Cervical, Whiplash - Medical Research Abstracts

1. AUTHOR	Olson-V-L.
INSTITUTION	Health East-St John's Hospital, Maplewood, Minn, USA.
TITLE	Whiplash-associated chronic headache treated with home cervical traction.
SOURCE	Phys-Ther 1997 Apr, VOL: 77 (4), P: 417-24, ISSN: 0031-9023.
ABSTRACT	The subject of this case report was a 56-year-old woman who sustained a whiplash-associated disorder as a result of a motor vehicle accident. Within a few hours after the accident, she developed a headache, which became chronic, creating disability and hindering the quality of her life. In the following year, a variety of diagnostic tests, medications, and physical therapy were unsuccessful in determining the cause of her complaints or in relieving them. After this year, she expressed anger, frustration, and a reluctance to undergo additional physical therapy. By listening to her explain how she coped with her problem and observing that she lacked the ability to reduce her cervical lordosis, the therapist developed and implemented a home program of supine cervical traction and exercise. After 30 days of treatment, she was able to reduce and control her headache. This treatment and the approach used to develop the treatment may benefit other patients who have whiplash-associated chronic headache. Author.

2. AUTHOR	Garcia-R-Jr, Arrington-J-A.
INSTITUTION	Department of Radiology at the University of South Florida College of Medicine, USA.
TITLE	The relationship between cervical whiplash and temporomandibular joint injuries: an MRI study.
SOURCE	Cranio 1996 Jul, VOL: 14 (3), P: 233-9, ISSN: 0886-9634.
ABSTRACT	Temporomandibular joint (TMJ) symptoms are a common finding in motor vehicle accident (MVA) patients with hyperextension/hyperflexion injuries of the cervical spine (cervical whiplash). The relationship between cervical whiplash and TMJ injuries was documented with magnetic resonance imaging (MRI) in 87 consecutive MVA cervical whiplash patients who presented with TMJ symptoms and had sustained no direct trauma to the face, head or mandible and had no TMJ complaints prior to the MVA. One hundred sixty-four TMJ patients were evaluated for internal derangement, effusion and inflammation, utilizing T1 and T2 weighted images. A high percentage of the TMJ patients demonstrated abnormal findings: disk displacement with reduction (DDR), 118/164 (72%); disk displacement without reduction (DDNR), 25/164 (15%); effusion, 113/164 (69%); inflammation or edema, 84/164 (51%); total TMJ abnormalities, 156/164 (95%). The high percentage of TMJ abnormalities in this study significantly illustrates the proximate relationship between cervical whiplash and TMJ injuries. Author.

3. AUTHOR	Verhagen-A-P, Lanser-K, de-Bie-R-A, de-Vet-H-C.
INSTITUTION	Department of Epidemiology, University of Maastricht, The Netherlands.
TITLE	Whiplash: assessing the validity of diagnostic tests in a cervical sensory disturbance.
SOURCE	J-Manipulative-Physiol-Ther 1996 Oct, VOL: 19 (8), P: 508-12, ISSN: 0161-4754.
ABSTRACT	OBJECTIVE: To determine the ability of two diagnostic tests that examine sensory disturbance in whiplash patients to discriminate between 'extreme' groups. BACKGROUND: The neuromuscular theories have been accepted as explanations of the symptoms after a whiplash injury. Dutch manual therapists often use the diagnostic tests under study to diagnose and treat sensory disturbances after such an injury. The validity of a test needs to be assessed before its efficacy as a treatment in whiplash patients can be tested. The aim of this study was to validate two diagnostic tests and to initiate further research on the efficacy of a treatment of a sensory disturbance in whiplash patients. METHOD: Twelve subjects with chronic symptoms (> 3 months) after a whiplash injury (patient group) and 18 subjects without any head or neck problems (control group) were studied. The tests under study were the extension test and the coordination test. All researchers were blind to the characteristics of the subjects. RESULTS: The extension test and the coordination test were able to discriminate adequately between subjects with symptoms after a whiplash injury (patients) and subjects without any head or neck complaints (control subjects). Patients clearly show a smaller degree of extension compared with the control subjects and an increase of extension movement with external fixation. The sensitivity as well as the specificity of the coordination test were good (both > .80). CONCLUSION: These diagnostic tests seemed to be valid instruments for discriminating between whiplash patients with symptoms and healthy people. Author.

4. AUTHOR	Lord-S-M, Barnsley-L, Wallis-B-J, Bogduk-N.
INSTITUTION	Cervical Spine Research Unit, University of Newcastle, Callaghan, Australia.
TITLE	Chronic cervical zygapophysial joint pain after whiplash. A placebo- controlled prevalence study.
SOURCE	Spine 1996 Aug 1, VOL: 21 (15), P: 1737-44; discussion 1744-5, ISSN: 0362-2436.
ABSTRACT	STUDY DESIGN: The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. OBJECTIVE: To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury. SUMMARY OF BACKGROUND DATA: The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. METHODS: Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection. RESULTS: Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%). CONCLUSION: Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance. Author.

