Abstract
Summary of Literature Review
There are controversies over the definition, symptoms, and treatment of whiplash injury.
Results
Symptoms of whiplash injury caused by an acceleration-deceleration force may present as widespread pain involving the neck or trapezius muscles, the interscapular area, the shoulders and arms, or as suboccipital headaches. Accompanying symptoms may include neurologic symptoms such as sensory dysfunction, motor weakness, or deep tendon reflex loss; non-specific symptoms such as dyspha-gia, dizziness, visual disturbances, tinnitus, deafness, memory loss, or temporo-mandibular joint disorders; and psychological symptoms such as depression, acute stress syndrome, or fear avoidance. The most important factor that facilitates spontaneous resolution of whip-lash injury, which is a self-limiting disorder, has been shown to be prevention of the acute-to-chronic pain transition. Yet in spite of this knowledge the efficacy of several treatment methods for whiplash injury remains controversial.
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Table 1.
Grade | Clinical presentation |
---|---|
0 | No complaint about the neck No physical sign(s) |
I | Neck complaint of pain, stiffness or tenderness only No physical sign(s) |
II | Neck complaint AND Musculoskeletal sign(s)∗ |
III | Neck complaint AND Neurologic sign(s)† |
IV | Neck complaint AND Fracture or dislocation |
Table 2.
Table 3.
Reference | Type of study | Study Population | N | F/U∗ rate (%) | Mean duration of F/U† | Proportion with neck pain at end of F/U (%) |
---|---|---|---|---|---|---|
Norris (1983) | Prospective | All patients presenting to a single hospital after rear-end collision | 61 | 100 | 20 | 67(15% severe) |
Olsson (1990) | Prospective | Volvo drivers with non-serious neck injury | 33 | 100 | 12 | 36 |
Pennie (1991) | Prospective | Consecutive whiplash patients at 2 hospital accident departments | 144 | 95 | 5 | 14 |
Miles (1988) | Prospective | Consecutive whiplash patients at a hospital who had X-rays taken | 76 | 100 | 24 | 29 |
Deans (1987) | Retrospective | Consecutive car accident victims who developed neck pain | 85 | 78 | 18 | 42(6% constant pain) |
Maimaris (1988) | Retrospective | Consecutive whiplash patients at a hospital accident department | 102 | 85 | 24 | 35 |
Gargan (1990) | Retrospective | Same cohort as Norris and Watt | 43 | 70 | 120 | 88(12% severe) |
Watkinson (1991) | Retrospective | Same cohort as Norris and Watt | 35 | 57 | 120 | 86(9% severe) |