Week 2 Whiplash P4

Whiplash and Associated Manifestations

Key Manifestations of Whiplash

• Classification of Trusted Related Conditions:

  • Fractures: Potential for cervical spine fractures following whiplash.

  • Low Back Pain: Common symptom following an injury.

  • Vestibular Injuries: Dizziness or balance issues may arise.

  • Tinnitus: Ringing in the ears, possibly linked to neck issues.

  • Basilar Artery Injury: Can cause vestibular symptoms, especially in children.

  • Subarachnoid Hemorrhage: Risk linked with carotid artery dissection (reference: Uhrenholt et al, 2015).

  • Retropharyngeal Abscess: Can result in serious complications like osteomyelitis and epidural abscess (reference: Goulart et al, 2016).

Structural Injuries Related to Whiplash

• Fracture and Ligament Damage:

  • Description of injury vectors impacting the cervical spine, affecting the posterior and anterior longitudinal ligaments.

• Kyphosis:

  • Acute kyphosis observed at C5-C6 due to whiplash injuries.

  • Potential tearing of interspinous and longitudinal ligaments noted.

Low Back Pain Following Whiplash

• Lumbopelvic Deceleration Syndrome:

  • Definition: Low back pain that follows whiplash injury as per Webb and Terrett (1985).

  • Literature focus on severe trauma cases but also includes joint and soft tissue injuries (16.5% - 40% reported incidence).

Mechanisms for Low Back Tissue Injury

• Five Mechanisms of Injury (Webb and Terrett, 1985):

  1. Torsional Stress: Occurs in thoracolumbar region during vehicle restraints during an accident.

  2. Lumbosacral Transitional Area Stress: High movement at L5 meets a relatively immobile sacrum causes injury.

  3. Shear Stress at Lumbosacral Junction: Forces from immobilised ilia affecting the L5 segment.

  4. Shear Stress at Sacroiliac Joint: Lumbar torsion causing displacement of the sacrum relative to the ilium.

  5. Compression Force: Results in jamming at the sacroiliac joint, can produce endplate fractures.

Diagnosis Techniques for Whiplash-Related Tinnitus

• Cervicogenic Somatic Tinnitus (CST):

  • Various causes: hearing loss or noise trauma; may relate to cervical spine sensory systems.

  • Useful diagnostic tests include:

    • Ear, nose, and throat exams.

    • Neck Bournemouth Questionnaire (NBQ).

    • Manual rotation tests, adapted Spurling test, and trigger point tests.

  • Positive tests can confirm CST.

Tinnitus in Whiplash Patients

• Definition and Impact:

  • Tinnitus is an auditory sensation without an external source (defined by Kreuzer et al, 2012).

  • Trauma-associated tinnitus can result in greater psychological distress compared to other types of tinnitus.

  • Studies indicate that approximately 10% of whiplash patients may experience symptoms like tinnitus, vertigo, and deafness.

  • Literature review indicates a 14%-37.5% incidence of Temporo-mandibular Disorders (TMD) in whiplash populations (Fernandez et al, 2009).

Temporo-Mandibular Joint Syndromes Post-Whiplash

• Potential Mechanism:

  • Deceleration injury leads the mandible to move relative to the skull, causing potential injuries to various components of the TMJ.

Whiplash and TMJ Dysfunction

• Clinical Findings by Roydhouse:

  • Patients with whiplash commonly present symptoms of TMJ dysfunction following injury.

  • Clinical studies of 14 patients showed significant relief in symptoms post-TMJ treatment.

Proposed Aetiologies of TMJ Dysfunction Post-Whiplash

• Suggestions from Roydhouse:

  • Damage to mandibular condyles (bone/cartilage) from displacement due to accident.

  • Neurological dysfunction of upper cervical nerves.

  • Alterations in posture affecting neck and jaw relationship.

  • Post-traumatic headaches may also be associated with TMJ complaints.

Mechanisms of TMJ Injury from Acceleration

• Posterior Movement of Skull: During whiplash, the mandible can be displaced anteriorly, leading to tension in related structures, resulting in TMJ dysfunction complaints.

Additional Factors in TMJ Dysfunction

• Muscle Spasms and Postural Changes:

  • Myospasms can lead to improper jaw positioning, affecting joint coordination and resulting in pain.

  • Other influences include post-injury stress and altered posture which may exacerbate TMJ symptoms.

Kinematic Relationship Between TMJ and Surrounding Structures

• Anatomical Context: Illustrated the dynamic relationships between TMJ and surrounding anatomical structures, underscoring functional interrelations.