Whiplash Associated Disorders: Difference between revisions
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== Clinically Relevant Anatomy<br> == | |||
Whiplash and whiplash associated disorders (WAD) affects variable areas of the cervical spine, depending on the force and direction of impact as well as many other factors. In a whiplash injury, bony structures, ligamentous structures, muscles, neurological structures, and other connective tissue may be affected. Anatomic causes of pain can be any of these structures, with the strain injury resulting in secondary edema, hemorrhage, and inflammation. | |||
== | == Mechanism of Injury / Pathological Process<br> == | ||
The mechanism of injury is variable, usually involving a motor vehicle accident but also including causes such as sports injury, child abuse, blows to the head from a falling object, or similar accelleration-decceleration event. | |||
== Clinical Presentation == | == Clinical Presentation == | ||
<br> | The most common presentation will be sub-occipital headaches and/or neck pain that is constant or motion-induced. There may be up to 48 hrs delay of symptom onset from the initial injury. Other signs include neurologic signs, dizziness, tinnitus, visual disturbances, UE radicular pain, difficulty sleeping due to pain, and difficulty concentrating/poor memory. ([http://emedicine.medscape.com/article/306176-overview eMedicine]) It is important to provide a thorough spinal exam and neurologic exam in patient with WAD to screen for delayed-onset of cervical spine instability or myelopathy. <ref name="Delfini et al">Delfini R, Dorizzi A, Facchinetti G, Faccioli F, Galzio R, Vangelista T. Delayed post-traumatic cervical instability. Surg Neurol. 1999;51:588-95.</ref><br> | ||
QTFC (Quebec Task Force Classification)<br> | ===== QTFC (Quebec Task Force Classification)<br> ===== | ||
<br> | <br> | ||
{| cellspacing="1" cellpadding="1" border="1 | {| style="width: 417px; height: 500px" cellspacing="1" cellpadding="1" border="1" | ||
|- | |- | ||
| '''QTFC Grade'''<br> | | '''QTFC Grade'''<br> | ||
| '''Clinical presentation'''<br> | | '''Clinical presentation'''<br> | ||
|- | |- | ||
| 0'''<br>''' | | 0'''<br>''' | ||
| | | | ||
No complaint about neck pain | No complaint about neck pain | ||
No physical signs<br> | No physical signs<br> | ||
|- | |- | ||
| I<br> | | I<br> | ||
| | | | ||
Nec complaints of pain, stiffness or tenderness only | Nec complaints of pain, stiffness or tenderness only | ||
No physical signs<br> | No physical signs<br> | ||
|- | |- | ||
| II<br> | | II<br> | ||
| | | | ||
Neck complaint | Neck complaint | ||
Musculoskeletal signs including<br> | Musculoskeletal signs including<br> | ||
*decreased ROM<br> | *decreased ROM<br> | ||
*point tenderness<br> | *point tenderness<br> | ||
|- | |- | ||
| <span style="font-weight: bold | | <span style="font-weight: bold">III</span><br> | ||
| | | | ||
Neck complaint | Neck complaint | ||
| Line 69: | Line 70: | ||
|- | |- | ||
| IV<br> | | IV<br> | ||
| Neck complaint and fracture or dislocation<br> | | Neck complaint and fracture or dislocation<br> | ||
|} | |} | ||
<br> | <br> | ||
<br> | <br> | ||
'''MQTFC (Modified Quebec Task Force Classification) '''<ref name="PMID: 15040964 [PubMed - indexed for MEDLINE]">Sterling M., Man Ther. 2004 May;9(2):60-70. A proposed new classification system for whiplash associated disorders--implications for assessment and management.</ref><br> | '''MQTFC (Modified Quebec Task Force Classification) '''<ref name="PMID: 15040964 [PubMed - indexed for MEDLINE]">Sterling M., Man Ther. 2004 May;9(2):60-70. A proposed new classification system for whiplash associated disorders--implications for assessment and management.</ref><br> | ||
<br> | <br> | ||
<br> | <br> | ||
{| | {| style="width: 596px; height: 1318px" cellspacing="1" cellpadding="1" align="center" border="1" | ||
|- | |- | ||
| | | | ||
Proposed<br> | Proposed<br> | ||
classificaiton grade | classificaiton grade | ||
