The Gazette 1989

DECEMBER 1989

GAZETTE

Painful reflex spasm produced in the muscles is relieved by analgesic medication. Physical therapy plays an important role in the treatment of whiplash injuries. Ultrasound or deep heat therapy helps to heal the inflammatory processes in the muscles and paraspinal structures. Early treatment with mobilization and exercise regimes further re- duces dysfunction. "People who were relatively fit prior to the accident with good muscle tone and who are treated as above, tend to recover relatively easily." Older people, people wi th poor muscle tone and people wi th de- pression tend to have difficulty in recovering from these accidents. People who were relatively fit prior to the accident wi th good muscle tone and who are treated as above, tend to recover relatively easily. " I t is important . . . to read the immediate post-accident radiographs . . . to Arthritis is seen in many cervical spine x-rays. The large majority of these patients do not complain of pain or limitation of movement. Studies in the United States show that thirty three (33) per cent of all adults and ninety (90) per cent of those over sixty five (65) show osteoarthritic changes on x-ray. It is important, therefore, to read the immediate post-accident radio- graphs as a baseline of spoldylotic changes, and compare at twelve (12) and twen ty four (24) months to assess possible development of the condition. . . neck pain persists for six months in seventy five per cent (75%) and for two years in sixty five per cent (65%) of patients with whiplash injuries." assess possible development of [arthritis]."

Whiplash injuries result in mul- tiple complaints and prolonged disability. The authenticity of these complaints is often queried due to subsequent litigation. However, neck pain persists for six months in seventy five per cent (75%) and for t wo years in sixty five per cent (65%) of patients w i th whiplash injuries. It is also reported in medical literature that forty five per cent (45%) continue to complain " . . . figures and the possible incidence of arthritis . . . dictate a careful measured treatment regime and prolonged follow-up with regular review and radiographs . . long after a satisfactory outcome of the legal action. These figures and the possible incidence of arthritis in a whiplash damaged spine dictate a careful measured treatment regime and prolonged follow-up with regular review and radiographs before final assessment of disa- bility can be ascertained. This process enables the lawyer to better present his client's case at litigation. • L A W S O C I E T Y ANNUAL CONFERENC 1990 Thursday, 3rd May to Sunday, 6th May 1990

The patient thus has painful restricted movement of his neck and back, and is unable to sit com- fortably or adopt a normal posture on standing. He is plagued by pain^ on movement, paraesthesiae of the extremities, headache, blurred vis- ion, dysfunction of the temporo- mandibular joint, poor memory, poor concentration, disturbed sleep pattern and resultant irritability. The muscles affected are tender to palpation, especially at points of origin over the spine, and muscle spasm may be distinguished by the palpating hand. Rarely areas of sensory loss are demonstrated with muscle atrophy and reduced re- flexes of the limbs. Hearing dis- turbance is gauged by audiometry and EMG (internal ear test) chang- es, and ocular muscle imbalance is often demonstrated in patients complaining of blurred vision. Radiographs of the spine rarely show bone injury as it is the inter- vertebral joint structures (synovial membrane, supporting ligaments and muscles) that are affected. However, it is important to assess the condition of the spine at the time of accident as a baseline for comparison later (possibility of arthritis at a later date). "The treatment of whiplash injury should be directed towards curing the pathology produced by the force, and relief of the symptoms." Electro encephalogram of the brain waves (EEG) will disclose major organic injury of the brain. Follow up compu t e r i zed axial tomography (CT) scan is indicated should this be positive. It is con- sidered wise to perform haemo- globin t es ts to establish the presence or otherwise of anaemia, especially in women. The treatment of whiplash injury should be directed towards curing the pathology produced by the force, and relief of the symptoms. It is particularly important to offer continuous care wi th encourage- ment and a graduated increase in therapy. Anit-inflammatory drugs are prescribed to reduce the inflammation of the joints and sur- rounding tissues. A cervical supp ort collar may be used to rest the area and allow healing to com- mence over the first few days.

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