Low Velocity Impacts Cause Whiplash
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.
