Cervical Whiplash

Question 1

What describes an acute whiplash injury?

Answer 1

Sudden or excessive:

• Hyperextension
• Hyper Flexion
• Rotation of the neck

Question 2

What scenario may cause a Whiplash injury?

Answer 2

• Road Traffic accident
• Sports injury
• Falls
• Assaults

Question 3

Most common cause of a Whiplash injury?

Answer 3

Rear-end vehicular collisions at speeds of less than 14mph.

Question 4

How does a rapid deceleration cause Whiplash?

Answer 4

When the cervical Spine flexes the movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil.

Question 5

How many grades of injury are within a Whiplash injury?

Answer 5

Grade 0-4

Question 6

What does a Grade 0 Whiplash injury consist of?

Answer 6

No complaints or physical signs.

Question 7

What does a Grade 1 Whiplash injury consist of?

Answer 7

Indicates neck complaints but no physical signs.

Question 8

What does a Grade 2 Whiplash injury consist of?

Answer 8

Indicates neck complaints and musculoskeletal signs.

Question 9

What does a Grade 3 Whiplash injury consist of?

Answer 9

Neck complaints and neurological signs.

Question 10

What does a Grade 4 Whiplash injury consist of?

Answer 10

Neck complaints and fracture/dislocation.

Question 11

Where do most Cervical spine fractures occur at?

Answer 11

• C2

- C6-C7

Question 12

Where do most fatal Cervical spine injuries occur at?

Answer 12

Upper Cervical levels:

• Cranio-Cervical junction C1
• C2

Question 13

Why do women sustain higher rates of whiplash?

Answer 13

Less developed neck muscles.

Question 14

What and when would the Canadian Cervical Spine Rule (CCR) be applied?

Answer 14

Decision making tool used to determine when radiography should be utilised during trauma.
Trauma patients who are alert and stable.

Question 15

High risk factors to be taken into account when assessing a Whiplash injury?

Answer 15

• > 65 years old
• Paraesthesia in extremities
• Dangerous mechanism of injury:
  
  • Fall from height
  • Axial load on the head
  • High speed Vehicle collision
  • bicycle collision

Question 16

Low risk factors to be taken into account when assessing a Whiplash injury?

Answer 16

• Low speed vehicle collision:
• Able to sit rather than lie down in the emergency room
• Ambulatory at anytime
• Delayed onset of neck pain
• Absence of midline Cervical spine tenderness

Question 17

Clinical symptoms may not develop until 6-12 hours after the injury, what do these symptoms include?

Answer 17

• Neck Pain (may peak 1-2 days after)
• Jaw Pain
• Paraspinal muscle tightness
• Interscapular and LBP
• Muscle spasm
• Reduced ROM and neck tenderness
• Headaches, Fatigue, Dizziness, Vertigo, Vision
• Numbness in shoulders and arms
• Paraesthesia and weakness in arms and legs
• Insomnia, Anxiety, Depression
• Hyperactive tendon reflexes

Question 18

Risk factors for serious Whiplash injuries:

Answer 18

• Immediate onset of pain
• > 65 years old
• Dangerous mechanism of injury
• Unable to walk or sit following injury

Question 19

Do not examine neck movements until you have excluded:

Answer 19

• Feature of serious head or neck injury
  
  • Altered level of consciousness
  • A focal neurological deficit or Paraesthesia in the extremities
  • Midline Cervical Tenderness

Question 20

Why would you assess for yellow flags?

Answer 20

Any psychological barriers that may hinder progression and cause the injury to become chronic.

Question 21

Differential Diagnosis to consider following serious injury as another possible cause of acute neck pain and stiffness.

Answer 21

• Spinal Fracture
• Cervical Disc Herniation
• Subarachnoid Heamorrhage
• Meningitis (systemic infection)