Upload
bernardo-bridgham
View
218
Download
1
Tags:
Embed Size (px)
Citation preview
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
definition: neck pain experienced as a result of a motor
vehicle collision or similar trauma
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
whiplash injury: any structural damage sustained because of
the whiplash forces
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
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
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
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
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)
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)
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
The Quebec Classification for Whiplash Associated Disorders
Grade 4 Neck Complaint and fracture or dislocation
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
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
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
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
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
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
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
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
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
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
Whiplash
structural etiologydisk ?
craniocervical ligaments?
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
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain rehabilitation
injections
medication
spinal manipulative therapy
cervical orthosis
surgery
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
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
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
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck pain
spinal manipulative therapy
No evidence concerning efficacy
Dr Gert Van EsbroeckAZ Nikolaas Sint Niklaas
WhiplashTreatment:
chronic neck paincervical orthosis
No evidence for efficacy
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 !
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