Download - Whiplash Injury
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WHIPLASH INJURY Presenter :Dr. Md. Kamrul Islam D-ortho Student , Department Of Orthopaedic Surgery BSMMU, Dhaka
ANOTHER NAMESPRAINED NECKDEFINITION Whiplash is a neck injury that can occur during rear-end automobile collisions, when head suddenly moves backward and then forward-similar to the motion of someone cracking a whip. These extreme motions push neck muscles and ligaments beyond their normal range of motion.CAUSESAuto accidents- Rear end collisions are the most common cause of whiplash.Physical abuse- Whiplash may also result from incidents of being punched or shaken. It is one of the injuries sustained in shaken baby syndrome.Contact sports- Football tackles and other sports related collisions can sometimes cause whiplash injuries.Pathophysiology a Sprain
Majority of whiplash injuries arise in soft tissue injury to neck involving ligaments, joints, joint capsules, muscles and tendons
Type 1: Injury at microscopic level without altering structure
Type 2: Partial tear at macroscopic level no separation
Type 3: Severe stretching and tearing with separation of tissues
Cervical Spine Anatomy
Cervical Spine Anatomy8
Atlanto-Axial JointCervical Spine Anatomy9
Cervical Spine Anatomy10Mechanism Of Injury Flexion InjuriesHead-on collisionFalling face forwardForcible forward flexionStructures primarily injuredDiscNerve rootVertebral bodyCompressionSubluxationExtension injuryRear ended collisionFalling backwardsForcible extension of the neckStructures injuredFacet jointsMusclesVertebral arteryMixed InjuriesFlexion-rotationExtension-rotationVertical compressionStructures injuredMultiple structuresMuscles and ligamentsClinical PresentationNeck painUpper back painHeadachesRadiating pain to the occiput, shoulders, armsNeurological symptomsNumbness, weaknessRemote signs and symptomsLeg weakness and numbnessBowel or bladder symptoms
EvaluationHistory Mechanism of injury (Flexion, extension or mixed)Aggravating and relieving factorsAdditional symptoms and complainsBowel or bladder symptoms
EvaluationPhysical examinationMuscolo-skeletal exam Range of motion (cervical spine and shoulders + arms)PalpationNeurological examSensory and motor examinationReflexesGaitAlways assume spinal cord trauma unless proven otherwiseInvestigations
Plain x-rayMRICT Scan EMG/NCV
MRI Cervical Spine
ManagementBased on injured structuresImmobilizationMulti-modal approachInterventionsPhysical therapyPharmaceuticalsFlexion injuriesDisc injurySurgical approachPercutaneous decompressionNerve rootSteroid injectionsCervical epiduralTransforaminal approach vs. interlaminar approachInterlaminar Epidural Injection
Transforaminal Epidural Injection
24Selective Nerve Root Block
Extension InjuriesSubluxationsSurgical approachFacet joint injuryDirect joint injectionNeuro-ablative techniquesMuscular injuryPhysical therapyWhiplash Associated Disorders (WAD)
Classed by severity of signs and symptoms-
WAD 0 No complaints or physical signsWAD 1 Neck complaints but no physical signsWAD 2 Neck complaints and musculoskeletal signsWAD 3 Neck complaints and neurological signs WAD 4 Neck complaints and fracture / dislocation
Most whiplash injury results from low impact collisionsPreventionHead restraints
3 in 4 not properly adjusted!
SummaryWhipash injuries are very common in MVAsVery high mortality rate with upper cervical spine injuriesHigh morbidity with lower cervical spine injuriesMRI is the best modality for evaluationSurgical interventions should be considered earlier due to risk of spiral cord traumaNeurological assessment is a must (upper and lower extremities)Effective management includes multimodal approach
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