Face / Head / Neck

Whiplash Associated Disorders (WAD)

Definition

Whiplash associated disorders (WAD) is the official name for patterns of complaints after an accident with an acceleration-deceleration mechanism, whereby forces are transferred to the neck and cervical spine. WAD occurs after car accidents, in particular after rear-end, frontal or side collisions, but can also caused after diving accidents.

In 1995, the Quebec Task Force made a theoretical subdivision of whiplash trauma:

  • Grade 0: no neck complaints, no physical abnormalities.
  • Grade 1: neck complaints, neck stiffness and sensitivity, no physical abnormalities.
  • Grade 2: neck complaints and neuromuscular abnormalities.
  • Grade 3: neck complaints and neurological deficits.
  • Grade 4: neck complaints and a fracture or dislocation.

We will focus on WAD I and II.

Acute WAD is restricted to the first three weeks after an accident. Thereafter, a subacute stage of WAD takes over during which most complaints disappear due to conservative treatment. If WAD symptoms persist after three months, WAD becomes known as chronic.

Aetiology

Any trauma involving an acceleration/deceleration mechanism may lead to WAD, such as rear-end, frontal or side collisions during car accidents, diving trauma, etc.

Signs and symptoms

Typical symptoms of acute whiplash injury are: (1) pain in the neck, shoulders and, possibly, the arms;(2) headache, especially in the occipital region, sometimes extending to the forehead above both eyes; and (3) limited motion of the neck due to stiffness in the neck immediately after the accident. Additional symptoms include dizziness, visual disturbances, nausea, tinnitus, numbness and tingling in the hands, unilateral brachalgia due to acromio-clavicular (AC) joint distortion pain, lower back pain, post-traumatic stress disorder (depression), and cognitive impairment.

Diagnostics

Physical Examination

The physical examination must exclude or confirm any damage to the nervous system. Fractures must also be excluded. Standard neurological and neck and shoulder examinations should be performed, focused on the sensory and motor functions of the arms and hands. Moreover, a radicular provocation (Spurling) test should be performed and further examination must be focused on passive motion restriction in the cervical spine and shoulder.

Additional Somatic Diagnostics

Additional examinations should only performed when there is an indication. MRI scans of the neck are of no use in WAD I and WAD II. However, they should be considered when there is any suspicion of a neurological disorder.  An MRI scan must be performed when there is shoulder restriction, in order to exclude AC distortion. Neuropsychological and vestibular evaluation is indicated in persistent memory and concentration deficits, and dizziness, respectively. Psychological evaluation is indicated when a post-traumatic stress disorder is suspected.

Additional Psychocognitive Diagnostics

  • RAND-36 (quality of life)
  • TSK (fear of movement)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

The patient should receive a clear explanation of the nature and cause of the complaints, as well as the expected course.

  • Active treatment strategies are slightly more effective that passive ones.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatments