Low Velocity Impacts Cause Whiplash

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 Thursday, March 26, 2009 

                        Low Velocity Impacts Cause Whiplash

                        Written by William J. Owens, D.C., D.A.A.M.L.P.
                        TAC, Research Review , Volume 31, Issue 3
                        Published:
                              

 

                        Have you ever had a patient present to your office for
                        evaluation after a low-velocity rear-end collision?
                        Conversations in the medical legal community abound
                        regarding injuries sustained as a result of a motor
                        vehicle accident and the force of impact. Many
                        clinicians and legal professionals understand each
                        patient must be evaluated as an individual, being worked
                        up as they present. There are many instances where the
                        case has the potential of being dismissed because of a
                        low impact and low property damage situation.
                        What is important to point out is that the objective
                        evidence of injury and its correlation to causation and
                        persistent functional loss must be the primary
                        objective.
                        "A 46-year-old man presented with a history of
                        debilitating neck pain and headaches. His condition was
                        precipitated by trauma sustained when he was rear-ended
                        by another bumper car in 1996." (Duffy, Stuberg, DeJong,
                        Gold, & Nystrom, 2004, p. 1881) "The patient’s headaches
                        and neck pain that developed immediately after the
                        accident did not improve over subsequent weeks. The
                        patient, therefore, sought medical attention; but an
                        investigation, including radiograph studies of the
                        cervical spine and left shoulder, MRI of the neck, CT
                        scan of the neck and electromyography, did not provide
                        evidence of an acute injury in the recent or distant
                        past or show any degenerative or other chronic changes
                        that could be associated with his headaches or neck
                        pain." (Duffy, et al., 2004, p.1882)
                        This paper was presented for publication in 2004 and
                        outlines a specific case study of a low impact collision
                        that resulted in a chronic debilitating pain syndrome
                        resulting in surgery eight years later. This case
                        highlights the difficulty in defining threshold of
                        injury in Whiplash Associated Disorders (WAD) in regard
                        to velocity. The highlight of this article is presented
                        when a previous paper by Gargen, Bannister, Main, et
                        al., (1997) published in the Journal of Bone and Joint
                        Surgery is discussed. The article outlines the use of
                        cervical range of motion measurements as a predictor of
                        permanent disability after whiplash trauma. Duffy, et
                        al., (2004) highlight that the study determined
                        "…measurements obtained at three months serve as valid
                        predictors of permanent disability after a whiplash
                        trauma." (p. 1881)
                        When clinicians are evaluating patients that have been
                        involved in a traumatic injury, identifying the
                        traumatic lesion is critical. What has been compressed,
                        torn or stretched as a result of the injury? Are there
                        multiple structures and what type of treatment and
                        prognosis is there? The mechanism of injury can be an
                        important tool but, in the end, correlating the victim’s
                        subjective complaints with objective findings is
                        critical.
                        The article concludes by stating, "Although radiology is
                        not 100% sensitive for skeletal injury, the authors
                        maintain that soft-tissue damage is a more likely cause
                        of WAD in patients with negative imaging studies."
                        (Duffy, et al., 2004, p. 1884) The patient had obtained
                        relief from trigger point injections, but it was
                        transient in nature. The thought was that, if the local
                        anesthetic caused reduction in symptoms, then surgical
                        excision would give permanent relief. "Although no gross
                        abnormality was observed...the most intense tenderness
                        to palpation was found in the immediate proximity of a
                        small sensory nerve and accompany perforator vessels at
                        their point of passage between two tendinous portions of
                        the trapezius muscle." (Duffy et al., 2004, p. 1882)
                        This case illustrates that debilitating pain can be
                        produced by low speed rear end collisions and, in many
                        cases, can cause a diagnostic dilemma for clinicians
                        that are not educated on triaging trauma victims.
                        Disclaimer:
                        The following preview is provided for educational
                        purposes only. It is not designed or intended to
                        reproduce or replace the author’s work. Readers are
                        encouraged to obtain full licensed versions of the full
                        article as determined by Copyright Law. For information
                        on how to obtain a licensed copy, please contact the
                        Academy directly.
                        In each issue, a clinical topic is covered by William J.
                        Owens of the American Academy of Medical Legal
                        Professionals (AAMLP), which is a national, non-profit
                        organization, comprised of doctors and lawyers. The
                        purpose of the organization is to provide its members
                        with current research in trauma and spinal related
                        topics, to keep the profession on the cutting edge of
                        healthcare. Members may also sit for a Diplomate
                        examination and be conferred a DAAMLP. The organization
                        also offers support to the individual member’s practice.

                        To learn more or join, go to www.aamlp.org  or call
                        1-716-228-3847.