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Sunday, August 26, 2012

Whiplash Syndrome. Is it a Medical Emergency?

Whiplash Syndrome.  Is it a Medical Emergency?


This is another post on whiplash syndrome.  Again, I am not writing this stuff for the purpose of spinning something into something more than what it is.

Ask anyone who has ever been rear ended in a car accident, and they will tell you how it felt.  I remember one of my patients a couple years back described to me that it felt like he got his bell rung.  I thought that was a good way of putting it.  He was a huge guy also... almost like an NFL lineman.

Of course, some people, depending on how they are sitting, eg, if their head was against the head rest or turned (6) at the time of the impact, may feel less discomfort than others.  There are also other factors involved like whether your car is moving at the time it was rear ended. (I would actually like to get into that in another post, because what happens here is actually paradoxical to one's thinking.  I will explain in another post.)

So, in a previous post, we have already talked about the fact that more than 50% of  whiplash syndromes fail to resolve. But, what, for example is so terrible about a sprain/strain of the cervical muscles, or even a disc herniation?  What other things occur to a victim of whiplash, or an acceleration/deceleration injury?  I actually did a little research this morning.  www.Pubmed.com is a wonderful source for the latest research abstracts for virtually any scientific subject you may be interested in.  I use it all the time. And you should not take MY word on this topic, when there's tons of literature on this subject.

The following is just the tip of the iceberg when it comes to research on whiplash injury.  Matsui et al, at the Japan Neurological Institute studied whiplash victims and saw that many of these patients experienced various conditions such as chronic fatigue, headache, and vertigo.  Furthermore, his group saw that individuals who underwent treatment for these injuries had reported "good outcome" rates up into the 80% range. (1) Now, what they consider good outcome I don't know.  Good outcome and complete recovery may be two entirely different things.  I actually saw multitudes of studies on vertigo and whiplash.  It seems that vertigo is a common theme after getting rear ended.  Here is a a few articles:  Clinical Symptoms of Equilibrium disorders in patients with whiplash syndrome, Benitez, et al., and Postural  Control Disorders in Initial Phases of Whiplash, Cobo, et al (2,3).  Other authors concluded that 10% of whiplash injuries result in tinnitus, deafness, and vertigo. Trantor, et al.(4).  I can go on for hours finding new articles on this subject. Here is one that caught my attention:  Here is a young lady with minor trauma to the neck, and was diagnosed as having a whiplash.  Patient had normal X-rays, however had paraesthesia of the left arm.  Angiography later revealed the patient had a vertebral artery dissection. (5)

I don't think it is a very long stretch to see that whiplash injuries are very often medical emergencies.  They don't always present as medical emergencies, but the research confirms it.  Doctors should assess these patients objectively, however relating the patient's complaints back to the cause.  And, clinicians should not assume that all whiplash injuries are the same and require the same treatment.  These injuries very often cause permanent deficits of body function and use.  Tinnitus, vertigo, postural changes, and deafness are just a very small handful of the seriousness of whiplash injuries.   If you have been hurt in a whiplash type injury, you can email Dr. Himmel, or you can call Dr. Himmel at 954-659-8600.  I generally answer the phone myself.

Stay tuned.  My next post will be on the physics of the rear end car accident.


1.  2012;52(2):75-80.Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles.Matsui T, Ii K, Hojo S, Sano K.

Source

Japan Neurological Institute and Matsui Hospital, Kannonji, Kagawa, Japan. t.matsui@matsui-hp.com
2.   2009 May-Jun;60(3):155-9.[Clinical symptoms of equilibrium disorders in patients with whiplash syndrome]. Uehara Benites MAPérez-Garrigues HMorera Pérez CUnidad de Otoneurología, Servicio de Otorrinolaringología, Hospital La Fe, Valencia, España. michel_u@hotmail.com

3.  2009 May 2;132(16):616-20. Epub 2009 Apr 22.[Postural control disorders in initial phases of whiplash].Pleguezuelos Cobo EGarcía-Alsina JGarcía Almazán COrtiz Fandiño JPérez Mesquida MEGuirao Cano LSamitier Pastor BPerucho Pont CColl Serra EMatarrubias CReveron G.

Source

INVALCOR (Laboratorio de Biomecánica), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Hospital de Mataró, Mataró (Barcelona), España; Universidad Pompeu Fabra, Barcelona, España. 34260ep@comb.es
4.  2009 Feb;16(2):53-5. Epub 2008 Nov 1.A review of the otological aspects of whiplash injury.Tranter RMGraham JRENT Department, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX, United Kingdom. rtranter@uk-consultants.co.uk


5.  2008 Sep;25(9):609-10. Neck pain and minor trauma: normal radiographs do not always exclude serious pathology. Ribbons TBell SAccident and Emergency Department, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK. tamsinribbons@doctors.org.uk

6.  2008 Jul 1;33(15):1643-9.  Head-turned postures increase the risk of cervical facet capsule injury during whiplashSiegmund GPDavis MBQuinn KPHines EMyers BSEjima SOno KKamiji KYasuki TWinkelstein BA.

Source

MEA Forensic Engineers & Scientists, Richmond, BC, Canada. gunter.siegmund@meaforensic.com