subjects within 1 month of injury and then 2 and 3 months post injury. Subjects were classified at 3 months post injury using scores on the neck disability index: recovered (<8), mild pain and disability (10-28) or moderate/severe pain and disability (>30). Motor system function was also measured in 20 control subjects. All whiplash groups demonstrated decreased ROM and increased EMG (compared to controls) at 1 month post injury. This deficit persisted in the group with moderate/severe symptoms but returned to within normal limits in those who had recovered or reported persistent mild pain at 3 months. Increased EMG persisted for 3 months in all whiplash groups. Only the moderate/severe group showed greater JPE, within 1 month of injury, which remained unchanged at 3 months. TAMPA scores of the moderate/severe group were higher than those of the other two groups. The differences in TAMPA did not impact on ROM, EMG or JPE. This study identifies, for the first time, deficits in the motor system, as early as 1 month post whiplash injury, that persisted not only in those reporting moderate/severe symptoms at 3 months but also in subjects who recovered and those with persistent mild symptoms.
Loudon JK, Ruhl M, Field E.
Ability to reproduce head position after whiplash injury.
Spine (Phila Pa 1976). 1997 Apr 15;22(8):865-8. doi: 10.1097/00007632-199704150-00008.
Abstract/Text
STUDY DESIGN: A two-group design with repeated measures.
OBJECTIVES: To determine if there is loss of the ability to reproduce target position of the cervical spine individuals who have sustained a whiplash injury.
SUMMARY OF BACKGROUND DATA: The ability to sense position is a prerequisite for functional movement. Injury may have a deleterious effect on this ability, resulting in inaccurate positioning of the head and neck with respect to the body coordinates and to the environment.
METHODS: Eleven subjects with history of whiplash injury (age, 42 +/- 8.7 years) and 11 age-matched asymptomatic subjects (age, 43 +/- 3.1 years) participated in the study. Effects of whiplash injury on the ability to replicate a target position of the head were assessed. Maximum rotation of the neck and ability to reproduce the target angle were measured using a standard cervical range-of-motion device. Subjects' perception of "neutral" position was also assessed.
RESULTS: Analysis of variance indicated the whiplash subjects were less accurate in reproducing the target angle than were control subjects. These whiplash subjects tended to overshoot the target. In addition, the subjects in the whiplash group were often inaccurate in their assessment of neutral position.
CONCLUSIONS: Subjects who have experienced a whiplash injury demonstrate a deficit in their ability to reproduce a target position of the neck. These data are consistent with the hypothesis that these subjects possess an inaccurate perception of head position secondary to their injury. This study has implications for the rehabilitation of individuals with whiplash injury.
Treleaven J, Jull G, Sterling M.
Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error.
J Rehabil Med. 2003 Jan;35(1):36-43. doi: 10.1080/16501970306109.
Abstract/Text
Dizziness and/or unsteadiness are common symptoms of chronic whiplash-associated disorders. This study aimed to report the characteristics of these symptoms and determine whether there was any relationship to cervical joint position error. Joint position error, the accuracy to return to the natural head posture following extension and rotation, was measured in 102 subjects with persistent whiplash-associated disorder and 44 control subjects. Whiplash subjects completed a neck pain index and answered questions about the characteristics of dizziness. The results indicated that subjects with whiplash-associated disorders had significantly greater joint position errors than control subjects. Within the whiplash group, those with dizziness had greater joint position errors than those without dizziness following rotation (rotation (R) 4.5 degrees (0.3) vs 2.9 degrees (0.4); rotation (L) 3.9 degrees (0.3) vs 2.8 degrees (0.4) respectively) and a higher neck pain index (55.3% (1.4) vs 43.1% (1.8)). Characteristics of the dizziness were consistent for those reported for a cervical cause but no characteristics could predict the magnitude of joint position error. Cervical mechanoreceptor dysfunction is a likely cause of dizziness in whiplash-associated disorder.
Herren-Gerber R, Weiss S, Arendt-Nielsen L, Petersen-Felix S, Di Stefano G, Radanov BP, Curatolo M.
Modulation of central hypersensitivity by nociceptive input in chronic pain after whiplash injury.
Pain Med. 2004 Dec;5(4):366-76. doi: 10.1111/j.1526-4637.2004.04055.x.
Abstract/Text
OBJECTIVE: Chronic pain after whiplash injury is associated with hypersensitivity of the central nervous system to peripheral stimulation. It is unclear whether central hypersensitivity is modulated by peripheral nociceptive input. We hypothesized that changes in nociceptive input would correlate with changes in magnitude of central hypersensitivity.
