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. 1996 Jan;13(1):3–8. doi: 10.1136/emj.13.1.3

Hyperextension soft tissue injuries of the cervical spine--a review.

G Johnson 1
PMCID: PMC1342595  PMID: 8821214

Abstract

While a full understanding of continuing symptoms following a soft tissue hyperextension injury of the cervical spine remains elusive, recent research has shown that the explanation may lie with occult lesions beyond the musculoskeletal structures of the neck. The balance of the roles of injury, psychological factors, and the effects of litigation has shifted towards the former. However this injury would be unique if the latter two played only a minor role in determining recovery. It seems likely that among the large numbers of patients presenting with symptoms after hyperextension soft tissue injuries, a proportion will have occult bone, joint, or intervertebral disc lesions. Improvements in medical imaging techniques may allow better definition of these specific injuries and the development of more appropriate treatment. The search for a central nervous system lesion in humans continues and until this is demonstrated, many will dispute the existence of an organic brain syndrome. Evidence for significant injury to the temporomandibular joints, ear, and ophthalmic system has been found and this may be amenable to specialist intervention. While there is little evidence for effective treatments of the established injury, reduction in related disability appears most likely to be achieved by prevention. Improvements in automobile design, with particular reference to head restraints, could limit the cost to society of this common and disabling injury.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Algers G., Pettersson K., Hildingsson C., Toolanen G. Surgery for chronic symptoms after whiplash injury. Follow-up of 20 cases. Acta Orthop Scand. 1993 Dec;64(6):654–656. doi: 10.3109/17453679308994591. [DOI] [PubMed] [Google Scholar]
  2. Allen M. J., Barnes M. R., Bodiwala G. G. The effect of seat belt legislation on injuries sustained by car occupants. Injury. 1985 Jul;16(7):471–476. doi: 10.1016/0020-1383(85)90169-x. [DOI] [PubMed] [Google Scholar]
  3. Aubrey J. B., Dobbs A. R., Rule B. G. Laypersons' knowledge about the sequelae of minor head injury and whiplash. J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):842–846. doi: 10.1136/jnnp.52.7.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burke J. P., Orton H. P., West J., Strachan I. M., Hockey M. S., Ferguson D. G. Whiplash and its effect on the visual system. Graefes Arch Clin Exp Ophthalmol. 1992;230(4):335–339. doi: 10.1007/BF00165941. [DOI] [PubMed] [Google Scholar]
  5. Byrn C., Olsson I., Falkheden L., Lindh M., Hösterey U., Fogelberg M., Linder L. E., Bunketorp O. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. Lancet. 1993 Feb 20;341(8843):449–452. doi: 10.1016/0140-6736(93)90204-t. [DOI] [PubMed] [Google Scholar]
  6. Carette S. Whiplash injury and chronic neck pain. N Engl J Med. 1994 Apr 14;330(15):1083–1084. doi: 10.1056/NEJM199404143301512. [DOI] [PubMed] [Google Scholar]
  7. Chester J. B., Jr Whiplash, postural control, and the inner ear. Spine (Phila Pa 1976) 1991 Jul;16(7):716–720. doi: 10.1097/00007632-199107000-00004. [DOI] [PubMed] [Google Scholar]
  8. Deans G. T., Magalliard J. N., Kerr M., Rutherford W. H. Neck sprain--a major cause of disability following car accidents. Injury. 1987 Jan;18(1):10–12. doi: 10.1016/0020-1383(87)90375-5. [DOI] [PubMed] [Google Scholar]
