PowerPoint Presentation
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
Thank You All
