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Whiplash, Cervical - Medical Research Abstracts

Dr. John Limbert

Pathophysiology - Physiology



1. AUTHOR Radanov-B-P, Dvorak-J.
INSTITUTION Department of Psychiatry, University of Berne, Inselspital, Switzerland.
TITLE Spine update. Impaired cognitive functioning after whiplash injury of the cervical spine.
SOURCE Spine 1996 Feb 1, VOL: 21 (3), P: 392-7, ISSN: 0362-2436 26 Refs.
ABSTRACT To enhance the awareness of physicians treating whiplash patients, findings from previous research regarding cognitive functioning of these patients are discussed and recommendations for assessment provided. Cognitive disturbances (i.e., deficient attentional functioning and impairment of memory) are frequent complaints in patients after whiplash injury. However, few prospective studies of nonselected patients have been performed. These studies indicate that impaired cognitive functioning relates either to trauma-induced somatic symptoms (i.e., pain) or psychologic symptoms resulting from problems adjusting to trauma-related somatic symptoms. Accordingly, cognitive disturbances after whiplash show a fair rate of recovery, which parallels recovery from trauma-related somatic symptoms. Current research does not indicate disturbances in higher cognitive functions after whiplash. Author.
2. AUTHOR Barrett-K, Buxton-N, Redmond-A-D, Jones-J-M, Boughey-A, Ward-A-B.
INSTITUTION Department of Psychiatry, School of Postgraduate Medicine, Stoke-on- Trent, UK.
TITLE A comparison of symptoms experienced following minor head injury and acute neck strain (whiplash injury).
SOURCE J-Accid-Emerg-Med 1995 Sep, VOL: 12 (3), P: 173-6, ISSN: 1351-0622.
ABSTRACT The symptoms reported by patients who have experienced minor head or minor neck injury are compared. Symptoms were identified using a questionnaire-based out-patients interview. Rank order correlation analyses were carried out on data obtained at 2 and 6-12 weeks post- injury. Data on 24 head-injured and 29 neck-injured patients are presented. There was a significant rank order correlation at both assessments but neck injured patients reported more phobia (fear of travelling in car) and depression, and head-injured more dizziness. It is likely that neck-injury contributes to the symptomatology experienced after minor head injury, and vice-versa. Author.
3. AUTHOR Barnsley-L, Lord-S-M, Wallis-B-J, Bogduk-N.
INSTITUTION Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle, Callaghan, Australia.
TITLE The prevalence of chronic cervical zygapophysial joint pain after whiplash.
SOURCE Spine 1995 Jan 1, VOL: 20 (1), P: 20-5; discussion 26, ISSN: 0362-2436.

A survey of the prevalence of cervical zygapophysial joint pain was conducted.


To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash.


In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks.


Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order.


A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%).


In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash. Author.

