Whiplash (medicine)

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 14122
ICD10 = ICD10|S|13|4|s|10
ICD9 = ICD9|847.0
ICDO =
OMIM =
MedlinePlus = 000025
eMedicineSubj =
eMedicineTopic =
MeshID = D014911

Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck. [cite web | authorlink = Insurance Institute for Highway Safety | author = Insurance Institute for Highway Safety | url = http://www.iihs.org/research/qanda/neck_injury.html#1 | title = Q&A: Neck Injury | accessdate = 2007-09-18 | language = english | format = html ]

Whiplash is commonly associated with motor vehicle accidents, [citation needed] usually when the vehicle has been hit in the rearcite web | url = http://www.vv.se/filer/24498/Folksam%20SRA%20whiplash%202005.pdf | format = pdf | title = Assessment of Whiplash Protection in Rear Impacts | last = Krafft | first = M | coauthors = Kullgren A, Lie A, Tingval C | publisher = Swedish National Road Administration & Folksam | date = 2005-04-01 | accessdate = 2008-01-18 | language = english] however the injury can be sustained in many other ways, including falls from bicycles [citation needed] or horses [citation needed] or headbanging.

Cause

The exact injury mechanism that causes whiplash injuries is unknown. A whiplash injury may be the result of impulsive stretching of the spine, mainly the ligament: anterior longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a whiplash injury.cite web | url = http://www.nlm.nih.gov/medlineplus/ency/article/000025.htm | title = Whiplash | author = MedlinePlus | authorlink = MedlinePlus | date = 2007-06-05 | accessdate = 2007-09-18 | language = english | format = html]

Whiplash may be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster [ [http://www.spinalinjuryfoundation.org/research%20PDF/rollercoasterneckpain.pdf Roller Coaster Neck Pain] , from the Spinal Injury Foundation] or other rides at an amusement park, sports injuries such as skiing accidents, other modes of transportation such as airplane travel, or from being hit, kicked or shaken. [cite web | url = http://www.montazem.de/english/html/whiplash_injury.html | title = Whiplash injury | date = 2006-08-23 | language = english ] Shaken baby syndrome can result in a whiplash injury.

Symptoms

Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms & legs and headaches. Symptoms can appear directly after the injury, but often are not felt until days afterwards. Whiplash is usually confined to the spinal cord (neck to pubic bone), and the most common areas of the spinal cord affected by whiplash are the neck, and the mid-back (middle of the spine).

Diagnosis

Diagnosis occurs through a patient history, head and neck examination, X-rays to rule out bone fractures and may involve the use of medical imaging to determine if there are other injuries. [cite web | url = http://www.webmd.com/back-pain/tc/whiplash-topic-overview | title =Whiplash - Topic Overview | publisher = WebMD | date = 2006-11-16 | accessdate = 2008-01-18 ]

Québec Task Force

The "Québec Task Force" ("QTF") was a task force sponsored by the Société de l'assurance automobile du Québec, the public auto insurer in Quebec, Canada. The QTF submitted a report on whiplash-associated disorders in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. These recommendations have become the base for "Guideline on the Management of Claims Involving Whiplash-Associated", a guide to classifying WAD and guidelines on managing the disorder.cite web | url = http://www.fsco.gov.on.ca/English/pubs/guidelines/guidelineb7-1.asp | title = Guideline on the Management of Claims Involving Whiplash-Associated Disorders | date = 2005-11-24 | accessdate = 2007-09-18 | language = english | format = html] The full report titled "Redefining "Whiplash" was published in the April 15, 1995 issue of Spine. [cite journal |author=Freeman MD, Croft AC, Rossignol AM |title="Whiplash associated disorders: redefining whiplash and its management" by the Quebec Task Force. A critical evaluation |journal=Spine |volume=23 |issue=9 |pages=1043–9 |year=1998 |pmid=9589544|doi=10.1097/00007632-199805010-00015] An update was published in January 2001. [cite web | url = http://www.maa.nsw.gov.au/getfile.aspx?Type=document&ID=1917&ObjectType=3&ObjectID=436 | format = pdf | title = Update Quebec Task Force Guidelines for the Management of Whiplash-Associated Disorders | accessdate = 2007-09-18 | date = 2001-01-01|language = english]

Québec Task Force grades of disorder

Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs):
* Grade 1: complaints of neck pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
* Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
* Grade 3: decreased range of motion plus neurological signs such as decreased deep tendon reflexes, weakness, insomnia and sensory deficits.
* Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.