  9. Deans G. T., McGalliard J. N., Rutherford W. H. Incidence and duration of neck pain among patients injured in car accidents. Br Med J (Clin Res Ed) 1986 Jan 11;292(6513):94–95. doi: 10.1136/bmj.292.6513.94-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ettlin T. M., Kischka U., Reichmann S., Radii E. W., Heim S., Wengen D., Benson D. F. Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury. J Neurol Neurosurg Psychiatry. 1992 Oct;55(10):943–948. doi: 10.1136/jnnp.55.10.943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Evans R. W. Some observations on whiplash injuries. Neurol Clin. 1992 Nov;10(4):975–997. [PubMed] [Google Scholar]
  12. FRANKEL V. H. TEMPOROMANDIBULAR JOINT PAIN SYNDROME FOLLOWING DECELERATION INJURY TO THE CERVICAL SPINE. Bull Hosp Joint Dis. 1965 Apr;26:47–51. [PubMed] [Google Scholar]
  13. Farbman A. A. Neck sprain. Associated factors. JAMA. 1973 Feb 26;223(9):1010–1015. [PubMed] [Google Scholar]
  14. Foley-Nolan D., Moore K., Codd M., Barry C., O'Connor P., Coughlan R. J. Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study. Scand J Rehabil Med. 1992;24(1):51–59. [PubMed] [Google Scholar]
  15. GAY J. R., ABBOTT K. H. Common whiplash injuries of the neck. J Am Med Assoc. 1953 Aug 29;152(18):1698–1704. doi: 10.1001/jama.1953.03690180020006. [DOI] [PubMed] [Google Scholar]
  16. GOTTEN N. Survey of one hundred cases of whiplash injury after settlement of litigation. J Am Med Assoc. 1956 Oct 27;162(9):865–867. doi: 10.1001/jama.1956.02970260015005. [DOI] [PubMed] [Google Scholar]
  17. Gargan M. F., Bannister G. C. Long-term prognosis of soft-tissue injuries of the neck. J Bone Joint Surg Br. 1990 Sep;72(5):901–903. doi: 10.1302/0301-620X.72B5.2211780. [DOI] [PubMed] [Google Scholar]
  18. Hamer A. J., Gargan M. F., Bannister G. C., Nelson R. J. Whiplash injury and surgically treated cervical disc disease. Injury. 1993 Sep;24(8):549–550. doi: 10.1016/0020-1383(93)90035-5. [DOI] [PubMed] [Google Scholar]
  19. Harris W. H., Hamblen D. L., Ojemann R. G. Traumatic disruption of cervical intervertebral disk from hyperextension injury. Clin Orthop Relat Res. 1968 Sep-Oct;60:163–167. [PubMed] [Google Scholar]
  20. Hildingsson C., Toolanen G. Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims. Acta Orthop Scand. 1990 Aug;61(4):357–359. doi: 10.3109/17453679008993536. [DOI] [PubMed] [Google Scholar]
  21. Hildingsson C., Wenngren B. I., Bring G., Toolanen G. Oculomotor problems after cervical spine injury. Acta Orthop Scand. 1989 Oct;60(5):513–516. doi: 10.3109/17453678909150113. [DOI] [PubMed] [Google Scholar]
  22. Hodge J. R. The whiplash neurosis. Psychosomatics. 1971 Jul-Aug;12(4):245–249. doi: 10.1016/S0033-3182(71)71514-X. [DOI] [PubMed] [Google Scholar]
  23. Hohl M. Soft-tissue injuries of the neck in automobile accidents. Factors influencing prognosis. J Bone Joint Surg Am. 1974 Dec;56(8):1675–1682. [PubMed] [Google Scholar]
  24. Kischka U., Ettlin T., Heim S., Schmid G. Cerebral symptoms following whiplash injury. Eur Neurol. 1991;31(3):136–140. doi: 10.1159/000116663. [DOI] [PubMed] [Google Scholar]
  25. Kronn E. The incidence of TMJ dysfunction in patients who have suffered a cervical whiplash injury following a traffic accident. J Orofac Pain. 1993 Spring;7(2):209–213. [PubMed] [Google Scholar]
  26. Livingston M. Whiplash injury and peer copying. J R Soc Med. 1993 Sep;86(9):535–536. [PMC free article] [PubMed] [Google Scholar]
  27. Lord S. M., Barnsley L., Wallis B. J., Bogduk N. Third occipital nerve headache: a prevalence study. J Neurol Neurosurg Psychiatry. 1994 Oct;57(10):1187–1190. doi: 10.1136/jnnp.57.10.1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. MILLER H. Accident neurosis. Br Med J. 1961 Apr 8;1(5231):992–998. doi: 10.1136/bmj.1.5231.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Macnab I. The "whiplash syndrome". Orthop Clin North Am. 1971 Jul;2(2):389–403. [PubMed] [Google Scholar]
  30. Maimaris C., Barnes M. R., Allen M. J. 'Whiplash injuries' of the neck: a retrospective study. Injury. 1988 Nov;19(6):393–396. doi: 10.1016/0020-1383(88)90131-3. [DOI] [PubMed] [Google Scholar]
  31. Mannheimer J., Attanasio R., Cinotti W. R., Pertes R. Cervical strain and mandibular whiplash: effects upon the craniomandibular apparatus. Clin Prev Dent. 1989 Jan-Feb;11(1):29–32. [PubMed] [Google Scholar]
  32. McKinney L. A., Dornan J. O., Ryan M. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Arch Emerg Med. 1989 Mar;6(1):27–33. doi: 10.1136/emj.6.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McKinney L. A., Dornan J. O., Ryan M. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Arch Emerg Med. 1989 Mar;6(1):27–33. doi: 10.1136/emj.6.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Mealy K., Brennan H., Fenelon G. C. Early mobilization of acute whiplash injuries. Br Med J (Clin Res Ed) 1986 Mar 8;292(6521):656–657. doi: 10.1136/bmj.292.6521.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Mendelson G. Not "cured by a verdict". Effect of legal settlement on compensation claimants. Med J Aust. 1982 Aug 7;2(3):132–134. [PubMed] [Google Scholar]
  36. Miles K. A., Maimaris C., Finlay D., Barnes M. R. The incidence and prognostic significance of radiological abnormalities in soft tissue injuries to the cervical spine. Skeletal Radiol. 1988;17(7):493–496. doi: 10.1007/BF00364043. [DOI] [PubMed] [Google Scholar]
  37. Norris S. H., Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Joint Surg Br. 1983 Nov;65(5):608–611. doi: 10.1302/0301-620X.65B5.6643566. [DOI] [PubMed] [Google Scholar]
  38. Olney D. B., Marsden A. K. The effect of head restraints and seat belts on the incidence of neck injury in car accidents. Injury. 1986 Nov;17(6):365–367. doi: 10.1016/0020-1383(86)90070-7. [DOI] [PubMed] [Google Scholar]
  39. Ommaya A. K., Faas F., Yarnell P. Whiplash injury and brain damage: an experimental study. JAMA. 1968 Apr 22;204(4):285–289. [PubMed] [Google Scholar]
  40. Pang L. Q. The otological aspects of whiplash injuries. Laryngoscope. 1971 Sep;81(9):1381–1387. doi: 10.1288/00005537-197109000-00002. [DOI] [PubMed] [Google Scholar]
  41. Parmar H. V., Raymakers R. Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation. Injury. 1993 Feb;24(2):75–78. doi: 10.1016/0020-1383(93)90191-8. [DOI] [PubMed] [Google Scholar]
  42. Pearce J. M. Subtle cerebral lesions in "chronic whiplash syndrome"? J Neurol Neurosurg Psychiatry. 1993 Dec;56(12):1328–1329. doi: 10.1136/jnnp.56.12.1328-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Pearce J. M. Whiplash injury: a reappraisal. J Neurol Neurosurg Psychiatry. 1989 Dec;52(12):1329–1331. doi: 10.1136/jnnp.52.12.1329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Pennie B. H., Agambar L. J. Whiplash injuries. A trial of early management. J Bone Joint Surg Br. 1990 Mar;72(2):277–279. doi: 10.1302/0301-620X.72B2.2312568. [DOI] [PubMed] [Google Scholar]