4. AUTHOR Woltring-H-J, Long-K, Osterbauer-P-J, Fuhr-A-W.
INSTITUTION Whiplash Analysis Incorporation, Phoenix, AZ 85018.
TITLE Instantaneous helical axis estimation from 3-D video data in neck kinematics for whiplash diagnostics.
SOURCE J-Biomech 1994 Dec, VOL: 27 (12), P: 1415-32, ISSN: 0021-9290.
ABSTRACT To date, the diagnosis of whiplash injuries has been very difficult and largely based on subjective, clinical assessment. The work by Winters and Peles Multiple Muscle Systems--Biomechanics and Movement Organization. Springer, New York (1990) suggests that the use of finite helical axes (FHAs) in the neck may provide an objective assessment tool for neck mobility. Thus, the position of the FHA describing head-trunk motion may allow discrimination between normal and pathological cases such as decreased mobility in particular cervical joints. For noisy, unsmoothed data, the FHAs must be taken over rather large angular intervals if the FHAs are to be reconstructed with sufficient accuracy; in the Winters and Peles study, these intervals were approximately 10 degrees. in order to study the movements' microstructure, the present investigation uses instantaneous helical axes (IHAs) estimated from low-pass smoothed video data. Here, the small-step noise sensitivity of the FHA no longer applies, and proper low-pass filtering allows estimation of the IHA even for small rotation velocity omega of the moving neck. For marker clusters mounted on the head and trunk, technical system validation showed that the IHAs direction dispersions were on the order of one degree, while their position dispersions were on the order of 1 mm, for low-pass cut-off frequencies of a few Hz (the dispersions were calculated from omega-weighted errors, in order to account for the adverse effects of vanishing omega). Various simple, planar models relating the instantaneous, 2-D centre of rotation with the geometry and kinematics of a multi-joint neck model are derived, in order to gauge the utility of the FHA and IHA approaches. Some preliminary results on asymptomatic and pathological subjects are provided, in terms of the 'ruled surface' formed by sampled IHAs and of their piercing points through the mid-sagittal plane during a prescribed flexion-extension movement of the neck. Author.
5. AUTHOR Rothhaupt-D, Liebig-K.
INSTITUTION Orthopadische Universitats-Klinik, Erlangen.
TITLE (Diagnosis, analysis and evaluation of functional disorders of the upper cervical spine within the scope of whiplash injuries with nuclear magnetic resonance tomography). TT Diagnostik, Analyse und Bewertung von Funktionsstorungen der oberen HWS im Rahmen von Beschleunigungsverletzungen unter Einsatz der Kernspintomographie.
SOURCE Orthopade 1994 Aug, VOL: 23 (4), P: 278-81, ISSN: 0085-4350.
ABSTRACT We tested the diagnosis of malfunctions in the upper cervical spine after whiplash injury using MRI. In the spinal segments C 0-1 and C 1-2 MRI functional diagnosis showed clear advantages compared to X- ray diagnosis. Apart from data about the normal course of movement in these joints it was possible to classify and reproduce malfunctions exactly. The malfunctions diagnosed can be found in normal volunteers as well, so that in an evaluation no causal link between the very existence of a malfunction and the complaints can be established. Author.
6. AUTHOR Penning-L.
INSTITUTION Abteilung fur Neuroradiologie, Academisch Ziekenhuis Groningen.
TITLE (Backward hypertranslation of the head: participation in the whiplash injury mechanism of the cervical spine?). TT Hypertranslation des Kopfes nach hinten: Teil des Schleuderverletzungsmechanismus der HWS?
SOURCE Orthopade 1994 Aug, VOL: 23 (4), P: 268-74, ISSN: 0085-4350 27 Refs.
ABSTRACT Based upon a review of the literature, a theory is developed that in whiplash injury the primary mechanism of the trauma is not hyperantiflexion but hypertranslation of the head backwards. Thus a hyperanteflexion (not hyperretroflexion) of the upper cervical spine, probably especially of the atlanto-axial segment, is induced, causing an overstretching of the ligaments concerned (also the alar ligaments) and the joint capsule. The disorder of the propriosensitive information concerning the position of the head relative to the body with chronic disturbances of posture and equilibrium is explained by the thus generated chronic ligamentous instability of the upper cervical spine. In humans our theory is not yet sufficiently supported by experimental results. Author.
7. AUTHOR Dvorak-J, Ettlin-T, Jenzer-G, Murner-J, Radanov-B-P, Walz-F.
TITLE (Determining the status of the cervical spine after whiplash injury). TT Standortbestimmung zum Zustand nach Beschleunigungsmechanismus an der Halswirbelsaule.
SOURCE Z-Unfallchir-Versicherungsmed 1994 Jul, VOL: 87 (2), P: 86-90, ISSN: 0040-3603 11 Refs.
ABSTRACT The results of medical investigations following acceleration mechanism to the cervical spine (so called "soft tissue neck injury") are to be described in common diagnostic terms. Biomechanical and legal considerations are beyond medical competence. In certain cases, the clinical examination must be completed in cooperation with specialists. Within the entire medical context, the neuropsychological and neuropsychiatric assessment may contribute to a comprehensive understanding of the consequences. In cases of litigation, the full array of facts, like the patients' previous history, and differential diagnoses, have to be drawn to attention. At present, compensation takes place only exceptionally and in a limited range, if an impairment by an accompanying brain injury is excluded. Author.
8. AUTHOR Kronn-E.
INSTITUTION Physiotherapy Department, The Mater Hospital, Dublin, Ireland.
TITLE The incidence of TMJ dysfunction in patients who have suffered a cervical whiplash injury following a traffic accident (published erratum appears in J Orofacial Pain 1993 Summer; 7(3):234).
SOURCE J-Orofac-Pain 1993 Spring, VOL: 7 (2), P: 209-13, ISSN: 1064-6655.
ABSTRACT Forty consecutive patients with a cervical whiplash injury were examined and compared with 40 matched controls. The incidence of signs and symptoms was high in both groups. Temporomandibular joint pain (P < .001), limitation of mouth opening (P < .01), and masticatory muscle tenderness (P > .01) were found significantly more frequently in the patient group, while the presence of joint sounds, deviation during mouth opening, and the overall presence of a symptom were not significantly different between groups. When asked whether they would seek treatment for the observed signs and symptoms, a significantly higher number of the whiplash group responded positively when compared to the control group. These findings warrant further study and suggest the benefit of a routine examination of the temporomandibular joint and masticatory system in patients with cervical whiplash injury. Author.
9. AUTHOR Ernst-E.
INSTITUTION Postgraduate Medical School, University of Exeter, United Kingdom.
TITLE (The cervical spine whiplash trauma). TT Das Hals-Wirbelsaulen-Schleudertrauma.
SOURCE Acta-Med-Austriaca 1993, VOL: 20 (5), P: 115-9, ISSN: 0303-8173 49 Refs.
ABSTRACT The whiplash injury is a classical injury of the upper spine following a car crash. It results from hyperextension and hyperflexion of the upper spine. In most cases no morphological changes can be verified. Thus the diagnosis has to be clinical, based on subjective symptoms. The prognosis is often good; the true problem are those few patients who develop chronic complaints. Therapy consists of initial immobilisation, analgetics and physiotherapy. Reasonable driving, safe cars and head rests should help to prevent whiplash injuries. Author.

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