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Whiplash neck injury, cervico-cranial syndrome

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Whiplash neck injury, cervico-cranial syndrome

Cervico-cranial syndrome is a painful condition of the cervico-occipital junction resulting from a head or neck (cervical spine) injury or chronic overload. This causes irritation of pain receptors in the ligamentous apparatus, in the capsules of the intervertebral (facet) joints, the muscles of the cervical spine, and the aponeurosis in the occipital part of the skull.

The source of pain in the neck and back of the head is an injury or chronic overload of the supporting structures of this area (injury or contusion of the cervical spine). Injury to the cervical spine by the time of occurrence can be either acute (as a result of car accidents, falls, blows to the head or blows to the head, bruised neck and back of the head in a fall), and chronic (sedentary work, feeding or long-term carrying of the child in the arms, etc.).

Whiplash mechanism of injury to the ligaments and muscles of the neck and brain during a car accident or collision while skating, rollerblading, skiing, or snowboarding, bruised neck and back of the head from a fall.

Acute injury to the neck (cervical spine) and cervico-occipital junction occurs when falling, colliding with another moving or stationary object, a person (while skiing, snowboarding, etc.). From a similar mechanism of injury or contusion of the cervical spine, there is a sharp movement in the cervico-occipital junction and intervertebral joints. As a result of this whiplash injury of the cervical spine, the ligaments and muscles of the neck (posterior, anterior, lateral group, and their combinations) are stretched.

Sometimes this movement in the neck can be larger than the physiological norm for the cervical spine. Then ruptures of ligaments and muscles with subluxation of the intervertebral joints and the odontoid process of the cervical C2 vertebra are likely.

Localization of typical muscle pain points in trauma (injury) or chronic overload of muscles and ligaments of the neck.

Localization of typical muscle pain points in trauma (injury) or chronic overload of muscles and ligaments of the neck.

Depending on the intensity of pain in the back of the head and neck in case of injury or contusion of the cervical spine, the patient cannot find a comfortable sleeping position.

Chronic trauma to the neck (cervical spine) and cervico-occipital junction is formed by a static load from monotonous efforts for a long period (sedentary work). At the same time, for a certain amount of time, a person experiences discomfort in the neck and back of the head. Exacerbation of pain in the cervical spine can cause hypothermia, sudden head movement (turning the head to the side or back), uncomfortable neck position during sleep.

Against the background of whiplash and pain in the cervical spine, irritation of the vertebral arteries occurs, which pass in the transverse processes of the cervical vertebrae.

Localization of pain in the case of a whiplash injury of the neck, radiating from the back of the head to the zone between and below the shoulder blades, to the shoulders.

It should be noted that in addition to pain in the neck and head (back of the head, temples, crown, forehead), patients may also experience vestibular disorders. Vestibular disorders as a result of irritation of the vertebral arteries, which are expressed by dizziness and unsteadiness when walking, nausea, and vomiting. Sometimes the clinical manifestations of the cervical-cranial syndrome lead to an erroneous diagnosis by some doctors of a concussion.

With cervical-cranial syndrome, complaints of the appearance of noise or ringing in the ears and head (cochlear manifestation), numbness of the skin of the face, the back of the head, in the ear region, and the mucous membrane of the tongue are also possible.

Rapid fatigability occurs. In the morning after sleep, there is no feeling that you have managed to get enough sleep. Sometimes insomnia may occur against this background. General performance and attention decrease, irritability arises.

Vertebral arteries running in the transverse processes of the cervical vertebrae can react with vascular spasm with dizziness.

 

Classification of subaxial injuries of the cervical spine

The clinical classification of subaxial (C3-C7 vertebrae) injuries of the cervical spine includes the following types of injuries:

  • compression fracture
  • explosive fracture
  • flexion-distraction injury of the neck
  • dislocation of articular processes (unilateral or bilateral)
  • fracture of the articular processes

There is also a classification by Alain and Ferguson for injuries of the cervical spine, which is used in specialized literature and scientific research. This classification of subaxial (C3-C7 vertebrae) injuries of the cervical spine is based on X-ray data and the mechanism of injury:

  • flexion-compression
  • vertical compression
  • flexion-distraction:
    • subluxation of the articular process
    • unilateral dislocation of the articular processes
    • bilateral dislocation of the articular processes with 50% displacement
    • complete dislocation (100% displacement),
  • extension-compression
  • extension-distraction
  • lateral flexion

 

Diagnostics of the neck injury and cervico-cranial syndrome

To diagnose an injury and bruise of the neck (cervical spine) and cervical-cranial syndrome, you should consult a doctor for a neurological examination, which should evaluate the biomechanics of the cervical spine (range of motion, muscle tone, and strength, the presence of fibromyalgia in the muscles of the neck, etc.). etc.).

Neurological examination of a patient with a neck injury may reveal:

  • symptoms of monoradiculopathy
  • symptoms of spinal cord compression

Monoradiculopathy occurs in patients with unilateral dislocation. Unilateral dislocation of the articular processes at the level of the C5-C6 vertebrae usually manifests itself in the form of C6 radiculopathy. In this case, the patient complains of muscle weakness when extending the hand, numbness, and tingling in the fingers.

The pattern of segmental innervation on the surface of the human body helps in clarifying the localization of the level of radiculopathy and spinal cord compression.

Unilateral dislocation of the articular processes at the level of the C6-C7 vertebrae usually manifests itself in the form of C7 radiculopathy. In this case, the patient complains of muscle weakness when extending the arm at the elbow (triceps), when flexing the hand, as well as numbness and tingling in the index and middle fingers.

Neurological symptoms of spinal cord compression occur with bilateral dislocations of the cervical vertebrae, which can increase with increasing subluxation.

Based on the results of the examination, a clinical diagnosis can be made and treatment offered. In the case of an unspecified diagnosis, additional diagnostic purposes may be given:

  • REG, Doppler ultrasound of neck and brain vessels
  • X-ray of the cervical spine with functional tests
  • CT of the cervical spine
  • MRI of the cervical spine

Magnetic resonance imaging (MRI) of the cervical spine (side view) helps in diagnosing disc damage and determining the position of the cervical vertebrae when they are displaced.

 

Treatment of neck injury and cervico-cranial syndrome

In case of injury to the cervical spine, the muscles of the neck and intervertebral joints can be treated with blockages when conventional treatment does not give a positive effect. For this, low doses of an anesthetic (Novocaine, Lidocaine) and Cortisone, Diprospan, or Kenalog, injected into the lumen of the affected joint, are sufficient.

When combined with a properly selected physiotherapy regimen, these injections can have a good and long-term effect on headaches and neck pain following a cervical spine injury.

Elimination of puffiness, inflammation, soreness, restoration of the range of motion in the joints and muscles of the neck in the treatment of cervical spine injury is accelerated with the use of physiotherapy.

Depending on the severity of the patient's pain in the neck, back of the head, and dizziness after a head or neck (cervical spine) injury with cervico-cranial syndrome, the following therapeutic actions are possible:

  • wearing a neck brace or corset (Shantz splint, Philadelphia collar)
  • drug therapy (NSAIDs, analgesics, hormones)
  • therapeutic injections - injection of drugs into trigger points
  • manual therapy
  • physiotherapy (UHF, TENS, etc.)
  • acupuncture
  • surgical treatment

Wearing a neck brace (Philadelphia collar) in the treatment of sprained ligaments and injured neck joints after an injury to the cervical spine.

Wearing a special cervical brace (Philadelphia collar) or a cervical brace (Shants' splint) limits the range of motion in the stretched ligaments and injured joints of the neck in case of cervico-cranial syndrome (trauma of the cervical spine). At the same time, a cervical corset and a cervical brace create additional unloading of tense and spasmodic (to protect the neck) muscles as a result of a neck injury (cervical spine).

Wearing a neck brace (Philadelphia collar) in the treatment of sprained ligaments and injured neck joints after an injury to the cervical spine.

Against the background of limited movement when wearing a cervical corset (Philadelphia collar) or a cervical brace, the pain symptom in the neck and back of the head with cervico-cranial syndrome will be eliminated much faster, which leads to a rapid restoration of the previous range of motion in stretched ligaments and injured joints of the cervical spine after injury to the cervical spine.