Whiplash (medicine)

As whiplash (English whiplash injury ) disease symptoms are referred to ( head and neck pain, dizziness, slurred speech, unsteady gait, and many more ), generally within 0 to 72 hours after an acceleration and hyperextension of the neck, usually during a car accident, typically a rear impact - without direct injury of the skull, brain, spinal cord and cervical spine - occur. It is the most common complication after car accidents and a dreaded cause of chronic disorders, which to this day the reason for this chronic, which occurs in some casualties is unknown, but highly controversial. The Cochrane Association ( " Cochrane Collaboration" ), an international network of scientists and medical professionals, which is committed to the principles of evidence-based medicine, defined whiplash as Fast tracking Dezelerationsmechanismus with energy transfer to the neck region as a result of rear-end or side-impact accidents but also diving accidents.

Classification

The term whiplash ( whiplash ) was first introduced in 1928 by the U.S. orthopedic surgeon Harold Crowe to describe a clinical picture after indirect trauma of the cervical spine associated with traffic accidents. A very common classification of severity is called the Quebec classification:

• 0 - no complaints, no symptoms
• 1 - neck pain, stiff neck
• 2 - Complaints and muscle tightness, restricted movement, muscle myogelosis
• 3 - complaints and neurological findings
• 4 - fracture ( s) and displacement (s)

However, the proposal of the already quoted above Swedish working group appears from the year 2008 that the levels 0 and 4 are unnecessary, in particular makes sense because it is the " whiplash ", by definition, an indirect injury is and the extent to classify a fracture is otherwise; the waiver of the level "0" means no loss of information anyway.

It is undisputed that usually subside after a whiplash complaints within days to weeks without therapy. In about 10% or more of cases, however, a chronic whiplash disease develops, some authors speak of 13-67 %. The error is referred to as chronic when symptoms longer than 6 months after the accident found. For thirty years, the incidence increases this problem. To this chronic " whiplash - disease" ( WAD, whiplash associated disorder), whose exact etiology (cause) is unknown to this day, a huge controversy has formed. (See below.)

Etiology ( causes)

The acceleration trauma to the cervical spine is caused by energy transfer in the context of acceleration - deceleration mechanism. The most common cause of this are car rear-end collisions, but also come into question as well as side impact, independent of transit events, such as after a dip in shallow waters or injury to the martial arts.

Symptoms

Main symptoms in simple whiplash are the effects of muscle tension in the neck and neck muscles, which lead to head and neck pain. Often, the complaints keep longer and can become chronic. As symptoms are often given:

• Vertigo
• Dizziness and quantitatively higher grade Vigilanzstörungen
• Burning or stabbing pain in the back of the head
• Hearing and vision problems, limitations of the visual field
• Attention disorders, disorientation
• Rapid exhaustion
• Sleep
• Weakness
• Pain and / or paresthesia in the face and arms
• Transition uncertainties
• Muscle dysfunction
• Spasms

Course

The symptoms after an acute whiplash injury usually heal without consequences. In Quebec rebounded from 1551 casualty 87% within 6 months and 97 % within one year. This insurance study is however criticized for being equated with healing setting of insurance benefits. Other sources state that 14-42 % of accident victims do not recover, the disorder becomes chronic ( WAD - whiplash associated disorder) and 10 % report constant pain. In a study of 586 whiplash patients were 7% suffer from permanent disability. In a second, continuing Quebec study by Berg Holm, Cassidy, Holm is found that even seven years after the accident whiplash - injured significantly more health problems had as a healthy comparison group.

Prognostic factors: The most conclusive predictor of poor Ausheilungsergebnisse is neck pain in the acute phase, but also limitations in neck mobility. Factors from the accident reconstruction have limited value when it comes to the question of Ausheilungs opportunities. Health prior to the accident, possibly wear, genetic steep position of the cervical spine is more susceptible to injury. Psychological factors such as pain tolerance, Katastrophieren, fear - avoidance behavior play a role, but also PTSD.

Patients after whiplash injury were after 1 week, after 1 month, 3 months, 6 months and 12 months examined ( Physical Examination in University Hospital, no questionnaire, University Hospital of Aarhus / Denmark). As the largest risk factors for the transition from acute to long-term injury complaints are: limitations in neck mobility and acute neck and headaches, but also Syptome of pre-and post-traumatic stress. Also vertigo, tinnitus, hyperacusis, sleep problems, etc. played a certain role.

• Medium Disabilities: 5-6 of 10 points
• Neck pain and headache: 6-7 of 10 points
• Numerous non-painful symptoms such as tinnitus, dizziness 5-6 of 10 points

In subgroup 1, most patients had recovered (ca. 98%) after one year. In addition, a non- recovery depend on genetic factors. The Danish Study Group Whiplash " Risk Assessment Score" recommends an early clarification of risk factors a) restriction of movement of the cervical spine b ) pain neck and head c) other symptoms such as dizziness, tinnitus, insomnia, nausea, etc. This clarification can optimize treatment.

Australian studies have concerned themselves with Ausheilungsverläufen after whiplash injury. After 3 months, still had about 75 % health complaints, after 6 months still about 60%. These 60 % stayed until 12 months after the accident almost constant. (Charts: 269) The medical examinations were carried out at the University Hospital of Sydney, there were no questionnaires, for example, as in the Lithuania study. Main attention was paid to criteria, the precision with which such long-term studies should be performed. Differentiating (light, medium, heavy) after the chronic risk, the following picture: Description: There are all constellations with long-term consequences, it is inappropriate - just like the so-called safe level a flat-rate viewing: After 3 months still complaints at about 60 % in patients with chronic low- risk, 80 % in patients with moderate chronic risk and 95 % for patients with high risk of chronicity. After 6 months or complaints: about 50% at a low, 60% medium and 90% in high risk chronicity. After 12 months, still complaints: 40 percent low, 60% medium and 70 percent at high risk of chronicity.

