WHIPLASH INJURY

Presenter :
Dr. Md. Kamrul Islam
D-ortho Student ,
Department Of Orthopaedic Surgery
BSMMU, Dhaka

ANOTHER NAME

SPRAINED NECK

DEFINITION
Whiplash is a neck injury that can
occur during rear-end automobile
collisions, when head suddenly
moves backward and then forwardsimilar to the motion of someone
cracking a whip.
These extreme motions push neck
muscles and ligaments beyond
their normal range of motion.

CAUSES
Auto

accidents- Rear end collisions are

the most common cause of whiplash.
Physical abuse- Whiplash may also
result from incidents of being punched
or shaken. It is one of the injuries
sustained in shaken baby syndrome.
Contact sports- Football tackles and
other sports related collisions can
sometimes cause whiplash injuries.

Pathophysiology a Sprain
Majority of whiplash injuries arise in soft tissue injury to neck
involving ligaments, joints, joint capsules, muscles and tendons

Type 1: Injury at microscopic level without altering structure

Type 2: Partial tear at macroscopic level no separation
Type 3: Severe stretching and tearing with separation of
tissues

Cervical Spine Anatomy

Cervical Spine Anatomy

Cervical Spine Anatomy

Atlanto-Axial Joint

Cervical Spine Anatomy

Mechanism Of Injury
Flexion Injuries
Head-on

collision
Falling face forward
Forcible forward flexion
Structures primarily injured
Disc
Nerve root
Vertebral body
Compression
Subluxation

Extension injury
Rear

ended collision
Falling backwards
Forcible extension of the neck
Structures injured
Facet joints
Muscles
Vertebral artery

Mixed Injuries
Flexion-rotation
Extension-rotation
Vertical

compression
Structures injured
Multiple structures
Muscles and ligaments

Clinical Presentation
Neck

pain
Upper back pain
Headaches
Radiating pain to the occiput,
shoulders, arms
Neurological symptoms
Numbness, weakness
Remote

signs and symptoms

Leg weakness and numbness

Bowel or bladder symptoms

Evaluation
History

Mechanism of injury (Flexion,

extension or mixed)
Aggravating and relieving factors
Additional symptoms and complains
Bowel or bladder symptoms

Evaluation
Physical

examination

Muscolo-skeletal exam
Range of motion (cervical spine and shoulders +
arms)
Palpation

Neurological exam
Sensory and motor examination
Reflexes
Gait

Always assume spinal cord trauma unless

proven otherwise

Investigations
Plain x-ray
MRI
CT Scan
EMG/NCV

MRI Cervical Spine

Management

Based on injured structures

Immobilization

Multi-modal approach
Interventions
Physical therapy
Pharmaceuticals

Flexion injuries
Disc

injury

Surgical approach
Percutaneous decompression
Nerve

root

Steroid injections
Cervical epidural
Transforaminal approach vs. interlaminar
approach

Interlaminar Epidural Injection

Transforaminal Epidural Injection

Selective Nerve Root

Block

Extension Injuries
Subluxations

Surgical approach
Facet

joint injury

Direct joint injection

Neuro-ablative techniques
Muscular

injury

Physical therapy

Whiplash Associated Disorders (WAD)

Classed by severity of signs and symptoms-

WAD 0
No complaints or physical signs
WAD 1
Neck complaints but no physical signs
WAD 2
Neck complaints and musculoskeletal signs
WAD 3
Neck complaints and neurological signs
WAD 4
Neck complaints and fracture /
dislocation

Most whiplash injury results from low impact collisions

Prevention
Head
3

restraints

in 4 not properly adjusted!

Summary

Whipash injuries are very common in MVAs

Very high mortality rate with upper cervical
spine injuries
High morbidity with lower cervical spine
injuries
MRI is the best modality for evaluation
Surgical interventions should be considered
earlier due to risk of spiral cord trauma
Neurological assessment is a must (upper
and lower extremities)
Effective management includes multimodal
approach

Thank You All