Whiplash injury

Background

Neck ligament anatomy. A: Anterior atlantooccipital membrane, B: Apical ligament of dens, C: Cruciate ligament of atlas, D: Tectorial membrane of atlanto-axial joint, E: Anterior longitudinal ligament, F: Posterior longitudinal ligament, G: Posterior atlanto-occipital membrane, H: Ligamenta flava, I:Nuchal ligament , J: Supraspinous ligament

• Also known as Acute Cervical Strain
• Sudden acceleration-deceleration trauma that occurs when car is rear-ended

Clinical Features

• Pain, stiffness, paracervical muscle tenderness
• Isolated cervical strain should have normal neuro exam

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Evaluation

• Clinical diagnosis by history and physical exam
• Use C-Spine (NEXUS) criteria to determine whether imaging is required
• Consider brain, cord, carotid/vertebral artery dissection if neuro findings are present

Management

• Symptomatic treatment e.g. ibuprofen
• Studies have shown worsened range of motion and pain scores at 1 and 6 months after whiplash injury with placement of non-rigid (soft) cervical collars

Disposition

• Generally outpatient management

See Also

• Neck pain
• Blunt neck trauma
• Cervical spine clearance