| Physical and psychological impairments present<br> | | Physical and psychological impairments present<br> | ||
|- | |- | ||
| WAD 0<br> | | WAD 0<br> | ||
| | | | ||
No complaints about neck pain | No complaints about neck pain | ||
No physical signs<br> | No physical signs<br> | ||
|- | |- | ||
| WAD I<br> | | WAD I<br> | ||
| | | | ||
'''Neck complaings of pain, stiffness or tenderness only''' | '''Neck complaings of pain, stiffness or tenderness only''' | ||
No physical signs<br> | No physical signs<br> | ||
|- | |- | ||
| WAD IIA<br> | | WAD IIA<br> | ||
| | | | ||
Neck complaint | Neck complaint | ||
'''Motor impairment'''<br> | '''Motor impairment'''<br> | ||
*decreased ROM<br> | *decreased ROM<br> | ||
*altered muscle recruitment patterns (CCFT)<br> | *altered muscle recruitment patterns (CCFT)<br> | ||
| Line 120: | Line 121: | ||
|- | |- | ||
| WAD IIB<br> | | WAD IIB<br> | ||
| | | | ||
Neck complaint | Neck complaint | ||
| Line 129: | Line 130: | ||
*altered muscle recruitment patterns (CCFT) | *altered muscle recruitment patterns (CCFT) | ||
Sensory Impairment<br> | Sensory Impairment<br> | ||
*local cervical mechanical hyperalgesia<br> | *local cervical mechanical hyperalgesia<br> | ||
| Line 138: | Line 139: | ||
|- | |- | ||
| WAD IIC<br> | | WAD IIC<br> | ||
| Neck complaint | | Neck complaint | ||
Motor impairment | Motor impairment | ||
| Line 149: | Line 150: | ||
*local cervical mechanical hyperalgesia | *local cervical mechanical hyperalgesia | ||
*'''generalised sensory hypersensitivity (mechanical, thermal, ULNT)<br>''' | *'''generalised sensory hypersensitivity (mechanical, thermal, ULNT)<br>''' | ||
*'''Some may show SNS disturbances'''<br> | *'''Some may show SNS disturbances'''<br> | ||
Psychological impairment | Psychological impairment | ||
*elevated psychological disstress (GHQ, TAMPA)<br> | *elevated psychological disstress (GHQ, TAMPA)<br> | ||
*'''elevated levels of acute posttraumatic stress (IES)'''<br> | *'''elevated levels of acute posttraumatic stress (IES)'''<br> | ||
|- | |- | ||
| WAD III<br> | | WAD III<br> | ||
| | | | ||
Neck complaint | Neck complaint | ||
| Line 174: | Line 175: | ||
*Some may show SNS disturbances | *Some may show SNS disturbances | ||
'''Neurological signs of conduction loss including:'''<br> | '''Neurological signs of conduction loss including:'''<br> | ||
*decrease or absent deep tendon reflexes<br> | *decrease or absent deep tendon reflexes<br> | ||
*muscle weakness<br> | *muscle weakness<br> | ||
*sensory deficits<br> | *sensory deficits<br> | ||
| Line 186: | Line 187: | ||
|- | |- | ||
| WAD IV<br> | | WAD IV<br> | ||
| '''Fracture or dislocation'''<br> | | '''Fracture or dislocation'''<br> | ||
|} | |} | ||
<br> | <br> | ||
<br> | <br> | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Canadian C-Spine Rule (CCR): algorithm to determine the necessity for cervical spine radiography in alert and stable patients presenting with trauma and cervical spine injury. <br><br> | |||
== Management / Interventions<br> | == Management / Interventions<br> == | ||
add text here relating to management approaches to the condition<br> | add text here relating to management approaches to the condition<br> | ||
== Differential Diagnosis<br> | == Differential Diagnosis<br> == | ||
add text here relating to the differential diagnosis of this condition<br> | add text here relating to the differential diagnosis of this condition<br> | ||
== Key Evidence == | == Key Evidence == | ||
add text here relating to key evidence with regards to any of the above headings<br> | add text here relating to key evidence with regards to any of the above headings<br> | ||
== Resources <br> | == Resources <br> == | ||
www.som.uq.edu.au/whiplash | www.som.uq.edu.au/whiplash | ||
Whiplash evidence based informatin resources EBM Ressources (University of Queensland)<br> | Whiplash evidence based informatin resources EBM Ressources (University of Queensland)<br> | ||
== Case Studies == | == Case Studies == | ||
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== References == | == References == | ||
References will automatically be added here, see [[Adding References|adding references tutorial]]. | References will automatically be added here, see [[Adding References|adding references tutorial]]. <references /> | ||
<references /> | |||
Revision as of 04:28, 5 December 2009
|
Original Editor - Your name will be added here if you created the original content for this page. Lead Editors - Your name will be added here if you are a lead editor on this page. Read more. |
Clinically Relevant Anatomy
[edit | edit source]
Whiplash and whiplash associated disorders (WAD) affects variable areas of the cervical spine, depending on the force and direction of impact as well as many other factors. In a whiplash injury, bony structures, ligamentous structures, muscles, neurological structures, and other connective tissue may be affected. Anatomic causes of pain can be any of these structures, with the strain injury resulting in secondary edema, hemorrhage, and inflammation.
Mechanism of Injury / Pathological Process
[edit | edit source]
The mechanism of injury is variable, usually involving a motor vehicle accident but also including causes such as sports injury, child abuse, blows to the head from a falling object, or similar accelleration-decceleration event.
Clinical Presentation[edit | edit source]
The most common presentation will be sub-occipital headaches and/or neck pain that is constant or motion-induced. There may be up to 48 hrs delay of symptom onset from the initial injury. Other signs include neurologic signs, dizziness, tinnitus, visual disturbances, UE radicular pain, difficulty sleeping due to pain, and difficulty concentrating/poor memory. (eMedicine) It is important to provide a thorough spinal exam and neurologic exam in patient with WAD to screen for delayed-onset of cervical spine instability or myelopathy. [1]
QTFC (Quebec Task Force Classification)
[edit | edit source]
| QTFC Grade |
Clinical presentation |
| 0 |
No complaint about neck pain No physical signs |
| I |
Nec complaints of pain, stiffness or tenderness only No physical signs |
| II |
Neck complaint Musculoskeletal signs including
|
| III |
Neck complaint Musculosceletal signs Neurological signs including:
|
| IV |
Neck complaint and fracture or dislocation |
MQTFC (Modified Quebec Task Force Classification) [2]
|
Proposed classificaiton grade |
Physical and psychological impairments present |
| WAD 0 |
No complaints about neck pain No physical signs |
| WAD I |
Neck complaings of pain, stiffness or tenderness only No physical signs |
| WAD IIA |
Neck complaint Motor impairment
Sensory Impairment
|
| WAD IIB |
Neck complaint Motor impairment
Sensory Impairment
Psychological impairment
|
| WAD IIC |
Neck complaint
Motor impairment
Sensory Impairment
Psychological impairment
|
| WAD III |
Neck complaint Motor impairment
Sensory Impairment
Neurological signs of conduction loss including:
Psychological impairment
|
| WAD IV |
Fracture or dislocation |
Diagnostic Procedures[edit | edit source]
Canadian C-Spine Rule (CCR): algorithm to determine the necessity for cervical spine radiography in alert and stable patients presenting with trauma and cervical spine injury.
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
add text here relating to the differential diagnosis of this condition
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
www.som.uq.edu.au/whiplash
Whiplash evidence based informatin resources EBM Ressources (University of Queensland)
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Delfini R, Dorizzi A, Facchinetti G, Faccioli F, Galzio R, Vangelista T. Delayed post-traumatic cervical instability. Surg Neurol. 1999;51:588-95.
- ↑ Sterling M., Man Ther. 2004 May;9(2):60-70. A proposed new classification system for whiplash associated disorders--implications for assessment and management.