DESIGN: Fifteen patients with chronic pain after whiplash injury were investigated. Changes in nociceptive input were induced by infiltration of painful and tender muscles with bupivacaine (0.25%). Such infiltrations produce either pain reduction or pain enhancement, the latter effect probably resulting from transient injection-induced trauma. We used this individual variability in correlation analyses. Changes in intensity of neck pain, as assessed by a visual analog scale (VAS), after infiltration were assumed to reflect changes in nociceptive input. Changes in pressure pain thresholds recorded at healthy tissues (nonpainful point of the neck and the second toe) were used to measure changes in central hypersensitivity. The correlations between the change in VAS score and changes in pressure pain thresholds 15 minutes after infiltration were analyzed.
RESULTS: Statistically significant negative correlations were found between change in VAS score and changes in threshold measurements performed at the neck, but not at the toe.
CONCLUSIONS: Different mechanisms underlie hyperalgesia localized at areas surrounding the site of pain and hyperalgesia generalized to distant body areas. Central hypersensitivity as a determinant of neck pain is probably a dynamic condition that is influenced by the presence and activity of a nociceptive focus.
Stude P, Nebel K, Lüdecke C, Wiese H, Diener HC, Keidel M.
Quantification of acute neck pain following whiplash injury by computer-aided pressure algesimetry.
Cephalalgia. 2004 Dec;24(12):1067-75. doi: 10.1111/j.1468-2982.2004.00787.x.
Abstract/Text
Until now the clinical investigation of cervical pain due to whiplash injury is mainly based on finger palpation. The present study introduces a PC-interactive pressure algesimetry to standardize cervical pain measurement. Pressure pain scores of the splenius and trapezius muscles of 23 patients with an acute cervical syndrome after whiplash injury were compared to those of 24 healthy subjects. The pressure painfulness of neck and shoulder muscles was significantly increased in whiplash patients. The splenii muscles showed an equally increased muscle pain whereas the trapezii muscles showed a left-sided preponderance of painfulness, possibly due to the seat belt position in this group of motor vehicle drivers. The computer-interactive pressure algesimetry enables a standardized and rater-independent quantification of the cervical syndrome with neck and shoulder pain caused by whiplash injury.
Capistrant TD.
Thoracic outlet syndrome in whiplash injury.
Ann Surg. 1977 Feb;185(2):175-8. doi: 10.1097/00000658-197702000-00007.
Abstract/Text
Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome.
Wenngren BI, Pettersson K, Lowenhielm G, Hildingsson C.
Eye motility and auditory brainstem response dysfunction after whiplash injury.
Acta Otolaryngol. 2002 Apr;122(3):276-83. doi: 10.1080/000164802753648150.
Abstract/Text
The aim of this study was to identify the prevalence of brain/brainstem dysfunction after acute whiplash trauma (grades II and III according to the Quebec Task Force Classification on whiplash-associated disorders) and to investigate a possible correlation between the development of chronic symptoms and objective findings from auditory brainstem response (ABR) and eye motility tests. We used ABR and oculomotor tests and a thorough clinical, subjective and psychological evaluation in a sample of prospective whiplash trauma patients who were followed up for 2 years after the trauma. The initial test results did not reveal any prognostic clinical signs for the tested group as a whole, but we could discriminate some patients with clinical symptoms and signs paired with pathologic test results. Over time, some patients normalized clinically and their test results improved while others deteriorated clinically and their test results were worse at the 2-year investigation. Our findings of moderate derangements in the tests could be the effects of pain and/or changed cervical afferent activity at the brain/brainstem level, while eye motility dysfunction, in addition to pathological neuro-otological findings in a small proportion of the patients with severe symptoms, could be explained by lesions to the brain/brainstem.
Calseyde P, Ampe W, Depondt M.
E.N.G. and the cervical syndrome neck torsion nystagmus.
Adv Otorhinolaryngol. 1977;22:119-24. doi: 10.1159/000399494.
Abstract/Text
Toglia JU.
Vestibular and medico-legal aspects of closed cranio-cervical trauma.
Scand J Rehabil Med. 1972;4(3):126-32.
Abstract/Text
Pang LQ.
The otological aspects of whiplash injuries.
Laryngoscope. 1971 Sep;81(9):1381-7. doi: 10.1288/00005537-197109000-00002.
Abstract/Text
Compere WE Jr.
Electronystagmographic findings in patients with "whiplash" injuries.
Laryngoscope. 1968 Jul;78(7):1226-33. doi: 10.1288/00005537-196807000-00011.
Abstract/Text
Rubin W.
Whiplash with vestibular involvement.
Arch Otolaryngol. 1973 Jan;97(1):85-7. doi: 10.1001/archotol.1973.00780010089021.
