AZ Nikolaas Sint Niklaas Whiplash definition: neck pain experienced as a result of a motor vehicle collision or similar trauma Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash whiplash injury: any structural damage sustained because of the whiplash forces Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash whiplash injury: it is the abnormal motion between individual motion segments that has the potential to injure facets, disks, and ligaments Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash whiplash associated disorder: variety of clinical symptoms other than head, neck , and arm pain that occur after a whiplash type of trauma Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash The Quebec Classification for Whiplash Associated Disorders Grade 0 No Complaint about the neck No physical signs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash The Quebec Classification for Whiplash Associated Disorders Grade 1 Neck Complaint of pain , stifness or tenderness only No physical signs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash The Quebec Classification for Whiplash Associated Disorders Grade 2 Neck Complaint and musculoskeletal signs (including decreased ROM and point tenderness) Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash The Quebec Classification for Whiplash Associated Disorders Grade 3 Neck Complaint and neurological signs (including decreased or absent deep tendon reflexes, weakness, and sensory deficit) Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash The Quebec Classification for Whiplash Associated Disorders Grade 4 Neck Complaint and fracture or dislocation Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash annual incidence ranges from 0,1 to 7 per 1000 financial burden results from the small number of injuries that become chronic patients with disabilities of more than 6 months account for 46% of the total cost Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash 15% to 40% of patients with acute neck pain after MVC develop chronic pain 5% to 7% of patients become permanently partially or totally disabled Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Natural history: In +/- 80% pain after MVC begins the day of the collision complete recovery occurs in 60 to 85% of patients 5% to 12 % experience chronic moderate to severe pain 5% to 10% have permanent partial or total disability Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Prognostic factors: strongest indicator of poor outcome is high initial intensity of pain conflict in results regarding older age and female sex no prognostic differences in preinjury psychological factors , work related factors , litigation Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Prognostic factors: consulting a lawyer results in lesser chance on early claim settlement, longer treatment and slightly worse function in a no-fault no-tort system there is a shorter time to case closure Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Clinical symptoms : acute vs chronic neck pain (i.e. Pain that persists beyond 6 months) location: midline, uni- or bilateral , trapezius, shoulder, interscapular , arm or face Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Clinical symptoms : Headache is the second most common symptom involves the base of the skull and radiates to the crown of the head and the frontal region Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Clinical symptoms : WAD including LBP , visual disturbances, dizziness, tinnitus, weakness , fatigue , poor concentration , poor memory , difficulty sleeping , secondary psychological changes Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash structural etiology facet joint 49%-54% facet joints in chronic neck pain 60% facet joints in chronic neck pain and headache 53% C2/C3 facet joint pain in case of cervicogenic headache Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash structural etiology disk ? craniocervical ligaments? Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash Treatment: acute neck pain explanation, education, reassurance no orthosis « act as usual » as good as any other treatment active excercises conflicting results of SMT NSAIDs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain rehabilitation injections medication spinal manipulative therapy cervical orthosis surgery Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain rehabilitation strength training and endurance training intensive excercises are more effective than light excercises but not more effective than ordinary activity behavior modification : overcoming fear avoidance Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain injections level 1 evidence for efficacy of RFN for pain arising from facet joints Complete pain relief is possible with pure facet joint pain and in 86% of patients with facet-joint mediated cervicogenic headache Median of 270-400 days pain relief Corticosteroid injection of facet joints only short term relief No place for epidural infiltrations Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain medication Up to 3 trials of different NSAIDs (2wks), when response is meaningful drug should be continued Opioid analgesics No evidence for the use of TCA nor anticonvulsants Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain spinal manipulative therapy No evidence concerning efficacy Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain cervical orthosis No evidence for efficacy Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

Whiplash Treatment: chronic neck pain surgery Surgery may be considered for the patient wih severe pain, significant impairment and good psychological health who has not improved with high quality non-surgical care Diskography? ? Science , pff ! Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

AZ Nikolaas Sint Niklaas Whiplash key references spitzer wo, skovron ml, salmi lr et al: scientific monograph of the Quebec Task Force on whiplash-associated disorders: redifining whiplash and its management Spine 1995;20:1S-73S schofferman j, bogduk n, slosar p:chronic whiplash and whiplash-associated disorders: an evidence based approach Journal of the AAOS;vol 15, October 2007,No 10, pp 596-606 Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas