Whiplash, Cervical - Medical Research Abstracts

1. AUTHOR	Seckmeyer-M.
INSTITUTION	Abteilung Kraftschaden, Wiesbaden.
TITLE	(Detection of so-called "cervical whiplash trauma"). TT Zum Nachweis des sogenannten "HWS-Schleudertraumas".
SOURCE	Versicherungsmedizin 1997 Apr 1, VOL: 49 (2), P: 48-51, ISSN: 0933-4548.
ABSTRACT	For the evidence of causality of an accident for a cervical injury without any contact with the interior, it is necessary to provide a interdisciplinary expert's opinion. According to the state of experts knowledge for reconstruction of accidents a slight cervical injury can be precluded if the alteration of speed of the pushed car ist less than 15 km/h. Medical diagnoses are only valid if they have been proved by objective results. A diagnose based only on a subjective information is to be considered as a suspicious diagnose. Author.

2. 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.

3. AUTHOR	Mayou-R, Radanov-B-P.
INSTITUTION	Department of Psychiatry, Warneford Hospital, Oxford, UK.
TITLE	Whiplash neck injury.
SOURCE	J-Psychosom-Res 1996 May, VOL: 40 (5), P: 461-74, ISSN: 0022-3999 60 Refs.
ABSTRACT	Whiplash, or post-traumatic, neck injury is an increasingly frequent clinical problem. Large numbers of patients present with both acute and chronic physical symptoms. It has frequently been alleged that psychological factors and social variables (especially the influence of possible compensation) are major causes of persistent physical complaints and disability. There have been few methodologically satisfactory studies, and very little attention has been paid to mental state and quality of life issues. Epidemiology, clinical features, prognosis, and aetiology are all reviewed with a special emphasis on psychological outcome and variables. It is argued that such factors are as important in relation to whiplash injuries as are other physical conditions, especially musculoskeletal disorders. In addition, specific posttraumatic symptoms are common but usually unrecognized. 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	Jenzer-G.
TITLE	(Clinical aspects and neurologic expert assessment in sequelae of whiplash injury to the cervical spine). TT Klinische Aspekte und neurologische Begutachtung beim Zustand nach Beschleunigungsmechanismus an der Halswirbelsaule.
SOURCE	Nervenarzt 1995 Oct, VOL: 66 (10), P: 730-5, ISSN: 0028-2804 30 Refs.
ABSTRACT	Whiplash injury to the cervical spine and its possible long-term sequelae, the late (or chronic) whiplash syndrome, are analysed based on a clearly defined accident mechanism and an initial battery of investigations to exclude lesions other than those affecting the soft tissue of the neck region (i.e. the consequences of strain and sprain). Predictors are discussed that may point to a delayed and complicated recovery, with development of a complex array of symptoms. The pattern of this symptomatology, as reviewed on the basis of different neuropsychological investigations, appears inhomogeneous. Comparison with other non-traumatic conditions, such as the chronic fatigue syndrome, the fibromyalgia syndrome and chronic daily headache, as well as with chronic disturbances of cervical origin, reveals striking similarities. In cases of litigation, these circumstances require careful assessment of the patient's previous history and an extensive differential diagnosis. Whiplash injury to the cervical spine rarely results in disability and, if so, is only minor. 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	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.

10. 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.

11. 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.