Therapy

The once common practice of prescribing a ruff is inferior to a study conducted by the beginning of active exercise therapy clearly, as a study published in 2004 of 200 patients has shown. There are indications that such passive therapies contribute to the chronicity of the disease process. Supportive can analgesics / anti-inflammatory drugs such as diclofenac or ibuprofen, as well as - for the relief of muscular tension - Muscle relaxants are prescribed.

After a thorough medical examination the patient is to provide for a simple acute whiplash the harmlessness of the error and to avoid any " catastrophizing ". Part of therapy is to explain the symptoms reasonable ( examples: the dizziness is caused due to the rapid movement of the head, the jaw pain because of the geographical proximity of the neck and chin muscles, with muscle damage after accidents naturally have a strong capacity for self-healing, and the concentration, because you have pain, not because their brain has been permanently damaged, etc.) It should be noted that the symptoms pass more quickly, the more relieving postures to be abandoned and one active returns to previous mobility, while in contrast, during periods of inactivity and avoidance behavior is a risk of chronicity greater.

A 2012 published study found that patients with adequate pain medication and the declaration that it is indeed a painful but still harmless injury, may be discharged home. Intensive counseling and physiotherapy did not present clear advantages.

Accident Mechanics - Biomechanics

The impetus through a auffahrendes or laterally impacting vehicle for transmission of the movement to the occupants. This happens after a short latency, while the first crumple zones of the car are deformed and the bumped vehicle is set itself according to the force of the impact on the move. This acceleration is transmitted via car seat on the occupants (see impulse force, or the conservation of momentum ).

The spine is elongated while the so-called first ramping (Upgrade of the upper body at the back). The head ' pushes ' ​​it down on the other hand (moment of inertia ). Here are the discs ' compressed ' (squashed, distortion ). Add to this, already weakened spine act in the further onset of movement by a few milliseconds more powerful forces, which increase the risk of injury considerably, since such a compressed and stretched spine injury is much more susceptible to side movements. Only now namely the impact acceleration also converts to the occupants in a forward motion. Here, the upper body of the occupant is restrained by the safety belt, while the head will fast forward. However, this is not in a previously adopted pure whiplash movement (English whiplash ) instead, but in translation, that is, horizontal shearing movement with the highest risk of injury to all structures of the neck ( cervical spine ) and thoracic spine ( BWS). So you can see at motor sport racing, including Formula 1, for some years the Black Tower frames on the shoulders of the driver to which the helmet is fastened with ropes to prevent this translational motion and thus to protect the driver ( HANS System).

Protection systems in cars

To prevent whiplash in a car accident, insurance associations recommend if possible to adjust the headrest with a distance of less than four centimeters from the back of the head. Since 2009, informed in Switzerland Campaign " head restraints help protect " the Swiss Insurance Association of the aspired headrest adjustment.

Some vehicles are equipped with so-called "active" headrests that move in the event of a rear-end collision in the direction of the head to catch him sooner. The WHIPS whiplash protection system of the Swedish car manufacturer Volvo was developed in the 1990s and moved in a rear impact, the front seats complete. It has received numerous awards from road safety authorities and is part of the standard equipment since 2000. Other so-called anti -whiplash systems (anti- whiplash systems ) were developed by Delphi Automotive Systems, and Autoliv and find different OEMs use.

The whiplash controversy

Ultimately, it is still unknown why some people after a whiplash injury develop wide and protracted symptoms. Attempts to analyze this phenomenon, extending over the assertion organic lesions of certain structures by the trauma to cultural, psychological and psychosocial explanations. How could, for example, in the prestigious " Lithuania study" demonstrated that there are less of the car accident as such because the ( culturally based ) expectations, a family history and misinterpretations of pre-existing symptoms, which determine the persistence of whiplash.

Uncertainties often arise when - describe pathological- anatomical studies in a higher percentage of pathological changes in the intervertebral discs after whiplash trauma in patients with WAD symptoms compared to asymptomatic accident victims - mostly uncontrolled. Their results can be practically never understood in controlled studies. Thus, the research group led by Ronnen was not a single case of whiplash caused by cervical disc injury in 100 patients in a prospective study magnetresonanztomografischen. About the same applies to damage to the ligaments, particularly the anterior longitudinal ligament ( anterior longitudinal ligament ). Damage in this volume have been described in experimental studies, but prospective studies in patients magnetresonanztomografische have never demonstrated intervertebral disc degeneration.

Similarly, the facet joints or muscles were often viewed as a source of complaints after whiplash. Although previous studies have damage to those joints described as post traumatic stress and are often cited. However, these related to accident victims who had died after a serious traffic accidents and direct trauma.

Some researchers believe that chronic whiplash disorders ( WAD ) are not to be explained by an earlier trauma, but rather sensational reports, the popular notion, an acute whiplash injury is a serious event, and the prospect of compensation for the mishandling of some casualties resulted who was responsible for the chronicity. It is certain that, chronic consequences in terms of WAD are virtually unknown in countries that have neither medical treatment nor appropriate financial compensation after acute whiplash and devote little attention to the subject.