Elsevier

Injury

Volume 33, Issue 2, March 2002, Pages 97-101
Injury

Mini-review
Whiplash disorders—a review

https://doi.org/10.1016/S0020-1383(01)00111-5Get rights and content

Section snippets

Definitions

Crowe first used the term whiplash in 1928 [1]. Whiplash is generally considered to be a soft tissue injury of the neck, the diagnosis is made after fractures, dislocations and subluxations are excluded. The Quebec task force have suggested the term ‘Whiplash Associated Disorders’ (WAD) as a convenient term because the symptoms are not always confined to the neck [2]. Classically, a whiplash is a hyperextension injury following a rear impact. Soft tissue injuries to the neck can also occur from

Collision velocity

One particular aspect of the genesis of WAD which can be considered puzzling is the difference in velocity and force of injury which may give similar clinical outcomes. It has been shown that in 65% of all rear end impacts there is minimal damage to the vehicle but significant neck symptoms may be experienced [5], [6]. The velocity of impact causing symptoms may be less than experienced by participants using fairground bumper cars [5], [6].

One study of those severely injured in vehicular trauma

Epidemiology

There is no doubt that there are an increasing number of whiplash injuries, the numbers of those injured, reaching epidemic proportions [11]. There has been an annual increase in the number of patients attending an accident and emergency department, after a road traffic accident, from 1982 to 1983 (the year prior to the introduction of the compulsory wearing of seat belts in the UK). There was virtually a three-fold increase in the year after the compulsory introduction of seat belt usage, but

Outcome

Although there is no doubt that WADs occur, there is some dispute about their chronicity. Schrader et al. [16] have suggested that disabling or persisting symptoms do not occur as a result of a WAD but that the symptoms are due to expectation of disability, a family history of neck pain, and attribution of pre-existing symptoms to the trauma. They based their study on the retrospective analysis of accident victims and sex-matched and aged-matched controls. Awerbuch [17] concluded that WAD was

Cultural aspects

Much has been made about the lack of symptoms experienced by Lithuanians with WAD. In the absence of compensation a study population of 202 had full resolution of symptoms within 17 days [16], the suggestion being that compensation created the disorder. It should be noted that this paper has been criticised with regards to method [28]. A further study from Greece has suggested a similar outcome with few victims having persisting symptoms [29]

Pre-existing neck pains

Many patients develop neck pain without being involved in an accident. Marshall et al. [30] assessed the relationship between neck symptoms and preceding injury. They found that there was an increase in incidence of neck pain with age, that there was no significant difference between men and women, and that there was no correlation with the physical nature of the work undertaken. Overall, 34% complained of neck discomfort during or after carrying out normal everyday tasks. Those subjects with

Cause of chronicity

There is no good explanation as to why some patients are left with a severe residual disability. It may be the result of an abnormal psychological response to physical and persistent pain. Wallis et al. [34] studied 137 patients with chronic neck pain after a WAD and found a homogeneous pattern of responses characterised by high somatisation, obsessive-compulsive behaviour, and depression, confirming that the psychological distress exhibited by patients with whiplash was secondary to chronic

Investigations

Plain X-rays are often used to exclude bony injury, it may be that the loss of lordosis earlier reported as relevant may not be an accurate sign of significant musculo-ligamentous injury [40]. Magnetic resonance studies have shown the presence of anterior longitudinal ligament injury, vertebral endplate fracture, disc injuries, and posterior ligamentous injury [41], [42], but the changes may be slight, they may be normal variants, and they may be present in asymptomatic individuals [43]. Other

Psychology

It is agreed that some subjects are less able to cope with musculoskeletal disorders and thus their resolution of symptoms may be slower or incomplete. It has been shown that psychological factors are important in the continuance of symptoms [46] and that psychological profiles can be worsened by whiplash injury [47].

Degeneration

The debate about whether WAD can cause degeneration is not settled and controlled trials are needed [48]. It is thought that those with some cervical spondylosis before their injury will have a slower or less complete resolution of symptoms [20]. Authors have claimed that WAD does cause degeneration and may accelerate degeneration by up to 10 years [49] but their populations were selected and it is clear that patients with pre-existing degenerative changes were not excluded from these studies

Conclusions

Whiplash-associated disorders occur commonly after road traffic accidents. The incidence appears to be increasing, even though there may be a slight decrease in the total number of injuries after road traffic accidents. A significant minority of patients are left with permanent disability, and the severity of the disability decreases with time. The causes of the long-term disability are not known.

Several pleas have been made for scientific controlled studies to gain greater knowledge of this

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