whiplash injury

WordNet

1. any physical damage to the body caused by violence or accident or fracture etc. (同)hurt, harm, trauma
2. an act that causes someone or something to receive physical damage
3. wrongdoing that violates anothers rights and is unjustly inflicted
4. an accident that results in physical damage or hurt (同)accidental injury
5. an injury to the neck (the cervical vertebrae) resulting from rapid acceleration or deceleration (as in an automobile accident) (同)whiplash_injury

PrepTutorEJDIC

1. 『負傷』,『損害』,損傷 / (名誉などを)傷つけること,侮辱《+『to』+『名』》
2. 〈C〉むち先,むちひも / 〈U〉ぎょっとすること / 〈U〉(また whiplash injury)むち打ち症 / ‘を'むち打って励ます

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/19 07:58:00」(JST)

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Whiplash
Classification and external resources
ICD-10	S13.4
ICD-9	847.0
DiseasesDB	14122
MedlinePlus	000025
MeSH	D014911

Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension. The term "whiplash" is a colloquialism. "Cervical acceleration-deceleration" (CAD) describes the mechanism of the injury, while the term "whiplash associated disorders" (WAD) describes the injury sequelae and symptoms.

Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including headbanging,^{[medical citation needed]} bungee jumping and falls. It is one of the main injuries covered by the car insurers.^{[citation needed]} In the United Kingdom, 430,000 people made an insurance claim for whiplash in 2007, accounting for 14% of every driver's premium.

Before the invention of the car, whiplash injuries were called "railroad spine" as they were noted mostly in connection with train collisions. The first case of severe neck pain arising from a train collision was documented around 1919. The number of whiplash injuries has since risen sharply due to rear-end motor vehicle collisions. Given the wide variety of symptoms associated with whiplash injuries, the Quebec Task Force on Whiplash-Associated Disorders coined the phrase 'Whiplash-Associated Disorders'.

Epidemiology

Whiplash is the term commonly used to describe hyperflexion and hyperextension, and is one of the most common nonfatal car crash injuries. More than one million whiplash injuries occur each year due to car crashes. This is an estimate because not all cases of whiplash are reported. In a given year, an estimated 3.8 people per 1000 experience whiplash symptoms. “Freeman and co-investigators estimated that 6.2% of the US population have late whiplash syndrome”. The majority of cases occur in patients in their late fourth decade. Unless a cervical strain has occurred with additional brain or spinal cord trauma mortality is rare.

Whiplash can occur at speeds of fifteen miles per hour or less; it is the sudden jolt, as one car hits another, that causes ones head to be abruptly thrown back and sideways. The more sudden the motion, the more bones, discs, muscles and tendons in ones neck and upper back will be damaged. Spinal cord injuries are responsible for about 6,000 deaths in the U.S. each year and 5,000 whiplash injuries per year result in quadriplegia.

Most cases of whiplash occur among Caucasians 66.1%, as compared to 27.1% for African Americans, 8.1% for Hispanics, and 2% for Asians, as seen in figure A. After 12 months, only 1 in 5 patients remain symptomatic, only 11.5% of individuals were able to return to work a year after the injury, and only 35.4% were able to get back to work at a similar level of performance after 20 years. Estimated indirect costs to industry are $66,626 per year, depending on the level and severity. Lastly, the total cost per year was $40.5 billion in 2008, a 317% increase over 1998.

Anatomy

Whiplash can be described as a sudden strain to the muscles, bones and nerves in the neck. The neck is made up of seven bones and they make up the cervical vertebrae (Floyd, Thompson). The first two cervical vertebrae are distinctive because they are not shaped like the rest. The first cervical vertebra is the atlas and the axis follows. The atlas and axis are responsible for movement from side to side (cervical rotation to the right and left); also moving forward and backward (cervical flexion and extension) (Floyd, Thompson). Excessive extension and flexion can disrupt the vertebrae.

There are four phases that occur during “whiplash”: Initial position (before the collision), retraction, extension and rebound. In the initial position there is no force on the neck it is stable due to inertia. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. They explain that during the retraction phase that is when the actual “whiplash” occurs, since there is an unusual loading of soft tissues. The next phase is the extension, the whole neck and head switches to extension, and it is stopped or limited by the head restraint. The rebound phase transpires as result of the phases that are mentioned.

