Upload
london-pain-clinic
View
463
Download
0
Embed Size (px)
DESCRIPTION
Whiplash Injury Presented To AMLED (Association of Medicolegal Doctors) in London 1st December 2006.Tour de force of the main topics regarding Whiplash injury
Citation preview
Whiplash Injury.
Dr. Christopher A. Jenner MB BS, FRCAConsultant in Pain Medicine, St Mary’s Hospital, W2
Director, London Pain Consultants1st December 2006
Agenda
• Definition
• Clinical findings
• Management
• Prognosis
www.londonpainconsultants.com
Definition
www.londonpainconsultants.com
Definition
• Soft tissue injury to the neck
• Sudden Extension-Flexion injury
• Whip-like movement
• Collection of symptoms
Causes
www.londonpainconsultants.com
Causes
• RTA commonly- front/ back/ side
• Contact sport injuries
• Accidental/ intentional blows to head
Causes
• Repetitive stress injuries to neck (eg: phone)
• Child abuse- shaking, hitting
www.londonpainconsultants.com
Incidence
www.londonpainconsultants.com
Incidence
• US National Highway Traffic Safety Administration (1995)
• 53% of 5.5 million RTA victims suffered whiplash injury
www.londonpainconsultants.com
Soft Tissue Damage
www.londonpainconsultants.com
Soft Tissue Damage
• Ligaments
• Tendons
• Muscles
• Intervertebral discs
• Facet Joints
• Nerve roots
Serious
• Spine injuries
• Spinal Cord injury
Clinical
Symptoms and Signs
• Pain
• Stiffness
• ↓ ROM
Symptoms and Signs
• Nervous system- local
- abnormal sensations arms (burning/ paraesthesia)
www.londonpainconsultants.com
Symptoms and Signs
• Nervous system- general
dizziness headache blurred vision pain on swallowing ringing in ears irritability tinnitus
Symptoms and Signs
• Psychological-
memory loss
cognitive impairment
sleep disturbance
fatigue
depression
PTSD
Symptoms and Signs
• Secondary Myofacial Pain Syndrome (Fibromyalgia)
• Lower Back Pain
www.londonpainconsultants.com
Symptoms and Signs
• Whiplash syndrome-
continual headache
pain
reduced movement
tingling
lumbar pains
fatigue
sleep disturbance
Investigations
Investigations
• X-rays- exclude #
• CT
• MRI
Management
www.londonpainconsultants.com
Overall Aim
• Pain-free window
• Rehabilitation
www.londonpainconsultants.com
Management
• Medication
• Physical Therapy/ Rehabilitation
• Minimally Invasive Pain Management Procedures
www.londonpainconsultants.com
Medication
Medication
• Pharmacological
• WHO ladder (amended from cancer)
Step 1 paracetamol/ NSAID/ COX 2
Step 2 + weak opioids
Step 3 + strong opioids
www.londonpainconsultants.com
Medication
• Adequate medication- regularly, prevent breakthrough pain
• Muscle relaxant- Diazepam/ similar
www.londonpainconsultants.com
Physical Therapy/ Rehabilitation
Physical Therapy/ Rehabilitation
• Chris Pinches- Specialist Spinal PxTx at Central Health PxTx….
• Deep stability muscles
• Inhibitory interneurones and ascending nociceptor inputs
• EMG studies
• Retraining dysfunctions…..
Physical Therapy/ Rehabilitation
• Clear red flags – C-spine instability/ #
• Adequate medication- regularly, prevent breakthrough pain
www.londonpainconsultants.com
Physical Therapy/ Rehabilitation
• Keep neck moving as normally as possible!
• Collars not recommended
• Gentle mobilisation
Physical Therapy/ Rehabilitation
• Avoid ‘stiffening-up’
• Studies- quicker recovery with gentle exercise
www.londonpainconsultants.com
Physical Therapy/ Rehabilitation
• Pacing activities
• Fear avoidance
• Catastrophising- not torn muscle/ severe
Other
• Physical- heat/ cold/ TENS/ hydro/ supports/ US/ IR/ firm supportive pillow/ good posture
• Manipulation- PxTx/ chiropracter/ osteopathy/ deep tissue massage
Minimally Invasive Pain Management
www.londonpainconsultants.com
Cervical and Thoracic facet joint injections
www.londonpainconsultants.com
Trigger Point Injections
www.londonpainconsultants.com
1. Dry Needling
www.londonpainconsultants.com
…otherwise known as…
Acupuncture
Any Vets in the Audience?
5. (a) Veterinary practitioners?
2. Local Anaesthetic and Steroid preparations
www.londonpainconsultants.com
3. Botulinum Toxin A
www.londonpainconsultants.com
Prevention
www.londonpainconsultants.com
Prevention
• Head restraints
• 3 in 4 not properly adjusted!
www.londonpainconsultants.com
Prognosis
• Overall good in most cases
• Symptoms improve after few days
• 6 in 10 much better/ gone by 1-4 weeks
www.londonpainconsultants.com
Prognosis
• Up to several months
• 1 in 4 pain n stiffness at 6 months
• Small number persistent beyond 6 months
Any Questions
www.londonpainconsultants.com