S19_6

Whiplash injuries: Clinical picture and diagnostic work-up

G. Bono¹, F. Antonaci², S. Ghirmai², F. D'Angelo³, M. Berger⁴, G. Nappi⁵

¹Department of of Neuroscience, University of Insubria, Varese; Headache Center, ²Department of Neurological Sciences, “C. Mondino” Foundation, University of Pavia; ³Institute of Clinical Orthopaedics and Traumatology, University of Insubria, Varese, Italy; ⁴University Hospital, Innsbrück, Austria; ⁵Department of Nervous and Mental Disease, University “La Sapienza”, Rome, Italy.

ABSTRACT
The term “whiplash” commonly refers to symptoms and signs associated with a mechanical event such as a sudden acceleration and deceleration of the neck (due, in the majority of cases, to a road accident), instead of to the mechanism itself. The recent Quebec Classification of Whiplash Associated Disorders (WAD) contributed to define nosographically all the clinical manifestations usually grouped under the terms acute/post-traumatic and late “syndrome”. In the late phase of WAD, neck pain and neck muscle contraction have been reported in all cases, together with headache in over 50%. “Headache stemming from the neck”, despite numerous attempts to classify this entity (i.e. cervicogenic headache) according to the IASP classification (headache associated with neck disorders), is still a subject of debate. An adequate multiparametric procedure is required to study WAD, which takes into account: the patient's principal details; an exact reconstruction of the event; description and analysis of the signs and symptoms, with various complications and correlated dysfunctions; an objective neurological and neck-shoulder examination; and a battery of complementary instrumental tests which are described in this study. These investigations include evaluation of muscle tension (manual palpation, algometry, EMG recording), kinematic analysis of the cervical spine, neuropsycological and psycological evaluation, and evaluation of disability. In order to assess cervical spine mobility in WAD patients, a 3D kinematic analysis by means of the ELITE system and clinical evaluation were performed in our setting. Seventy patients with whiplash injury and 46 healthy volunteers were enrolled in the study. Patients were tested at the time of first consultation and again 6 months and 12 months later. Clinical evaluation of the range of motion was performed both in patients and in 41 healthy volunteers. Furthermore, patients diagnosed according to the WAD Classification as grade 2 (n = 68) or grade 3 (16) underwent a Quality of life (QoL) evaluation, measured using the short form (36-item) Health Survey (SF36) and the migraine-specific questionnaire (MSQ). According to our data, whiplash patients showed an impairment of cervical spine mobility, as well as a poor QoL, compared to a control group population, even though we observed a trend towards improvement over time in cervical ROM.

Key words
Whiplash, cervicogenic headache, cervical spine kinematic analysis.

This paper was supported by a grant from the Ministry of Public Health (ICS 57.2/RF 93.28, ISPEL 93-95).

Please address correspondence and reprint requests to: Professor Giorgio Bono, MD, Department of of Neuroscience, University of Insubria, Viale Borri 57, 21100 Varese, Italy.