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Whiplash

Whiplash definition: neck pain experienced as a result of a motor vehicle collision or similar trauma. Whiplash. Whiplash whiplash injury: any structural damage sustained because of the whiplash forces.

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Whiplash

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  1. Whiplashdefinition: neck pain experienced as a result of a motor vehicle collision or similar trauma Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  2. Whiplash Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  3. Whiplashwhiplash injury: any structural damage sustained because of the whiplash forces Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  4. Whiplashwhiplash injury: it is the abnormal motion between individual motion segments that has the potential to injure facets, disks, and ligaments Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  5. Whiplashwhiplash associated disorder: variety of clinical symptoms other than head, neck , and arm pain that occur after a whiplash type of trauma Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  6. WhiplashThe Quebec Classification for Whiplash Associated Disorders Grade 0 No Complaint about the neck No physical signs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  7. WhiplashThe Quebec Classification for Whiplash Associated Disorders Grade 1 Neck Complaint of pain , stifness or tenderness only No physical signs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  8. WhiplashThe Quebec Classification for Whiplash Associated Disorders Grade 2 Neck Complaint and musculoskeletal signs (including decreased ROM and point tenderness) Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  9. WhiplashThe Quebec Classification for Whiplash Associated Disorders Grade 3 Neck Complaint and neurological signs (including decreased or absent deep tendon reflexes, weakness, and sensory deficit) Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  10. WhiplashThe Quebec Classification for Whiplash Associated Disorders Grade 4 Neck Complaint and fracture or dislocation Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  11. Whiplashannual incidence ranges from 0,1 to 7 per 1000financial burden results from the small number of injuries that become chronicpatients with disabilities of more than 6 months account for 46% of the total cost Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  12. Whiplash15% to 40% of patients with acute neck pain after MVC develop chronic pain5% to 7% of patients become permanently partially or totally disabled Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  13. WhiplashNatural history:In +/- 80% pain after MVC begins the day of the collisioncomplete recovery occurs in 60 to 85% of patients 5% to 12 % experience chronic moderate to severe pain 5% to 10% have permanent partial or total disability Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  14. WhiplashPrognostic factors:strongest indicator of poor outcome is high initial intensity of painconflict in results regarding older age and female sex no prognostic differences in preinjury psychological factors , work related factors , litigation Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  15. WhiplashPrognostic factors:consulting a lawyer results in lesser chance on early claim settlement, longer treatment and slightly worse functionin a no-fault no-tort system there is a shorter time to case closure Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  16. WhiplashClinical symptoms :acute vs chronic neck pain (i.e. Pain that persists beyond 6 months)location: midline, uni- or bilateral , trapezius, shoulder, interscapular , arm or face Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  17. WhiplashClinical symptoms :Headache is the second most common symptominvolves the base of the skull and radiates to the crown of the head and the frontal region Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  18. WhiplashClinical symptoms :WAD including LBP , visual disturbances, dizziness, tinnitus, weakness , fatigue , poor concentration , poor memory , difficulty sleeping , secondary psychological changes Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  19. Whiplashstructural etiologyfacet joint49%-54% facet joints in chronic neck pain 60% facet joints in chronic neck pain and headache53% C2/C3 facet joint pain in case of cervicogenic headache Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  20. Whiplashstructural etiologydisk ?craniocervical ligaments? Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  21. WhiplashTreatment:acute neck painexplanation, education, reassuranceno orthosis« act as usual » as good as any other treatmentactive excercisesconflicting results of SMTNSAIDs Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  22. WhiplashTreatment:chronic neck pain rehabilitation injections medication spinal manipulative therapy cervical orthosis surgery Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  23. WhiplashTreatment:chronic neck pain rehabilitation strength training and endurance training intensive excercises are more effective than light excercises but not more effective than ordinary activity behavior modification : overcoming fear avoidance Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  24. WhiplashTreatment:chronic neck pain injections level 1 evidence for efficacy of RFN for pain arising from facet joints Complete pain relief is possible with pure facet joint pain and in 86% of patients with facet-joint mediated cervicogenic headache Median of 270-400 days pain relief Corticosteroid injection of facet joints only short term relief No place for epidural infiltrations Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  25. WhiplashTreatment:chronic neck pain medication Up to 3 trials of different NSAIDs (2wks), when response is meaningful drug should be continued Opioid analgesics No evidence for the use of TCA nor anticonvulsants Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  26. WhiplashTreatment:chronic neck pain spinal manipulative therapy No evidence concerning efficacy Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  27. WhiplashTreatment:chronic neck pain cervical orthosis No evidence for efficacy Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  28. WhiplashTreatment:chronic neck pain surgery Surgery may be considered for the patient wih severe pain, significant impairment and good psychological health who has not improved with high quality non-surgical care Diskography? ? Science , pff ! Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

  29. Whiplashkey referencesspitzer wo, skovron ml, salmi lr et al: scientific monograph of the Quebec Task Force on whiplash-associated disorders: redifining whiplash and its managementSpine 1995;20:1S-73Sschofferman j, bogduk n, slosar p:chronic whiplash and whiplash-associated disorders: an evidence based approachJournal of the AAOS;vol 15, October 2007,No 10, pp 596-606 Dr Gert Van Esbroeck AZ Nikolaas Sint Niklaas

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