dr gert van esbroeck az nikolaas sint niklaas whiplash definition: neck pain experienced as a result...
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![Page 1: Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas Whiplash definition: neck pain experienced as a result of a motor vehicle collision or similar trauma](https://reader036.vdocument.in/reader036/viewer/2022062417/5517a9c55503460e6e8b603a/html5/thumbnails/1.jpg)
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
definition: neck pain experienced as a result of a motor
vehicle collision or similar trauma
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
whiplash injury: any structural damage sustained because of
the whiplash forces
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
whiplash injury: it is the abnormal motion between individual motion segments that has
the potential to injure facets, disks, and ligaments
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
whiplash associated disorder: variety of clinical symptoms other than head, neck , and arm pain that occur after a whiplash type
of trauma
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 0 No Complaint about the neck No physical signs
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 1 Neck Complaint of pain , stifness or tenderness only
No physical signs
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 2 Neck Complaint and musculoskeletal signs
(including decreased ROM and point tenderness)
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 3 Neck Complaint and neurological signs
(including decreased or absent deep tendon reflexes, weakness,
and sensory deficit)
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 4 Neck Complaint and fracture or dislocation
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
annual incidence ranges from 0,1 to 7 per 1000
financial burden results from the small number of injuries that become chronicpatients with disabilities of more than 6
months account for 46% of the total cost
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
15% to 40% of patients with acute neck pain after MVC develop chronic pain
5% to 7% of patients become permanently
partially or totally disabled
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Natural history:In +/- 80% pain after MVC begins the day
of the collisioncomplete recovery occurs in 60 to 85% of
patients 5% to 12 % experience chronic moderate
to severe pain 5% to 10% have permanent partial or total
disability
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Prognostic factors:strongest indicator of poor outcome is
high initial intensity of painconflict in results regarding older age and
female sex no prognostic differences in preinjury psychological factors , work related
factors , litigation
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Prognostic factors:consulting a lawyer results in lesser
chance on early claim settlement, longer treatment and slightly worse functionin a no-fault no-tort system there is a
shorter time to case closure
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Clinical symptoms :
acute vs chronic neck pain (i.e. Pain that persists beyond 6 months)
location: midline, uni- or bilateral , trapezius, shoulder, interscapular , arm or
face
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Clinical symptoms :
Headache is the second most common symptom
involves the base of the skull and radiates to the crown of the head and the frontal
region
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Clinical symptoms :
WAD including LBP , visual disturbances, dizziness, tinnitus, weakness , fatigue ,
poor concentration , poor memory , difficulty sleeping , secondary
psychological changes
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
structural etiologyfacet joint
49%-54% facet joints in chronic neck pain 60% facet joints in chronic neck pain and
headache53% C2/C3 facet joint pain in case of
cervicogenic headache
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
structural etiologydisk ?
craniocervical ligaments?
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Treatment:acute neck pain
explanation, education, reassuranceno orthosis
« act as usual » as good as any other treatmentactive excercises
conflicting results of SMTNSAIDs
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain rehabilitation
injections
medication
spinal manipulative therapy
cervical orthosis
surgery
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain rehabilitation
strength training and endurance training
intensive excercises are more effective than light excercises but not more effective than ordinary activity
behavior modification : overcoming fear avoidance
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain
injectionslevel 1 evidence for efficacy of RFN for pain arising from facet
joints
Complete pain relief is possible with pure facet joint pain and in 86% of patients with facet-joint mediated cervicogenic
headache
Median of 270-400 days pain relief
Corticosteroid injection of facet joints only short term relief
No place for epidural infiltrations
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain
medicationUp to 3 trials of different NSAIDs (2wks), when response is
meaningful drug should be continued
Opioid analgesics
No evidence for the use of TCA nor anticonvulsants
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain
spinal manipulative therapy
No evidence concerning efficacy
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck paincervical orthosis
No evidence for efficacy
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain surgery
Surgery may be considered for the patient wih severe pain, significant impairment and good psychological health who has
not improved with high quality non-surgical care
Diskography?
? Science , pff !
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Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplashkey references
spitzer wo, skovron ml, salmi lr et al: scientific monograph of the Quebec Task Force on whiplash-associated disorders: redifining
whiplash and its managementSpine 1995;20:1S-73S
schofferman j, bogduk n, slosar p:chronic whiplash and whiplash-associated disorders: an evidence based approach
Journal of the AAOS;vol 15, October 2007,No 10, pp 596-606