Abstract/Text
Fischer AJ, Huygen PL, Folgering HT, Verhagen WI, Theunissen EJ.
Vestibular hyperreactivity and hyperventilation after whiplash injury.
J Neurol Sci. 1995 Sep;132(1):35-43. doi: 10.1016/0022-510x(95)00118-l.
Abstract/Text
Vestibular, oculomotor and respiratory tests were performed on 32 patients after whiplash injury caused by a rear-end car collision. Oculomotor functions were generally normal. The cervico-ocular reflex was usually absent or displayed the low gain typical of normal subjects. There was no nystagmic response to static neck torsion. The vestibulo-ocular reflex showed vestibular hyperreactivity (VH) in a significantly large number of cases (n = 17; 53%). The respiratory test results were also typical of the hyperventilation syndrome (HVS) in a significantly large number of cases (n = 12; 38%). The findings of VH and the HVS were not significantly correlated within the patient group. However, the combination of VH and the HVS occurred significantly more often (n = 7; 22%) than could be accounted for by combined false positivity. Most of the significant findings were due to high relative frequencies in the women: 11 out of the 17 women (65%) showed VH, 8 (47%) had the HVS and 5 (29%) showed a combination of VH and the HVS. The findings were not correlated with the patient's age or the time interval between the accident and the examination. VH might have been the result of plastic adaptation to limited head mobility secondary to neck pain. Behavioural and emotional distress might offer alternative explanations for both VH and the HVS.
Olsnes BT.
Neurobehavioral findings in whiplash patients with long-lasting symptoms.
Acta Neurol Scand. 1989 Dec;80(6):584-8. doi: 10.1111/j.1600-0404.1989.tb03931.x.
Abstract/Text
Thirty-four patients with persistent symptoms following whiplash injury and 21 controls with somatic complaints resembling those of the whiplash patients, but with no history of trauma, were studied. Forty-eight neuropsychological test variables were analyzed. The results indicated that whiplash patients with chronic symptoms are not much impaired in their performance as compared with controls. The differences found were not sufficiently strong to be taken as consistent evidence of brain damage occurring as a sequela of whiplash injury.
Taylor AE, Cox CA, Mailis A.
Persistent neuropsychological deficits following whiplash: evidence for chronic mild traumatic brain injury?
Arch Phys Med Rehabil. 1996 Jun;77(6):529-35. doi: 10.1016/s0003-9993(96)90290-7.
Abstract/Text
OBJECTIVE: To investigate claims of neuropsychological evidence for acquired brain damage (axonal degeneration) in chronic whiplash.
DESIGN: Fifteen whiplash patients (Whiplash) were compared with 10 patients who had documented moderate-to-severe head injury (Mod-Sev), and with 24 patients who had chronic pain syndrome (CPS) and no history of head injury on two tests of mental efficiency considered highly sensitive to and specific for the subtle effects of brain trauma. All 3 groups, assessed 4 years after onset in a teaching hospital setting were matched for age, education, and IQ. Exclusion criteria included narcotics/benzo-diazepines or (suspected) malingering. Subjective ratings of depression and pain were collected as well as objective indices of outcome (return to work/school).
MEASURES: Neuropsychological test scores were subjected to ANOVA followed by regression analysis regarding the possible effects of age, IQ, pain, and mood ratings.
RESULTS: No differences between the Whiplash, Mod-Sev, or CPS groups on the neuropsychological tests emerged. IQ was strongly related to mental efficiency. Counterintuitively, Mod-Sev patients complained of less depression and pain than did Whiplash or CPS patients (where no differences were seen) and displayed a better outcome. Finally, although results from 3 of the original 18 patients in the Whiplash group were later discarded for malingering, no malingering was detected in the 2 other groups.
CONCLUSIONS: The theory of neuronal degeneration in the etiology of whiplash-related cognitive complaints was not supported, nor was the specificity of neuropsychological tests in detecting the subtle effects of brain trauma.
Tencer AF, Mirza S, Cummings P.
Do "whiplash" victims with neck pain differ from those with neck pain and other symptoms?
Annu Proc Assoc Adv Automot Med. 2001;45:203-14.
Abstract/Text
Studying 432 patients with "whiplash" neck pain after a low speed rear-end crash, we determined whether those who reported associated symptoms (arm or low back pain) differed from those with neck pain only. Exposure variables were: age, gender, height, weight, surprised by impact, rotated position of the head, and pre-existing cervical or lumbar spinal degeneration. Immediate symptoms were considered. Odds ratios (OR) were derived from logistic regression. Only pre-existing lumbar spinal degeneration was associated with having arm symptoms (OR = 9.6, CI = 1.1, 83.6) or low back pain (OR = 23.3, CI = 2.6, 206.7) along with neck pain.
