Chronic Post-Traumatic Neck Pain: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Specific tissue damage are tears of the anterior anulus fibrosis, strain or tears of the facet joint capsules (rim lesions and avulsions), and impaction injuries of the facet joints. Impaction injuries include contusions of the intra-articular meniscoids with intra articular haemorrhage, and subchondral and transarticular fractures.<ref name="bogduk2011"/> | Specific tissue damage are tears of the anterior anulus fibrosis, strain or tears of the facet joint capsules (rim lesions and avulsions), and impaction injuries of the facet joints. Impaction injuries include contusions of the intra-articular meniscoids with intra articular haemorrhage, and subchondral and transarticular fractures.<ref name="bogduk2011"/> | ||
==History== | |||
Assess for red flags. | |||
==Examination== | ==Examination== | ||
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==Imaging== | ==Imaging== | ||
Imaging will often be normal or show "cervical spondylosis." This does ''not'' exclude a nociceptive source of pain. Osteoarthritis of the facet joints may be seen. Cervical degenerative disease refers to the combination of cervical spondylosis and facet joint osteoarthritis. | Imaging will often be normal or show "cervical spondylosis." This does ''not'' exclude a nociceptive source of pain. Osteoarthritis of the facet joints may be seen. Cervical degenerative disease refers to the combination of cervical spondylosis and facet joint osteoarthritis. | ||
In general there is no link between cervical degenerative joint disease and pain. However, there is a slight clinical significance with degenerative disc (but not facet osteoarthritis) findings at the C5/6 level. There is also an association with marked (level 3) degenerative changes and neck pain. | |||
CT scintigraphy is used a lot in New Zealand. It is good for picking up small occult fracture and tumours etc. It does not however show pain, only increased blood flow. It tends to miss cases where there is pain arising from soft tissue damage for example capsular tears. | |||
==Prognosis== | ==Prognosis== | ||
Revision as of 11:36, 10 August 2020
Whiplash is a compression injury. It is not a flexion/extension or acceleration/deceleration injury. Following impact, the trunk is thrust upwards, against the inertia of the head. This causes compression into a sigmoid deformation of the cervical spine at about 110ms after impact. During the deformation, the lower cervical segments undergo abnormal rotation into extension. The anterior annulus fibrosis is strained, and the facet joints are impacted. Extension is completed as the base of the neck descends.[1]
Pathophysiology
Specific tissue damage are tears of the anterior anulus fibrosis, strain or tears of the facet joint capsules (rim lesions and avulsions), and impaction injuries of the facet joints. Impaction injuries include contusions of the intra-articular meniscoids with intra articular haemorrhage, and subchondral and transarticular fractures.[1]
History
Assess for red flags.
Examination
There is no proven diagnostic value in the physical examination. There is good reliability of tenderness over the facet joints, but it lacks validity. Testing for gross range of motion has not been tested for reliability and lacks validity. Provocation of neck pain with various movements may be seen but this is also not diagnostic of a specific pain source.
Imaging
Imaging will often be normal or show "cervical spondylosis." This does not exclude a nociceptive source of pain. Osteoarthritis of the facet joints may be seen. Cervical degenerative disease refers to the combination of cervical spondylosis and facet joint osteoarthritis.
In general there is no link between cervical degenerative joint disease and pain. However, there is a slight clinical significance with degenerative disc (but not facet osteoarthritis) findings at the C5/6 level. There is also an association with marked (level 3) degenerative changes and neck pain.
CT scintigraphy is used a lot in New Zealand. It is good for picking up small occult fracture and tumours etc. It does not however show pain, only increased blood flow. It tends to miss cases where there is pain arising from soft tissue damage for example capsular tears.
Prognosis
There is good recovery after the first year, but then it tails off. At 24 months 14% have not fully recovered, and 4% are severely affected.[2]
Important Artciles
- {{#l:Bogduk2011 - On Cervical Zygapophysial Joint Pain After Whiplash.pdf}}
References
- ↑ 1.0 1.1 Bogduk. On cervical zygapophysial joint pain after whiplash. Spine 2011. 36:S194-9. PMID: 22020612. DOI.
- ↑ Radanov et al.. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine 1995. 74:281-97. PMID: 7565068. DOI.
- Kaneoka, K., Ono, K., Inami, S., Ochiai, N., & Hayashi, K. (2002). The Human Cervical Spine Motion During Rear-Impact Collisions. Journal of Whiplash & Related Disorders, 1(1), 85–97. doi:10.3109/j180v01n01_08
- Kaneoka et al.. Motion analysis of cervical vertebrae during whiplash loading. Spine 1999. 24:763-9; discussion 770. PMID: 10222526. DOI.
