454 / 482
GAZETTE
DECEMBER 1989
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.
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
assess possible
development of
[arthritis]."
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."
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
HOTEL EUROPE
KILLARNEY
CO. KERRY
4 32