  45. Pennie B., Agambar L. Patterns of injury and recovery in whiplash. Injury. 1991 Jan;22(1):57–59. doi: 10.1016/0020-1383(91)90166-c. [DOI] [PubMed] [Google Scholar]
  46. Pressman B. D., Shellock F. G., Schames J., Schames M. MR imaging of temporomandibular joint abnormalities associated with cervical hyperextension/hyperflexion (whiplash) injuries. J Magn Reson Imaging. 1992 Sep-Oct;2(5):569–574. doi: 10.1002/jmri.1880020515. [DOI] [PubMed] [Google Scholar]
  47. Radanov B. P., Di Stefano G., Schnidrig A., Sturzenegger M. Common whiplash: psychosomatic or somatopsychic? J Neurol Neurosurg Psychiatry. 1994 Apr;57(4):486–490. doi: 10.1136/jnnp.57.4.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Radanov B. P., Dvorák J., Valach L. Cognitive deficits in patients after soft tissue injury of the cervical spine. Spine (Phila Pa 1976) 1992 Feb;17(2):127–131. doi: 10.1097/00007632-199202000-00001. [DOI] [PubMed] [Google Scholar]
  49. Radanov B. P., Sturzenegger M., De Stefano G., Schnidrig A. Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash. Br J Rheumatol. 1994 May;33(5):442–448. doi: 10.1093/rheumatology/33.5.442. [DOI] [PubMed] [Google Scholar]
  50. Radanov B. P., di Stefano G., Schnidrig A., Ballinari P. Role of psychosocial stress in recovery from common whiplash [see comment]. Lancet. 1991 Sep 21;338(8769):712–715. doi: 10.1016/0140-6736(91)91441-v. [DOI] [PubMed] [Google Scholar]
  51. Robinson D. D., Cassar-Pullicino V. N. Acute neck sprain after road traffic accident: a long-term clinical and radiological review. Injury. 1993 Feb;24(2):79–82. doi: 10.1016/0020-1383(93)90192-9. [DOI] [PubMed] [Google Scholar]
  52. Roydhouse R. H. Whiplash and temporomandibular dysfunction. Lancet. 1973 Jun 16;1(7816):1394–1395. doi: 10.1016/s0140-6736(73)91728-5. [DOI] [PubMed] [Google Scholar]
  53. Rubin W. Whiplash with vestibular involvement. Arch Otolaryngol. 1973 Jan;97(1):85–87. doi: 10.1001/archotol.1973.00780010089021. [DOI] [PubMed] [Google Scholar]
  54. SNOW G. H. ECONOMIC ASPECTS OF "WHIPLASH" INJURY. Calif Med. 1964 Oct;101:260–262. [PMC free article] [PubMed] [Google Scholar]
  55. States J. D., Korn M. W., Masengill J. B. The enigma of whiplash injury. N Y State J Med. 1970 Dec 15;70(24):2971–2978. [PubMed] [Google Scholar]
  56. Sturzenegger M., DiStefano G., Radanov B. P., Schnidrig A. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology. 1994 Apr;44(4):688–693. doi: 10.1212/wnl.44.4.688. [DOI] [PubMed] [Google Scholar]
  57. Taylor J. R., Kakulas B. A. Neck injuries. Lancet. 1991 Nov 23;338(8778):1343–1343. doi: 10.1016/0140-6736(91)92653-j. [DOI] [PubMed] [Google Scholar]
  58. Toglia J. U. Acute flexion-extension injury of the neck. Electronystagmographic study of 309 patients. Neurology. 1976 Sep;26(9):808–814. doi: 10.1212/wnl.26.9.808. [DOI] [PubMed] [Google Scholar]
  59. Weinberger L. M. Trauma or treatment? The role of intermittent traction in the treatment of cervical soft tissue injuries. J Trauma. 1976 May;16(5):377–382. doi: 10.1097/00005373-197605000-00010. [DOI] [PubMed] [Google Scholar]
  60. Yarnell P. R., Rossie G. V. Minor whiplash head injury with major debilitation. Brain Inj. 1988 Jul-Sep;2(3):255–258. doi: 10.3109/02699058809150950. [DOI] [PubMed] [Google Scholar]

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