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9.01 Cervical Strain (Whiplash)


Presentation

The patient may arrive directly from a car accident, arrive the following day (complaining of increased neck stiffness and pain), or long after (to have injuries documented). The injury occured when the neck was subjected to sudden extension and flexion, possibly injuring intervertebral joints, discs, and ligaments, cervical muscles, or even nerve roots. As with other strains and sprains, the stiffness and pain may tend to peak on the day following the injury.

What to do:

What not to do:

Discussion

X ray results for whiplash neck injuries seldom add much to the clinical assessment but the sequelae of unrecognized cervical spine injuries are so severe that it is still worth while to x ray relatively mild injuries (in contrast to skull and lumbosacral spine radiographs, which are ordered far less often.) It is often useful to discuss the pros and cons of x rays with the patient, who may prefer to do without, or conversely may be in the ED purely to obtain radiological documentation of his injuries. The term "whiplash" is probably best reserved for describing the mechanism of injury, and is of little value as a diagnosis. Because of the many undesirable legal connotations which surround this term it may be advisable to substitute "flexion/extension injury."

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD