Cervical Soft Tissue Injuries
By Richard H. Adler
May 13, 1997
A study published in the Journal of Bone and Joint Surgery in November 1996, involved a follow up of patients involved in separate motor vehicle accidents approximately 15 years earlier.1 The authors wanted to know whether patients, 15 years after cervical injury, had improved or worsened symptoms, and whether psychological variables played a role in the patient’s condition.
The population studied involved a group of 61 patients who had presented to the same emergency department in England after soft tissue injury to the neck sustained in road traffic accidents. Forty were available for follow up. Ninety percent of this group had been involved in rear-end motor vehicle collisions.
The patients were questioned about symptoms. Physical examinations involved range of motion assessment and complete neurological exam. The patients also completed a McGill pain questionnaire, scored their pain on a visual analog scale, and sketched their pain on a pain map. Psychometric assessments included the General Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Beck Depression Inventory. The authors made many noteworthy conclusions, including:
Seventy percent (70%) of the patients still had symptoms 15 years after a whiplash injury.
Although 18 percent had improved over the past five years, a greater number, or 28 percent, had worsened.
Older patients were more likely to continue to experience symptoms, and only five percent of those who were aged over 40 at the time of the accident were free from symptoms in follow up.
Symptoms did not improve after conclusion of their claim.
The pain maps reinforced previously published views that radiating pain is associated with more severe disability.
The distribution of pain conforms more closely to radiation from the facet joints rather than dermatomes.
Radiating pain was much more common in patients with intrusive or severe symptoms.
An abnormal psychological profile in patients with symptoms after 15 years suggests that this is both reactive to physical pain and is persistent.
This study sheds further light on the reality of soft tissue injuries to the cervical spine following a motor vehicle accident. Soft tissue injuries can cause long-term symptoms and the pain involved is real and not a function of psychological disturbance. In principle, this interpretation is consistent with that of others who have reviewed the literature concerning the psychology of patients with chronic pain after whiplash.2
1 Squires, B.; Gargan, M.F.; Bannister, G.C., “Soft Tissue Injuries of the Cervical Spine: A 15-year Follow-up,” The Journal of Bone and Joint Survery, Vol. 78-B, No. 6, November 1996, pp. 955-57.
2 Merksey, H., “Psychiatry and the Cervical Sprain Syndrome,” Canadian Medical Association Journal, Vol. 130, pp. 1119-21 (1984); Merksey, H., “Psychological Consequences of Whiplash in Teasell, R.W., et al., Spine State of the Art Reviews Cervical Flexion-Extension/Whiplash Injuries,” 7:3 Philadelphia: Hanley & Belfus, 471-80 (1993). Shapiro, A.P., Roth, R.S., “The Effect of Litigation on Recovery From Whiplash in Teasell, R.W., et al., Spine State of the Art Reviews Cervical Flexion-Extension/Whiplash Injuries,” 7:3 Philadelphia: Hanley & Belfus, 531-56 (1993). Shapiro, A.P., Teasell, R.W., Steenhuisr, “Mild Traumatic Brain Injury Following Whiplash in Teasell, R.W., et al., Spine State of the Art Reviews Cervical Flexion-Extension. Whiplash Injuries,” 7:3 Philadelphia: Hanley & Belfus, 455-70 (1993). Wallis, B.J., Lord, S.M., Barnsley, Lee, Bogduk, N., “Pain and Psychological Symptoms of Australian Patients With Whiplash,” Spine, Vol. 21, No. 7, pp. 804-10 (1996).