Schrader H, Obelieniene D, Bovim G, Surkiene D, Mickeviciene D, Miseviciene I, Sand T.
Natural evolution of late whiplash syndrome outside the medicolegal context.
Lancet. 1996 May 4;347(9010):1207-11. doi: 10.1016/s0140-6736(96)90733-3.
Abstract/Text
BACKGROUND: In Lithuania, few car drivers and passengers are covered by insurance and there is little awareness among the general public about the potentially disabling consequences of a whiplash injury. We took this opportunity to study the natural course of head and neck symptoms after rear-end car collisions.
METHODS: In a retrospective questionnaire-based cohort study, 202 individuals (157 men; 45 women) were identified from the records of the traffic police department in Kaunas, Lithuania. These individuals were interviewed 1-3 years after experiencing a rear-end car collision. Neck pain, headache, subjective cognitive dysfunction, psychological disorders, and low back pain in this group were compared with the same complaints in a sex-matched and age-matched control group of uninjured individuals selected randomly from the population register of the same geographic area.
FINDINGS: Neck pain was reported by 71 (35% [95% CI 29-42]) accident victims and 67 (33% [27-40]) controls. Headache was reported by 107 (53% [46-60]) accident victims and 100 (50% [42-57]) controls. Chronic neck pain and chronic headache (more than 7 days per month) were also reported in similar proportions (17 [8.4%; 5-13] vs 14 [6.9%; 4-12] and 19 [9.4%; 6-15] vs 12 [5.9%; 3-10]) by the two groups. Of those who reported chronic neck pain or daily headache after the accident, substantial proportions had had similar symptoms before the accident (7/17 for chronic neck pain; 10/12 for daily headache). There was no significant difference found. No one in the study group had disabling or persistent symptoms as a result of the car accident. There was no relation between the impact severity and degree of pain. A family history of neck pain was the most important risk factor for current neck symptoms in logistic regression analyses.
INTERPRETATION: Our results suggest that chronic symptoms were not usually caused by the car accident. Expectation of disability, a family history, and attribution of pre-existing symptoms to the trauma may be more important determinants for the evolution of the late whiplash syndrome.
Joslin CC, Khan SN, Bannister GC.
Long-term disability after neck injury. a comparative study.
J Bone Joint Surg Br. 2004 Sep;86(7):1032-4. doi: 10.1302/0301-620x.86b7.14633.
Abstract/Text
Claims for personal injury after whiplash injury cost the economy of the United Kingdom more than pound 3 billion per year, yet only very few patients have radiologically demonstrable pathology. Those sustaining fractures of the cervical spine have been subjected to greater force and may reasonably be expected to have worse symptoms than those with whiplash injuries. Using the neck disability index as the outcome measure, we compared pain and functional disability in four groups of patients who had suffered injury to the cervical spine. After a mean follow-up of 3.5 years, patients who had sustained fractures of the cervical spine had significantly lower levels of pain and disability than those who had received whiplash injuries and were pursuing compensation (p < 0.01), but had similar levels to those whiplash sufferers who had settled litigation or had never sought compensation. Functional recovery after neck injury was unrelated to the physical insult. The increased morbidity in whiplash patients is likely to be psychological and is associated with litigation.
Côté P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW.
The association between neck pain intensity, physical functioning, depressive symptomatology and time-to-claim-closure after whiplash.
J Clin Epidemiol. 2001 Mar;54(3):275-86. doi: 10.1016/s0895-4356(00)00319-x.
Abstract/Text
Time-to-claim-closure is a common outcome in cohort studies of whiplash injuries. However, its relationship to health recovery is unknown. We investigated the association between neck pain, physical functioning, depressive symptomatology and time-to-claim-closure in a Saskatchewan cohort of 5398 whiplash claimants in 1994-1995. Participants were surveyed five times over 1 year. In 1995, the insurance system changed from tort to no-fault, eliminating compensation for pain and suffering. Under tort, a 10-point increase in pain reduced the claim-closure rate by 13-24% while a 10-point increase in physical functioning increased it by 17%. Depressive symptomatology reduced the claim-closure rate by 37%. Under no-fault, a 10-point increase in pain reduced the claim-closure rate by 18% while a 10-point increase in physical functioning increased it by 10-35%. The presence of depressive symptomatology reduced the claim-closure rate by 36%. The results suggests lower pain, better function and the absence of depressive symptoms are strongly associated with faster time-to-claim-closure and recovery after whiplash, independent of the insurance system.