During the refraction phase the spine forms an S-Shaped curve, and this caused by the flexion in the upper planes and hyperextension at the lower planes and this exceed their physiological limits this phase the injuries occur to the lower cervical vertebrae. At the extension phase all cervical vertebrae and the head are fully extended, but do not surpass their physiological limits. Most of the injuries happen in C-5 and C-6.

Signs and symptoms

Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms and legs, and headaches. Symptoms can appear directly after the injury, but often are not felt until days afterwards. Whiplash is usually confined to the spine. The most common areas of the spine affected by whiplash are the neck and middle of the spine.

"Neck" pain is very common between the shoulder and the neck. The “missing link” of whiplash may be towards or inside the shoulder and this would explain why neck therapy alone frequently does not give lasting relief.

Cause

The exact injury mechanism that causes whiplash injuries is unknown. A whiplash injury may be the result of impulsive stretching of the spine, mainly the ligament: anterior longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a whiplash injury.

A whiplash injury from an automobile accident is called a cervical acceleration-deceleration injury. Cadaver studies have shown that as an automobile occupant is hit from behind, the forces from the seat back compress the kyphosis of the thoracic spine, which provides an axial load on the lumbar spine and cervical spine. This forces the cervical spine to deform into an S-shape where the lower cervical spine is forced into a kyphosis while the upper cervical spine maintains its lordosis. As the injury progresses, the whole cervical spine is finally hyper-extended.

Whiplash may be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster or other rides at an amusement park, sports injuries such as skiing accidents, other modes of transportation such as airplane travel, or from being hit, kicked or shaken.^{[citation needed]} Shaken baby syndrome can result in a whiplash injury.

Whiplash associated disorders sometimes includes injury to the cerebrum. In a severe cervical acceleration-deceleration syndrome, a brain injury known as a coup-contra-coup injury occurs. A coup-contra-coup injury occurs as the brain is accelerated into the cranium as the head and neck hyperextend, and is then accelerated into the other side as the head and neck rebound to hyper-flexion or neutral position.

"Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms",

From this type of research it has been inferred that whiplash symptoms might not always have any pathological (injury) explanation. However, over the last decade, academic surgeons in the UK and US have sought to unravel the whiplash enigma. A 1000 case four year observational study published in 2012 said that the "missing link" in whiplash injuries is the trapezius muscle which may be damaged through eccentric muscle contraction during the whiplash mechanism described above and below. Another study suggested that “shneck pain” was in the nearby supraspinatus muscle and this resulted from a seemingly asymptomatic form of shoulder impingement. Shoulder impingement is commonly asymptomatic and the shoulder may be injured along with the neck in a motor vehicle accident. Whiplash due to The Referred Shoulder Impingement Syndrome was successfully treated. All of this work demonstrates that historically and indeed presently whiplash patients' pain sources may be missed. Hence the pathology in whiplash may have been missed.

Diagnosis

Diagnosis occurs through a patient history, head and neck examination, X-rays to rule out bone fractures and may involve the use of medical imaging to determine if there are other injuries.

Québec Task Force

The Québec Task Force (QTF) has divided whiplash-associated disorders into five grades.^{[citation needed]}

• Grade 0: no neck pain, stiffness, or any physical signs are noticed
• Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
• Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
• Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
• Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.

Pathophysiology

While the time associated with a specific collision will vary, the following provides an example of the occupant and seat interaction sequence for a collision lasting approximately 300 milliseconds.^{[citation needed]}

0 ms	Rear car structure is impacted and begins to move forward and/or crushes Occupant remains stationary No occupant forces
100 ms	Vehicle seat accelerates and pushes into occupant’s torso (i.e. central portion of the body in contact with seat) The torso loads the seat and is accelerated forward (seat will deflect rearward) Head remains stationary due to inertia
150 ms	Torso is accelerated by the vehicle seat and may start to ramp up the seat Lower neck is pulled forward by the accelerated torso/seat The head rotates and extends rapidly rearward hyper-extending the neck
175 ms	Head is still moving backwards Vehicle seat begins to spring forward The torso continues to be accelerated forward The head rotation rearward is increased and is fully extended
300 ms	Head and torso are accelerated forward Neck is “whipped” forward rotating and hyper-flexing the neck forward The head accelerates due to neck motion and moves ahead of the seat back

Prevention

The focus of preventive measures to date has been on the design of car seats, primarily through the introduction of head restraints, often called headrests. This approach is potentially problematic given the underlying assumption that purely mechanical factors cause whiplash injuries — an unproven theory. So far the injury reducing effects of head restraints appears to have been low, approximately 5–10%, because car seats have become stiffer in order to increase crash-worthiness of cars in high-speed rear-end collisions which in turn could increase the risk of whiplash injury in low-speed rear impact collisions. Improvements in the geometry of car seats through better design and energy absorption could offer additional benefits. Active devices move the body in a crash in order to shift the loads on the car seat.

