Whiplash injuries

Whiplash injuries are now a common cause of persistent cervical symptoms. Yet true whiplash injury occurs classically when, as a result of a rear impact, an initially stationary or slowly moving vehicle strikes another vehicle or object in front. Because of the inertial mass of the head of the vehicle occupant, there is a rapid extension of the cervical spine followed by flexion. In the partial whiplash injury, the main element is extension of the neck; this also commonly occurs as a result of a rear impact, but in this case the vehicle in which the occupant is traveling comes to rest more gradually without striking anything ahead.
Whiplash injury is more commonly misunderstood. It should only used as a term in soft tissue injuries of neck where extension is the main element. In the majority of cases the radiographs show normal alignment of cervical vertebrae but occasionally small avulsion fractures of the anterior margins of the vertebral bodies give evidence of forcible extension of the spine. In some cases, there are minor fractures involving the unco – vertebral joints. Where there are spondylotic changes next interfere with the dissipation of the forces involved, because of the localized areas of rigidity in the spine that may be avulsion of anterior osteophytes. The flexion elements may sometimes produce wedge compression fractures of the vertebral bodies or avulsion fractures of the spinous processes. These injuries produce symptoms of all degrees of severity. There is always pain and stiffness in the nape of the neck, sometimes with neurological disturbances involving the upper limbs and occasionally with the lower limbs. Even minor symptoms may be most protracted, often lasting 18 months or longer. In some cases, disability is permanent. Cervical collar support, local heat and analgesics are usually advised.
Severe extension injuries may occur in fall injuries when the neck is forcibly extended as the head strikes the ground. There is often a tell – tale bruise in the fore head. In a car accident an unbelted occupant may also suffer severe extension of the neck in the early phases of deceleration when the forehead strikes the roof and ricochets backwards. In both sets circumstances the head injury may attract prior attention, but the possibility of whiplash injury must not be overlooked. Cervical spondylosis again has a localizing effect on the forces involved and the neurological disturbance may be profound.