Prognostic factors in soft tissue injuries of the cervical spine

Watkinson, A.F.; Gargan, Martin; Bannister, G.C.

doi:10.1016/0020-1383(91)90012-4

Cited by 101 publications

(32 citation statements)

References 9 publications

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“…The considerably higher percentage of persisting symptoms [3,7,21,22] and protracted disability [2,4] due to whiplash injury previously reported in the literature may be interpreted as follows: (a) previous studies [3,[21][22][23] included patients who had fractures or dislocations of the cervical spine or who, in addition, to whiplash injury, had suffered a significant head injury; (b) studies [3,17,21,22] considered selected patients (e.g. those with long-lasting symptoms or litigation cases); (c) study results [3,17,21] were biased due to sociocultural differences or insurance schemes possibly promoting compensation-seeking behaviour.…”

Section: Was Results Involved In Litigation Duringmentioning

confidence: 92%

“…Furthermore, we have recently shown in a non-selected group of patients that psychosocial factors do not primarily influence the course of recovery from common whiplash [20]. Other studies have suggested that the poor outcome after this type of injury may rather be related to the severity of injury, as assessed by neurological signs [9,[21][22][23], early onset of neck pain [3,21] or radiologically detectable abnormalities [9,22,23]. While the debate on the etiology of the whiplash syndrome is still continuing [24,25] studies of the relationship or interplay between Submitted 13 August; revised version accepted 14 December 1993.…”

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confidence: 95%

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Relationship Between Early Somantic, Radiological, Congnitive and Psychosocial Findings and Outcome During a One-Year Follow-Up in 117 Patients Suffering From Common Whiplash

et al. 1994

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SUMMARYTo analyse the significance of the interplay between somatic and psychosocial factors in influencing the course of recovery a non-selected well defined group of 117 whiplash patients was investigated. Initial examination was performed, on average, 7.2 ± 4.2 days after trauma and follow-ups were carried out at 3, 6 and 12 months. At the initial investigation all patients were given a neurological examination, cognitive and psychosocial factor assessment and cervical spine X-rays. At each follow-up stepwise regression was performed to evaluate the relationship between initial findings and the course of recovery. Fifty-one (44%), 36 (31%) and 28 (24%) patients were symptomatic at 3, 6 and 12 months respectively. Poor improvement at all examinations was significantly correlated with factors associated with severity of injury such as initial symptoms of radicular irritation and intensity of neck pain. Moreover, results indicate that poor recovery is related to severity of injury in addition to some pre-traumatic factors (previous history of head trauma and headache) and initial injuryrelated reaction (i.e. sleep disturbances, reduced speed of information processing and nervousness). However, psychosocial factors did not prove predictive at any follow-up examination. These results indicate that symptoms suggesting a more severe neck injury appear to be particularly related to delayed recovery from common whiplash. Moreover these results may be of value in the obj ective evaluation of potentially difficult claims for compensation, which may in some cases be falsely based.

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Section: Was Results Involved In Litigation Duringmentioning

confidence: 92%

mentioning

confidence: 95%

Relationship Between Early Somantic, Radiological, Congnitive and Psychosocial Findings and Outcome During a One-Year Follow-Up in 117 Patients Suffering From Common Whiplash

et al. 1994

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“…That degeneration can be accelerated after a whiplash trauma has been shown in a study by Watkinson et al [11] and by Hamer et al [12]. In addition, it has been shown that approximately one third of patients with chronic neck pain have a previous neck trauma in their history [13,14].…”

Section: The Possibility For An Injury To Occurmentioning

confidence: 88%

“…In addition, the study [9], demonstrated a signifi cant relationship between the incidence of degenerative changes constricting root canals, and the development of whiplash related disorders with neurological signs. There is also evidence that degenerative changes occur signifi cantly more frequently in patients who had sustained soft tissue injuries than in a control population [11].…”

Section: Example 2: a Diagnostic Code Problemmentioning

confidence: 99%

WAD – Criteria for Evaluation of Causality

Bunketorp¹

2017

Open J Trauma

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“…Prospective studies of patients with whiplash-associated disorders, compared with age-matched controls, are lacking, which means that it is difficult to evaluate whether the radiological changes diagnosed in patients with whiplash are part of the normal development of spondylosis or are a result of the cervical spine trauma. Watkinson et al [283] reported, in a study using plain x-ray examination, an increased occurrence of degenerative changes in patients with residual symptoms ten years after whiplash trauma. Injuries of the annulus fibrosus and the attachment of the disc to the endplate have been reported from animal experimental studies [143,286] and after hyperextension trauma in cadavers [42].…”

Section: Intervertebral Discsmentioning

confidence: 99%

Whiplash injuries and associated disorders: new insights into an old problem

Rydevik¹,

Szpalski²,

Aebi³

et al. 2008

Eur Spine J

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SummaryThe Medical Task Force of the Swedish Society of Medicine and the Whiplash Commission has come to the following main conclusions:The term ''whiplash'' is so generally accepted that it should continue to be used, but the term ''whiplash trauma'' should only be used to refer to indirect cervical spine trauma. By deleting WAD grades 0 and IV from the classification system introduced in 1995 by the Quebec Task Force (QTF), the diagnosis of whiplash injury will be more exact and more realistically defined, which will reduce the risk of misunderstanding.The reported incidence of whiplash injuries in Sweden varies depending on the particular investigation cited, and ranges between 1.0 and 3.2/1000 per year. Whiplash injuries represent approximately 1/3 of all claims submitted after traffic injuries to insurance companies in Sweden, and give rise to a medical disability rate of 10% or more. Various studies of how the possibility of an insurance claim influences the course of a whiplash injury have produced quite different results, but generally there is no evidence of significant differences in outcome between those who have and have not sought claim.Ligament injuries can rarely be demonstrated acutely after whiplash trauma, and radiologically verified instability later in the course of the injury is also rare. Experimental studies have shown that whiplash trauma can lead to loads on discs and facet joints that might result in injury of these structures, but there is no scientific evidence to verify such injuries in patients with whiplash injury. Certain studies indicate that a dysfunction in the nervous system may exist in a small proportion of patients with whiplash injury.A series of physiological changes occurs in both the peripheral and the central nervous systems after whiplash injury, comprising peripheral as well as central sensitisation. There is no scientific evidence that such physiological changes are specific to the pain associated with whiplash injury; similar changes have been shown to occur in association with various other pain conditions, acute as well as long-term.It is likely that any previous mental ill-health and the patient's current mental state are both important for the clinical development and course of whiplash injury. To minimise the risk of long-term problems among people with acute whiplash injury, concurrently occurring acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) should be diagnosed and treated. It is also important to diagnose and adequately treat possible sleep disorder, depression, or anxiety among people with whiplash injury.Neck problems in terms of pain and stiffness, either with or without objective clinical findings such as decreased range of motion and tenderness at palpation (WAD grades I and II), are most common. Symptoms usually appear within the first day and up to a few days after whiplash trauma. Headache commonly occurs, along with pain in the shoulders and the thoracic spine. Neurological symptoms are present in approximately 20% of pat...

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Prognostic factors in soft tissue injuries of the cervical spine

Cited by 101 publications

References 9 publications

Relationship Between Early Somantic, Radiological, Congnitive and Psychosocial Findings and Outcome During a One-Year Follow-Up in 117 Patients Suffering From Common Whiplash

Relationship Between Early Somantic, Radiological, Congnitive and Psychosocial Findings and Outcome During a One-Year Follow-Up in 117 Patients Suffering From Common Whiplash

WAD – Criteria for Evaluation of Causality

Whiplash injuries and associated disorders: new insights into an old problem

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