5. AUTHOR	Otte-A, Ettlin-T-M, Fierz-L, Kischka-U, Muerner-J, Hogerle-S, Brautigam-P, Mueller-Brand-J.
INSTITUTION	Institut fur Nuklearmedizin, Universitatskliniken, Kantonsspital Basel.
TITLE	(Cerebral findings following cervical spine distortion caused by acceleration mechanism (whiplash injury). Assessment of current diagnostic methods in nuclear medicine). TT Zerebrale Befunde nach Halswirbelsaulendistorsion durch Beschleunigungsmechanismus (HWS-Schleudertrauma). Standortbestimmung zu neuen diagnostischen Methoden der Nuklearmedizin.
SOURCE	Schweiz-Rundsch-Med-Prax 1996 Sep 3, VOL: 85 (36), P: 1087-90, ISSN: 0369-8394.
ABSTRACT	In any grade of distortion of the cervical spine as a result of acceleration forces in addition to cervical symptoms cerebral symptoms like headache, vertigo, auditory disturbances, tinnitus, disturbances in concentration and memory, difficulties in swallowing, impaired vision and temporo-mandibular dysfunctions may appear. These symptoms can persist and become invalidating. Cerebral single-photon emission tomography (SPECT) and positron emission tomography (PET) enable new diagnostic horizons for neurotraumatology. In this article we summarize the actual findings of these nuclear medical methods in neuropsychologically deficient patients with distortion of the cervical spine as a result of acceleration forces. Especially the latest results of the group of Basle (University Hospital Basle, Clinic of Rehabilitation Rheinfelden, Switzerland) are illustrated. This group found parieto-occipital hypoperfusion by relative quantitation using SPECT and bicisate (Neurolite, ECD). A first pilot study using PET and F-18-fluoro-deoxyglucose (FDG) could verify the above observation. The group's working hypothesis is that parieto- occipital hypoperfusion may be caused by activation of nociceptive afferences from the upper cervical spine. A critical approach to interpreting new functional methods and, on the other hand, openness in new scientific findings may contribute to answering the lasting controversial medico-legal discussion with more objectivity. Author.

6. 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.

7. 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.
ABSTRACT	STUDY DESIGN. A survey of the prevalence of cervical zygapophysial joint pain was conducted. OBJECTIVES. To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash. SUMMARY OF BACKGROUND DATA. 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. METHODS. 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. RESULTS. 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%). CONCLUSION. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash. Author.

8. AUTHOR	Jonsson-H-Jr, Cesarini-K, Sahlstedt-B, Rauschning-W.
INSTITUTION	Department of Orthopaedic Surgery, Academic University Hospital, Uppsala, Sweden.
TITLE	Findings and outcome in whiplash-type neck distortions.
SOURCE	Spine 1994 Dec 15, VOL: 19 (24), P: 2733-43, ISSN: 0362-2436 116 Refs.
ABSTRACT	STUDY DESIGN. The authors assessed the clinical and imaging findings and late outcome in 50 patients with whiplash-type neck distortions (17 men, 33 women, mean age 33 years). SUMMARY OF BACKGROUND DATA. Early symptoms are neck pain, stiffness, and sometimes radiating pain; later bizarre symptomatology poses intricate clinical and medicolegal problems. Pathoanatomic studies indicate that soft tissue injuries may be overlooked. METHODS. Repeated clinical and radiographic examinations (plain and flexion-extension radiograms and contrast magnetic resonance imaging evaluated with a new grading system); surgical findings; follow-up were performed after 1 and 5 years by an independent observer neurologist. RESULTS. Neck pain persisted in 24 patients; radiating pain developed within 6 weeks in 19 patients. Two patients with segmental instability had posterior fusions and complete pain relief. Eight patients with severe radiating pain and large disc protrusions on magnetic resonance had nine surgically confirmed fresh disc herniations. Discectomy and fusion alleviated pain in these patients, whereas symptoms largely persisted in the conservatively treated patients. CONCLUSIONS. A high incidence of discoligamentous injuries was found in whiplash-type distortions. Most patients with severe persisting radiating pain had large disc protrusions on MRI that were confirmed as herniations at surgery. Neck and radiating pain were alleviated by early disc excision and fusion. Author.

