Australian researchers found[1] that patients with persistent neck pain more than 3 months after Cervical Whiplash commonly had evidence of injury to the lower cervical facet (zygapophysial) joints.
After excluding patients with dominant headache and a response to local anesthetic injection into the upper facet joints, they injected either local anesthetic or water into the lower facet joints, without patient or doctor knowing which liquid was being given (double-blind).
Half the patients
with chronic neck pain after Whiplash responded to injections of local
anesthetic but not water. Adding in those who had dominant headache and who
responded to local anesthetic injection into the facet joints of
the upper cervical spine, fully 60% had evidence of facet
joint injury.
| PRACTICE POINT Chronic neck pain in Late Whiplash commonly arises from injured facet joints |
Consistent with the recently
documented (Medical Litigation News
Volume 3, Issue 3) frequency of symptoms of Temporo Mandibular (Joint)
Dysfunction (TMD) after Cervical Whiplash, a US study[2]
of MRI findings found abnormalities in 95% of injured patients with TMD
symptoms.
| PRACTICE POINT Magnetic Resonance Imaging (MRI) is the most sensitive method for investigating symptoms of Temporo Mandibular Dysfunction after Cervical Whiplash |
According to research[3] at a US Emergency Department, acute use of soft collars has no effect on the persistence or intensity of neck pain.
A Swiss team[4] have shown by SPECT scanning (Medical Litigation News Volume 1, Issue 3) that Whiplash patients with persistent cerebral symptoms (hearing, dizziness, memory, vision, swallowing) have diminished blood flow to the occipital and parietal lobes of the brain.
The researchers' current hypothesis is that the reduction in blood supply is triggered by pain detectors in the neck.
| PRACTICE POINT Diminished blood supply to parts of the brain may explain persistent disturbances of hearing, balance, swallowing, memory and vision after Cervical Whiplash |
Other Swiss researchers[5] have causally related cognitive problems (memory, concentration) after Whiplash either to pain itself or to psychological adjustment to bodily symptoms. English psychiatrists quantified[6] the contribution of psychological symptoms to disability. Consecutive emergency-room attenders with a diagnosis of Whiplash were assessed, and reviewed at 3 and 12 months.
A significant minority had persistent symptoms (intrusive memory, travel-related phobia) of Post Traumatic Stress Disorder (Medical Litigation News Volume 1, Issue 4), and in a quarter these caused considerable social impairment.
Both these psychological problems
and Compensation were unrelated to persistent complaints of neck pain.
| PRACTICE POINT The considerable social impairment experienced by a quarter of all Whiplash patients is mainly a result of symptoms of Post Traumatic Stress Disorder |
Medical Litigation News - Whiplash Articles
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