Low Velocity Impacts Cause Whiplash
by Dr. William J. Owens, D.C., D.A.A.M.L.P.
Have you ever had a patient present to your office for evaluation after a low-velocity rear-end collision?
Conversations in the medical legal community abound regarding injuries sustained as a result of a motor vehicle accident and the force of impact. Many clinicians and legal professionals understand each patient must be evaluated as an individual, being worked up as they present. There are many instances where the case has the potential of being dismissed because of a low impact and low property damage situation.
What is important to point out is that the objective evidence of injury and its correlation to causation and persistent functional loss must be the primary objective.
“A 46-year-old man presented with a history of debilitating neck pain and headaches. His condition was precipitated by trauma sustained when he was rear-ended by another bumper car in 1996.” (Duffy, Stuberg, DeJong, Gold, & Nystrom, 2004, p. 1881) “The patient’s headaches and neck pain that developed immediately after the accident did not improve over subsequent weeks. The patient, therefore, sought medical attention; but an investigation, including radiograph studies of the cervical spine and left shoulder, MRI of the neck, CT scan of the neck and electromyography, did not provide evidence of an acute injury in the recent or distant past or show any degenerative or other chronic changes that could be associated with his headaches or neck pain.” (Duffy, et al., 2004, p.1882)
This paper was presented for publication in 2004 and outlines a specific case study of a low impact collision that resulted in a chronic debilitating pain syndrome resulting in surgery eight years later. This case highlights the difficulty in defining threshold of injury in Whiplash Associated Disorders (WAD) in regard to velocity. The highlight of this article is presented when a previous paper by Gargen, Bannister, Main, et al., (1997) published in the Journal of Bone and Joint Surgery is discussed. The article outlines the use of cervical range of motion measurements as a predictor of permanent disability after whiplash trauma. Duffy, et al., (2004) highlight that the study determined “…measurements obtained at three months serve as valid predictors of permanent disability after a whiplash trauma.” (p. 1881)
When clinicians are evaluating patients that have been involved in a traumatic injury, identifying the traumatic lesion is critical. What has been compressed, torn or stretched as a result of the injury? Are there multiple structures and what type of treatment and prognosis is there? The mechanism of injury can be an important tool but, in the end, correlating the victim’s subjective complaints with objective findings is critical.
The article concludes by stating, “Although radiology is not 100% sensitive for skeletal injury, the authors maintain that soft-tissue damage is a more likely cause of WAD in patients with negative imaging studies.” (Duffy, et al., 2004, p. 1884) The patient had obtained relief from trigger point injections, but it was transient in nature. The thought was that, if the local anesthetic caused reduction in symptoms, then surgical excision would give permanent relief. “Although no gross abnormality was observed…the most intense tenderness to palpation was found in the immediate proximity of a small sensory nerve and accompany perforator vessels at their point of passage between two tendinous portions of the trapezius muscle.” (Duffy et al., 2004, p. 1882)
This case illustrates that debilitating pain can be produced by low speed rear end collisions and, in many cases, can cause a diagnostic dilemma for clinicians that are not educated on triaging trauma victims.
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In each issue, a clinical topic is covered by William J. Owens of the American Academy of Medical Legal Professionals (AAMLP), which is a national, non-profit organization, comprised of doctors and lawyers. The purpose of the organization is to provide its members with current research in trauma and spinal related topics, to keep the profession on the cutting edge of healthcare. Members may also sit for a Diplomate examination and be conferred a DAAMLP. The organization also offers support to the individual member’s practice.
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