Whiplash syndrome

Last revised by Daniel J Bell on 24 Jan 2022

Whiplash syndrome, also known as whiplash-associated disorders (WAD), are the various symptoms caused by rapid acceleration and/or deceleration injuries, which result in cervical sprain or strain.

Whiplash is a common injury, usually associated with motor vehicle collisions 1-5. The incidence of whiplash injury varies between different countries, and it may affect between 16 and 200 per 100,000 5. Approximately 50% of these patients will have neck pain symptoms at one year postinjury 4,6, which lead to considerable chronic disability and results in a significant economic burden 1,2,4,5.

Risk factors for whiplash syndrome include 2,3:

  • hyperextension, hyperflexion and lateral flexion mechanisms sustained in motor vehicle collisions (particularly rear-end automobile collision), sports accident, physical abuse, amusement park rides, or other trauma

The diagnosis of whiplash is clinical because there are no neuropsychological, electrophysiological, or radiological studies that can diagnose whiplash injury 1

Whiplash usually manifests with a variety of clinical symptoms, termed whiplash-associated disorders 1,2,4,5. The Quebec Task Force on Whiplash Associated Disorders grades symptoms as follows 1,2,4,5:

  • Grade 0, no neck complaints and no physical signs
  • Grade I, neck pain, stiffness or tenderness, and no physical signs
  • Grade II, neck complaints accompanied by musculoskeletal signs, with decreased range of motion and point tenderness
  • Grade III, neck complaints accompanied by musculoskeletal and neurologic signs, with muscle weakness and sensory deficits
  • Grade IV, neck complaints accompanied by fracture or dislocation

Other symptoms can be present in all grades such as headache, upper backache, numbness in head and face, temporomandibular joint pain, dizziness, tinnitus, hearing loss, double and blurred vision, dysphagia, angina-like chest pain, nausea and vomiting, paresthesias or pain in the shoulder, arm or hand, deficit of concentration, memory loss, sleeplessness, fatigability, irritability and depression 1,2,4.

Whiplash injury is poorly understood, and there are many questions regarding the pathology of this syndrome 2. Whiplash consists of injuries to the ligaments, tendons, nerves, muscles, discs, and bones in the cervical spine, caused by an acceleration-deceleration mechanism of energy to the neck; as a result, the head jerks back and forth 1-5,7.

There are no reliable radiologic findings to accurately confirm or refute tissue injury in the majority of patients with whiplash-associated disorders 3,6.

The most common radiographic abnormalities are a slight loss of the lordotic curve and spondylotic disease of the cervical spine 1.

CT is usually the initial imaging modality after cervical trauma because of the concern for fracture or another destabilizing injury 6.

Magnetic resonance imaging of the cervical spine is the best method for distinguishing between the various etiologies of neck pain, and for patients with neurologic signs or symptoms, as well as for the detailed assessment of the soft tissue 3,6.

The craniocervical junction is a very vulnerable region of the cervical spine. The usefulness of MRI in evaluating the ligamentous of the craniocervical junction is controversial in patients with acute whiplash injury 3,7.

MRI is recommended in patients with whiplash-associated disorders to evaluate for spur encroachment of the vertebral canal, disc herniations, fractures, ligament abnormalities, infection, or tumor 3.

Some findings in MRI studies of patients with whiplash-associated disorders are 1,6-8:

  • loss of lordosis
  • prevertebral edema
  • ligamentous injury, most often the alar and the transverse ligaments, that may be thicker and with signal alteration, which represents swelling and edema
  • fatty infiltration of the multifidus muscle of deepest dorsal neck
  • fractures of the articulating facet

The treatment of whiplash syndrome is usually conservative, initially with ice applications for the first hours after the trauma, neck immobilization with a cervical collar, anti-inflammatory therapy, gradual self-mobilization, physical therapy, and exercise 1,2,5.

Most patients with whiplash-associated disorders recover within a few weeks, but many patients have chronic symptoms, which may persist for several months or even years 1,2,4,6. There remains a paucity of best evidence treatment options to influence the rate of functional recovery 6.

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