Whiplash Injury

Moon Soo Park; Seong-Hwan Moon; Tae-Hwan Kim; Jae Keun Oh; Myung Ho Yang

doi:10.4184/jkss.2016.23.1.63

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Park, Moon, Kim, Oh, and Yang: Whiplash Injury

Review Article

Journal of Korean Spine Surg 2016;23(1):63-69.

Published online: 31 March 2016

DOI: https://doi.org/10.4184/jkss.2016.23.1.63

Whiplash Injury

Moon Soo Park, M.D., Seong-Hwan Moon, M.D., Tae-Hwan Kim, M.D.^∗, Jae Keun Oh, M.D., Myung Ho Yang, M.D.^†

Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University

^∗Department of Orthopaedic Surgery, Yonsei University College of Medicine

^†Department of Neurosurgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University

Corresponding author: Moon Soo Park, M.D. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-070, Republic of Korea TEL: +82-31-380-6000, FAX: +82-31-380-6008 E-mail: amhangpark@gmail.com

Received 16 February 201616 February 2016 Accepted 24 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Review of the literature.

Objectives

To present an overview of current research on whiplash injury.

Summary of Literature Review

There are controversies over the definition, symptoms, and treatment of whiplash injury.

Materials and Methods

Review of the relevant literature.

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.

Conclusions

The appropriateness of treatment for whiplash injury should be evaluated on the basis of up to date academic research on its diagnosis and natural history.

Keywords: Whiplash injury, Whiplash-associated disorders

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Fig. 1.

Pre-existing foraminal stenosis of cervical spine at the oblique view of MRI.

Fig. 2.

Anteroposterior (A) and lateral view (B) of cervical spine showing the alignment of spinous process, vertebral body and lateral mass.

Fig. 3.

Right oblique view (A) and left oblique view (B) of cervical spine showing the alignment of facet joints.

Table 1.

The ouebec classification of whiplash-associated disorders.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

^∗ Musculoskeletal signs include decreased range of motion and point tenderness.

^† Neurologic signs include decreased or absent deep tendon reflexes, weakness, and sensory deficits. Symptoms and disorders that can be manifested in all grades include deafness, dizziness, tinnitus, headache, memory loss, dysphagia and temporo-mandibular joint pain.

Table 2.

Presentation of symptoms of whiplash injury.¹⁾

Symptoms	Study
Symptoms	Norris 1983 (%)	Radanov 1991 (%)	Hildingsson 1990 (%)
Neck Pain	100	100	88
Neck stiffness	−	−	69
Headache	66	57	54
Shoulder pain	−	42	40
Arm pain/numbness	-	-	14
Paresthesia	62	13	-
Weakness	18	-	-
Dysphagia	16	-	-
Visual	8	21	9
Auditory	18	-	4
Dizziness	25	17	23

Table 3.

Studies in which an inception cohort was assembled to determine prognosis following whiplash injury.¹⁾

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)

^∗ F/U: Follow-up

^† months.

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