Cervical Sprain & Strain Injuries

Question 1

Whiplash

Answer 1

Sudden, forceful hyperextension of the neck with flexion recoil
Usually from riding in a wehicle and being struck by another
Acceleration-deceleration injuries

Question 2

Which groups are likely to obtain a serious injury from whiplash?

Answer 2

Women
Elderly
If there is significant underlying degenerative disc disease

Question 3

What is the highest force the head and neck can experience in a whiplash injury?

Answer 3

8 Gs

Question 4

It is better to brace yourself before an impact or not?

Answer 4

Not known, though some evidence says those who were intoxicated (relaxed) seemed to not be injured

Question 5

The jolt syndrome

Answer 5

When the seat back in a car acts like a spring and magnifies the forward injury

Question 6

What are the non-neck and shoulder whiplash type injuries?

Answer 6

Pelvis
Spine
Cranium
All segmentally-related structures

Question 7

What are the biomechanics of whiplash?

Answer 7

Initially, all parts of the body move toward point of impact then recoil away from the point of impact

Question 8

What are the osteopathic considerations in a whiplash injury?

Answer 8

X-ray and alteration of cervical lordosis
Soft tissue warm and boggy
Sacrum involvement 
Occiput and sacrum restriction
Temporal bones vulnerable due to SCM

Question 9

What types of areas may be injured in a whiplash causing accident?

Answer 9

Longitudinal arch of the foot
Ankle and knee
Posterior hip acetabulum
Anterior rotation of the innominate
Superior shear of a public bone unilaterally
Right lower costal cartilage (driver)
Structural and respiratory dysfunctions of lower right ribs

Question 10

What could happen in a disc is damaged in a whiplash type injury?

Answer 10

Internal derangement of cervical disc architecture leading to late sequel of degenerative disc disease
Potential or disc herniation, most commonly C5-C6 disc

Question 11

What would be seen in a whiplash injury that involved the brain?

Answer 11

Closed head injury:
Cerebral dysfinction
Cranial somatic dysfunction

Question 12

Macro trauma

Answer 12

Initial symptoms are present immediately following injury

Question 13

When would muscle hypertension develop in a whiplash injury?

Answer 13

2 to 3 days

Question 14

How long might it take for all injuries to fully appear?

Answer 14

Up to one month

Question 15

Where is pain often felt in the whiplash injuries (ligament)?

Answer 15

Ligamentum Nuchae
Especially C2 and T1
Partial or total ligament rupture

Question 16

Where is pain often felt in the whiplash injuries (bone)?

Answer 16

Fracture
Avulsion fracture Spinous process of C2
Avulsion fracture Spinous process of T1
Compression fracture most commonly C5

Question 17

What is posterior neck pain and muscle hypertonicity caused by?

Answer 17

Muscle overstretching (strain)
Reflex from injury to the anterior neck musculature, discs and ligaments
Guarding reaction to direct neural trauma

Question 18

How can you obtain and significant range of motion loss?

Answer 18

Fracture
Sprain and strain
Disc herniation
Congenital anomalies (klippel-feil, block vertebrae)

Question 19

What is the stated range of motion for flexion the neck?

Answer 19

60 degrees

45-90?

Question 20

What is the stated range for extension of the neck?

Answer 20

75 degrees

45-90?

Question 21

what is the stated range of motion for sidebending of the neck?

Answer 21

45 degrees

Question 22

What is the stated range of motion for rotaton of the neck?

Answer 22

80 degrees

Question 23

Where does half of the rotation of the neck occur at?

Answer 23

Atlanto-axial joint

Question 24

What muscles are active in torticollis and what do they cause?

Answer 24

Sternocleidomastoid - head rotates away from side of injury, sidebends to
Scalene muscles - head rotates and sidebends towards side of injury

Question 25

How could a pt obtain an occipital headache?

Answer 25

Suboccipital muscle injury | Irritation of greater & lesser occipital nerves

Question 26

How is the somatovisceral reflex mediated?

Answer 26

Through the upper thoracic cord segments which provide the sympathetic never supply to the head, neck and upper extremities Distortion of cranium

Question 27

What is raynaud syndrome?

Answer 27

Vasospasm of the distal blood vessel of the upper extremity in response to a hypersympathecotonia, again emanating from the upper thoracic spinal cord segments

Question 28

How could painful or difficulty swallowing be caused?

Answer 28

By direct stretching of the esopjagus over the anterior surface of the cervical spine Potential for formation of retropharyngeal hematoma (Dysgeusia/Dysphagia)

Question 29

What causes wallenberg's syndrome?

Answer 29

Injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis

Question 30

What are some symptoms of wallenberg syndrome?

Answer 30

``` Homolateral facial pain or paresthesias Vertigo Vomiting Unilateral paralysis of the palate, pharynx and vocal cords Nystagmus intention tremor Ataxia with a tendency to fall toward the side of lesion Akinetic Mutism ```

Question 31

What are some psychiatric repercussion of cervical strain and sprain?

Answer 31

``` Driving Phobia Depression Withdrawal Panic Attacks Anxiety ```

Question 32

What should be measured in vital signs in a neck injury?

Answer 32

``` Pulse (stretch injury to the vagus n. or cervical sympathetics can alter pulse rate Blood pressure (stretch injury to carotid sinus and/or carotid body can inc or dec BP ```

Question 33

What could happen in a cervical injury?

Answer 33

Injury to autonomic nerves can trigger dysrhythmias or coronary vasospasm

Question 34

What do all pts need in terms of imaging in a neck injury?

Answer 34

X-ray | Cervical AP, lateral, oblique, open mouth views

Question 35

What should be viewed in an imaging CT of a cervical spine?

Answer 35

Cervical spine - reserved for those with symptoms of nerve root injury and those with pain persisting without significant recovery beyond six weeks Brain - reserved for neurologic symptoms not just headache Special studies - retropharyngeal hematoma

Question 36

When would you use cervical spine x-ray flexion and extension films?

Answer 36

6-12 weeks Used to diagnose segmental instability Recurrent segmental somatic dysfunction

Question 37

What is the treatment for cervical sprain and strain?

Answer 37

Soft/hard collar OMT adjacent to most severely injured (craium and sacrum) NSAIDs After inflam dec treat somatic dysfunction

Question 38

What should you do if a pt has trigger points?

Answer 38

Inject botulinum toxin - type A

Question 39

How long do most pts take to recover?

Answer 39

4-6 weeks

Question 40

What percent of pts have not recovered at 6 months?

Answer 40

12%

Question 41

What are risk factor for poor recovery?

Answer 41

``` Being hit by a truck Neck pain on palpation Pain or numbness radiating from neck to arms Headache Significant degenerative disc disease ```

Question 42

Which heals better, "forward/lateral flexion" or "extension" injuries?

Answer 42

Extension

Question 43

Grade 0 whiplash-associated disorder

Answer 43

No neck pain, stiffness, tenderness

Question 44

Grade I whiplash-associated disorder

Answer 44

Neck pain, stiffness, tenderness (+)

Question 45

Grade II whiplash-associated disorder

Answer 45

Neck pain, stiffness, tenderness (+), physical signs (+), musculoskeletal signs (+)

Question 46

Grade III whiplash-associated disorder

Answer 46

Neck pain, stiffness, tenderness (+), physical signs (+), Musculoskeletal signs (+/-), neurological signs (+)

Question 47

Grade IV whiplash-associated disorder

Answer 47

Neck pain, stiffness, tenderness (+), physical signs (+), neurological signs (+/-), fracture/dislocation (+)