For the last 40 years, vehicle safety researchers have been designing and gathering information on the ability of head restraints to mitigate injuries resulting from rear-end collisions. As a result, different types of head restraints have been developed by various manufactures to protect their occupants from whiplash. Below are definitions of different types of head restraints.

Head restraint — refers to a device designed to limit the rearward displacement of an adult occupant’s head in relation to the torso in order to reduce the risk of injury to the cervical vertebrae in the event of a rear impact. The most effective head restraint must allow a backset motion of less than 60 mm to prevent the hyperextension of the neck during impact.

Integrated head restraint or fixed head restraint — refers to a head restraint formed by the upper part of the seat back, or a head restraint that is not height adjustable and cannot be detached from the seat or the vehicle structure except by the use of tools or following the partial or total removal of the seat furnishing”.

Adjustable head restraint — refers to a head restraint that is capable of being positioned to fit the morphology of the seated occupant. The device may permit horizontal displacement, known as tilt adjustment, and/or vertical displacement, known as height adjustment.

Active head restraint — refers to a device designed to automatically improve head restraint position and/or geometry during an impact”.

Automatically adjusting head restraint — refers to a head restraint that automatically adjusts the position of the head restraint when the seat position is adjusted.

A major issue in whiplash prevention is the lack of proper adjustment of the seat safety system by both drivers and passengers. Studies have shown that a well designed and adjusted head restraint could prevent potentially injurious head-neck kinematics in rear-end collisions by limiting the differential movement of the head and torso. The primary function of a head restraint is to minimize the relative rearward movement of the head and neck during rear impact. During a rear-end collision, the presence of an effective head restraint behind the occupant’s head can limit the differential movement of the head and torso. A properly placed head restraint where one can sufficiently protect his/her head lower the chances of head injury by up to 35% during a rear-end collision.

In contrast to a properly adjusted head restraint, research suggests that there may be an increased risk of neck injuries if the head restraint is incorrectly positioned. More studies by manufacturers and automobile safety organizations are currently undergoing to examine the best ways to reduce head and torso injuries during a rear-end impact with different geometries of the head restraint and seat-back systems.

In most passenger vehicles where manually adjustable head restraints are fitted, proper use requires sufficient knowledge and awareness by occupants. When driving, the height of the head restraint is critical in influencing injury risk. A restraint should be at least as high as the head's center of gravity, or about 9 centimeters (3.5 inches) below the top of the head. The backset, or distance behind the head, should be as small as possible. Backsets of more than 10 centimeters (about 4 inches) have been associated with increased symptoms of neck injury in crashes. In a sitting position, the minimum height of the restraint should correspond to the top of the driver’s ear or even higher. In addition, there should be minimal distance between the back of head and the point where it first meets the restraint.

Due to low public awareness of the consequence of incorrect positioning of head restraints, some passenger vehicle manufactures have designed and implemented a range of devices into their models to protect their occupants.

Some current systems are:

• Mercedes-Benz A-Class Active Head Restraint (AHR)^{[citation needed]},
• Saab (Responsible for the first active head restraint), Opel, Ford, Nissan, Subaru, Hyundai, and Peugeot — Active Head restraint (SAHR)^{[citation needed]},
• Volvo and Jaguar — Whiplash Protection System/Whiplash Prevention System (WHIPS)^{[citation needed]}, and
• Toyota — Whiplash Injury Lessening (WIL).^{[citation needed]}

The Insurance Institute for Highway Safety (IIHS) and other testing centers around the world have been involved in testing the effectiveness of head restraint and seat systems in laboratory conditions to assess their ability to prevent or mitigate whiplash injuries. They have found that over 60% of new motor vehicles on the market have “good” rated head restraints. Various organisations exist which list such vehicles