Consequences

The consequences of whiplash range from mild pain for a few days (which is the case for most people) [cite journal |author=Ferrari R, Schrader H |title=The late whiplash syndrome: a biopsychosocial approach |journal=J. Neurol. Neurosurg. Psychiatr. |volume=70 |issue=6 |pages=722–6 |year=2001 |pmid=11385003 |doi=] , to severe disability caused by restricted head movement or of the cervical spine, sometimes with persistent pain.

Whiplash protection

Protection efforts are hampered by lack of knowledge about the causes of whiplash injuries. The focus of preventive measures to date has been on the design of car seats, primarily through the introduction of headrestraints, often incorrectly called headrests. This approach is potentially problematic given the underlying assumption that purely mechanical factors cause whiplash injuries - an unproven theory. So far the injury reducing effects of head restraints appears to have been low, approximately 5-10%, because car seats have become stiffer in order to increase crash-worthiness of cars in high-speed rear-end collisions which in turn could increase the risk of whiplash injury in low-speed rear impact collisions. Improvements in the geometry of car seats through better design and energy absorption could offer additional benefits. Active devices move the body in a crash in order to shift the loads on the car seat.

Some car manufacturers have begun to implement various "whiplash protection" devices in their products in order to reduce the risk for and severity of injury, such as
* Mercedes-Benz A-Class Active Head Restraint (AHR) [ [http://www.all4engineers.com/index.php;do=show/lng=en/alloc=1/id=3121/sid=138427026044eb7d129e03b285836696 Long Fibre-Reinforced Polyamide for Crash-Active Car Headrests] , August 22, 2006 en icon] ,
* Saab (Responsible for the first active head restraint), Opel, Ford, Nissan, Subaru, and Peugeot - Active Head restraint (SAHR) [ [http://www.carpages.co.uk/saab/saab-active-head-restraints-22-11-05.asp Top Safety Ratings For Saab Active Head Restraints] , UK Motor Search Engine, August 22, 2006 en icon] ,
* Volvo and Jaguar - Whiplash Protection System/Whiplash Prevention System (WHIPS) [ [http://www.volvoclub.org.uk/press/releases/whiplash_protection_system.shtml Volvo Seat Is Benchmark For Whiplash Protection] , Volvo Owners Club, August 22, 2006 en icon] , and
* Toyota - Whiplash Injury Lessening (WIL).

Whether or not such devices offer a substantial benefit over vehicles without them remains controversial. In a test undertaken by the Swedish National Road Administration and an insurance company (Folksam), one test showed that a whiplash protection device was no guarantee against injury and that the degree of protection varies between vehicles both with and without whiplash protection devices. [ [http://www.ntf.se/Tidning/default23209.asp Whiplashskydd inte alltid säkrare (Whiplash protection not always safer)] , NTF, August 22, 2006 sv icon] Yet The Journal of TRAUMA, Volume 51, No 5, November 2001 found that an Active Head Restraint helps reduce the risk of neck injuries by up to 75% in rear-end collisions.

References

Bibliography

* cite book | title= [http://books.google.com/books?id=D4Sl9FqKUwMC The Whiplash Encyclopedia: The Facts and Myths of Whiplash] | author=Ferrari, R. | year=2006 | publisher=Jones and Bartlett | id=ISBN 0763729345 ----

External links

* [http://www.som.uq.edu.au/whiplash/ Whiplash - Evidence Based Information Resource]