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.

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