Rehabilitation

The potential injury to the cervical spine from hyper-flexion or hyperextension may be debilitating, and pain was reported to be the biggest stressor event experienced in daily living, so it is important to begin rehabilitation immediately to prevent future pain. In most clinical cases, cervical collars are recommended until the pain ceases. If adequate treatment and rest is not taken until the injury is fully healed it can grow into a chronic pain. Schnabel and colleagues also stated that the soft collar is not a suitable medium for rehabilitation, and the best way of recovery is to include an active rehabilitation program that includes physical therapy exercises and postural modifications. Another study found patients who participated in active therapy shortly after injury increased mobilization of the neck with significantly less pain within four weeks when compared to patients using a cervical collar. When beginning a rehabilitation regimen, it's important to begin with slow movements which include cervical rotation until pain threshold three to five times per day, flexion and extension of the shoulder joint by moving the arms up and down two to three times, and combining shoulder raises while inhaling and releasing the shoulder raise while exhaling. Soderlund and colleagues also recommend that these exercises should be done every day until pain starts to dissipate. Early mobilization is important for preventing chronic pain, but pain experienced from these exercises might cause psychological symptoms that could have negative impact on recovery

Treatment

According to the recommendations made by the Quebec Task Force, treatment for individuals with whiplash associated disorders grade 1–3 should include manipulation, mobilizations and range of motion exercises. Non-narcotic analgesics and non-steroidal anti-inflammatory drugs may also be prescribed in the case of WAD 2 and WAD 3, but their use should be limited to a maximum of three weeks. A cervical collar should not be used for longer than 72 hours as it may lead to prolonged inactivity. Return to normal activities of daily living should be encouraged as soon as possible to maximize and expedite full recovery.^{[citation needed]}

A different approach is taken by the National Institute for Neurological Disorders and Stroke, who suggest that treatment for individuals with whiplash may include pain medications, non-steroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and a cervical collar (usually worn for two to three weeks). Range of motion exercises, physical therapy, and cervical traction may also be prescribed. Supplemental heat application may relieve muscle tension.

Treatment for whiplash is dependent on the grade category. It can be categorized as grade 0 being no pain to grade 4 being very severe pain. A physical examination can help identify what type of treatment is most suitable. For the most part, we will be looking at treatment for grade 1 and 2. Whiplash Associated Disorders. Pain Practice, 10 (2), 131–136 states that there are two treatment options: conservative management and interventional management. Conservative management includes active and passive treatments. Interventional management is medical treatments and interventions this includes: steroid treatments and botulinum toxin injections.

Active treatments are light repetitive exercises that work the area to maintain normality. Basic information is used to teach the patient about their injury. These exercises are done at home or under the care of a health professional. Physiotherapy and Management in early whiplash associated disorders (WAD). Advances in Physiotherapy, 8, 98-105 suggested using three types of exercises to improve mobility: looking over each shoulder, moving the arms up and down anteriorly, and taking a deep breath while lifting the shoulders upwards and exhaling while relaxing the shoulders. Active treatments and are usually preferred.

Passive treatments are physiotherapy techniques such as acupuncture, massage therapy, and stimulation. These techniques all involve physical agents. used physiotherapy techniques such as acupuncture, stimulation, and heat treatments in their study and the results showed that patients showed significantly less pain. Botulinum toxin type-A is used to treat involuntary muscle contraction and spasms. Botulinum toxin type-A is only temporary and repeated injections need to take place in order to feel the effects

For chronic whiplash patients, rehabilitation is recommended. Patients who entered a rehabilitation program said they were able to control their pain, they continued to use strategies that were taught to them, and were able to go back to their daily activities

Prognosis

The consequences of whiplash range from mild pain for a few days (which is the case for most people), to severe disability caused by restricted head movement or of the cervical spine, sometimes with persistent pain.^{[citation needed]}

Alterations in resting state cerebral blood flow have been demonstrated in patients with chronic pain after whiplash injury. There is evidence for persistent inflammation in the neck in patients with chronic pain after whiplash injury.

There has long been a proposed link between whiplash injuries and the development of temporomandibular joint dysfunction (TMD). A recent review concluded that although there are contradictions in the literature, overall there is moderate evidence that TMD can occasionally follow whiplash injury, and that the incidence of this occurrence is low to moderate.

