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AB0195 Whiplash from head to toe
  1. N Yanes-Hoffman1,
  2. DM Fraser2
  1. 1Orthopaedic Medicine, NYH HealthCare Communications Group, Rochester, USA
  2. 2Orthopaedic Medicine, Orthopaedic Medicine Clinic, St Catharines, Ontario, Canada

Abstract

Background Although “Whiplash” is an overworked term, it is a troublesome, underdiagnosed, undertreated problem. Unless cervical “straightening” indicates muscle spasm secondary to soft-tissue injury, X-rays, CT scans, MRIs contribute little diagnostic information.

To diagnose true ?whiplash,? the old-fashioned fundamentals of medical practice?-a careful history and a thorough physical examination–are necessary.

Objectives Evaluating Cyriax’s dicta that: 1) examining the neck alone for post-traumatic, soft-tissue damage is an inadequate diagnostic approach; 2) since “All muscle spasm is secondary,” the source of the spasm must be found to diagnose and treat the condition.

Methods From 1–1–97 to 1–1–2000, 197 patients presented with musculoskeletal complaints of the neck secondary to trauma from an automobile accident.

Although all 197 had virtually no other musculoskeletal complaints, our examinations worked from the foot upward in sequence: 1) the foot for lost cuboid subluxation; 2) superior tibio-fibular joint for lost joint-play; 3) knee for passive “springy-block”; 4) sacro-iliac for subluxation and torsion; 5) lumbar spine for damaged lumbar discs; 5) thoracic spine for muscular imbalance and T3 syndromes; 6) cervical spine for disc derangements and Barre’s posterior cervical syndrome associated with discs at C2–3 and C3–4.

Results Pedal eversion loss; superior tibio-fibular subluxation; blocked knee movement with ?springy” end-feel denoting loose bodies in virtually all patients. Anterior superior iliac (ASIS) and posterior superior iliac spinal (PSIS) imbalances and “Lock Sign” were usually evident. Warm, swollen, tender PSIS areas and upper lumbar spinal levels indicated disc derangement. Compensatory scoliosis with muscular hypertonus over T/6 was usually present. The usually neglected costo-transverse syndrome was present in 75% of patients. Cervical disc derangement, at C2–3, C3–4, and C7/T1, with headaches, dizziness, pain and restricted motion on attempted extension evident almost universally.

Conclusion Once we had precisely identified the involved areas, mobilisation of affected areas, avoidance precautions, and occasional recourse to sclerotherapy achieved prompt?often dramatic, cost-effective, symptomatic amelioration of these vexing problems in 192 patients.

References

  1. Cyriax J. Textbook of orthopaedic medicine. 8th edn. London: Balliere & Tindal, 1988

  2. Bowen D, Cassidy M. Spine 1981;6(6):620–8

  3. Barre J. Paris Med. 1925;15:266

  4. Maigne R. Mid-orthopedic medicine. Illinois: Charles Thomas, 1992

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