9. AUTHOR	Kortschot-H-W, Oosterveld-W-J.
INSTITUTION	Academisch Medisch Centrum, Poliklinik fur Vestibulare Erkrankungen, Amsterdam.
TITLE	(Otoneurologic disorders after cervical whiplash trauma). TT Otoneurologische Storungen nach HWS-Schleudertrauma.
SOURCE	Orthopade 1994 Aug, VOL: 23 (4), P: 275-7, ISSN: 0085-4350.
ABSTRACT	An extensive vestibular examination was conducted in 462 patients suffering from the after-effects of a cervical whiplash trauma. Vertigo and dizziness were mentioned by 318 (68%) of the subjects, among a variety of other complaints. The examination revealed the existence of central-vestibular lesions in 258 (56%) of the patients. Author.

10. 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.

11. AUTHOR	Byrn-C, Olsson-I, Falkheden-L, Lindh-M, Hosterey-U, Fogelberg-M, Linder-L-E, Bunketorp-O.
INSTITUTION	Department of Anaesthesia, Sahlgrenska Hospital, University of Gothenburg, Sweden.
TITLE	Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries (see comments).
SOURCE	Lancet 1993 Feb 20, VOL: 341 (8843), P: 449-52, ISSN: 0140-6736.
CM	Comment in: Lancet 1993 Feb 20; 341(8843):470; Comment in: Lancet 1993 Apr 3; 341(8849):905.
ABSTRACT	In many cases of whiplash injury symptoms persist and do not respond to treatment. There is uncontrolled evidence to suggest that intracutaneous injections of sterile water might help. Since that route may be unacceptable to patients the subcutaneous route is used in the randomised trial reported here. 40 patients with whiplash syndrome, mean age 46 years (24-73) were given subcutaneous injections of 0.3-0.5 ml sterile water or saline over tender and trigger points in the neck and shoulder. A maximum of three treatments were given during the first two months of the study and the patients were followed up for 8 months. The accidents had occurred 4-6 years previously. X-ray examinations revealed no traumatic spinal lesions. Neck mobility and pain levels were evaluated by a physiotherapist immediately before and after the first treatment and after 1, 3, and 8 months. After 3 months, the mean total mobility of the cervical spine had increased by 39 degrees in the sterile water group and 6 degrees in the saline group (p < 0.05). Minimum and maximum levels of pain in the weeks just before treatment were evaluated by a visual analogue scale from 0 to 10. After 3 months the minimum pain level had fallen from 2.2 to 1.4 in the sterile water group but was not reduced in the saline group (p < 0.02); the maximum had fallen from 8.1 to 3.8 in the sterile water group and from 8.3 to 7.5 in the saline group (p < 0.001). After 3 months, 19 of 20 patients in the sterile water group assessed their condition as generally improved but only 6 in the saline group felt that they had got better. After 8 months there were still significant differences for minimum pain score and for mobility but not for maximum pain or for self-assessment of improvement. Author.

12. AUTHOR	Hamer-A-J, Gargan-M-F, Bannister-G-C, Nelson-R-J.
INSTITUTION	Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
TITLE	Whiplash injury and surgically treated cervical disc disease (see comments).
SOURCE	Injury 1993 Sep, VOL: 24 (8), P: 549-50, ISSN: 0020-1383.
CM	Comment in: Injury 1994 Aug; 25(6):409; discussion 410; Comment in: Injury 1994 Aug; 25(6):409-10.
ABSTRACT	The incidence of a previous whiplash injury in 215 unselected patients who underwent an anterior cervical discectomy and fusion between 1988 and 1991 was found to be twice that of a control population of 800 general orthopaedic outpatients (P < 0.05). The mean age at which the whiplash injury occurred in the surgical group was 37 years and in the control group 36 years. The mean age at operation of those patients with a previous whiplash injury (45 +/- 12 years) was significantly less than those patients without a previous whiplash injury (55 +/- 14 years, P < 0.001). This study provides further evidence that whiplash injury causes structural changes predisposing to premature degenerative disc disease. Author.

13. AUTHOR	Bohnen-N, Jolles-J, Verhey-F-R.
INSTITUTION	Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands.
TITLE	Persistent neuropsychological deficits in cervical whiplash patients without direct headstrike.
SOURCE	Acta-Neurol-Belg 1993, VOL: 93 (1), P: 23-31, ISSN: 0300-9009.
ABSTRACT	Persistent cognitive and neurasthenic complaints can be the consequence of a cervical whiplash injury. In contrast to otoneurological and orthopedic reports, neuropsychological studies on whiplash patients are scarce. We report disturbances of information processing and memory functions in two patients with a pure cervical whiplash injury with demonstrated central otoneurological abnormalities, whereas there was no evidence of intellectual deterioration or focal cortical deficits. The results suggest that the cognitive disturbances and neurasthenic symptoms may be part of one syndrome which appears to manifest itself under conditions of time pressure and distraction. Author.