References

External links

• "Whiplash Evidence Based Information Resource". University of Queensland. 

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 頚部痛および頚椎症の患者の評価 evaluation of the patient with neck pain and cervical spine disorders
• 2. 頚部痛の治療 treatment of neck pain
• 3. 小児または思春期のアスリートにおける頸部の筋骨格損傷の概要 overview of musculoskeletal neck injuries in the child or adolescent athlete
• 4. 耳鳴の病因および診断 etiology and diagnosis of tinnitus
• 5. 成人における硬膜下血腫：病因、臨床的特徴、および診断 subdural hematoma in adults etiology clinical features and diagnosis

English Journal

• Out-of-Position Rear Impact Tissue-Level Investigation Using Detailed Finite Element Neck Model.

• Shateri H1, Cronin DS.
• Traffic injury prevention.Traffic Inj Prev.2015 Oct 3;16(7):698-708. doi: 10.1080/15389588.2014.1003551. Epub 2015 Feb 9.
• OBJECTIVE: Whiplash injuries can occur in automotive crashes and may cause long-term health issues such as neck pain, headache, and visual and auditory disturbance. Evidence suggests that nonneutral head posture can significantly increase the potential for injury in a given impact scenario, but epid
• PMID 25664486

• Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine.

• Leahy PD1, Puttlitz CM.
• European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society.Eur Spine J.2015 Jul 11. [Epub ahead of print]
• PURPOSE: This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries.METHODS: The study was accomplished by measurement of ROM throughou
• PMID 26162921

• Structural and Construct Validity of the Whiplash Disability Questionnaire in Adults with Acute Whiplash-associated Disorders.

• Stupar M1, Côté P2, Beaton D3, Boyle E4, Cassidy JD5.
• The spine journal : official journal of the North American Spine Society.Spine J.2015 Jul 9. pii: S1529-9430(15)00685-3. doi: 10.1016/j.spinee.2015.07.006. [Epub ahead of print]
• BACKGROUND CONTEXT: Few instruments are available to measure disability associated with Whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD.PURPOSE: To determine the structu
• PMID 26165476

Japanese Journal

• なぜむち打ち損傷後の頚部痛は慢性化するのか

• 北見 公一
• 賠償科学 : 日本賠償科学会雑誌 -(38) (-), 68-71, 2012-03
• NAID 40019264858

• Cervical Neuro-Muscular Syndrome : Discovery of a New Disease Group Caused by Abnormalities in the Cervical Muscles

• MATSUI Takayoshi,II Kunio,HOJO Shuntaro,SANO Keiji
• Neurologia medico-chirurgica = 神経外科 52(2), 75-80, 2012-02-15
• … Our previous study of whiplash injury found that abnormalities in the cervical muscles cause autonomic dystonia. … Patients treated within a 2-year period from April 1, 2002 to March 31, 2004 reported good outcomes in 83.8% for headache, 88.4% for vertigo and dizziness, 84.5% for chronic fatigue syndrome, 88.0% for autonomic dystonia, and 83.7% for whiplash-associated disorder. …
• NAID 10030127305

Related Links

• Whiplash (medicine) - Wikipedia, the free encyclopedia

Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension. The term "whiplash" is a colloquialism. "Cervical acceleration-deceleration" (CAD) ...

• Whiplash - NHS Choices

Whiplash is a term used to describe a neck injury caused by a sudden movement of the head forwards, backwards or sideways. It often occurs after a sudden impact such as a road traffic accident. The vigorous movement of the head damages ...

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★リンクテーブル★

リンク元	「むち打ち損傷」「むち打ち症」
関連記事	「injury」「whiplash」

「むち打ち損傷」

　　[★]

英

whiplash injury

関

むち打ち症

同

whiplash injury

「むち打ち症」

　　[★]

英

whiplash、whiplash injury

関

むち打ち損傷

「injury」

　　[★]

• n.

• 傷害、損傷、外傷、受傷
• wound or trauma; harm or hurt; usually applied to damage inflicted on the body by an external force.

関

damage、injure、insult、lesion、spoilage、trauma、traumatic、traumatic injury、wound

　 　 　 　 　

「whiplash」

　　[★]

むち打ち症

関

whiplash injury