“WHIPLASH ASSOCIATED DISORDERS – (WAD)”
A soft tissue injury occurs due to trauma to the human body when the tissues that connect, support or surround other structures and organs of the body are damaged. By definition, soft tissue includes muscles, tendons, ligaments, fascia nerves, fibrous tissues, blood vessels and synovial membranes.
Usually, the spine and the shoulders are often affected in this type of injury.
Immediate disability does follow injury to ligaments and healing, from a functional view point is seldom perfect.
Since soft tissue injury always heals with scar or fibrous tissues, it lacks the viability or elasticity of the original tissue, therefore soft tissue is always weaker after injury (whilst bone will be strengthened by scar tissue).
On occasions, some medico legal doctors imply that a whiplash associated disorder can be detected using an MRI scan. There is research to the contrary.
There was a study conducted in Sweden in 1994 where 39 consecutive cases of whiplash injury of the neck were examined clinically and with an MRI at a mean of 11 days after trauma.
26 of these showed changes on MRI with disc lesions in 25 cases, 10 of which were classified as disc herniations and a muscle lesion in one case. All of these persons had neck pain or headache.
29 cases had neurological deficits, mostly sensibility disturbances. 22 of the 26 cases with pathological MRI had neurological signs, as had 7 of the 10 cases with disc herniation.
The relationship between the MRI findings and the clinical symptoms and signs was poor.
The study was undertaken to evaluate if MRI within two days of a motor vehicle accident could reveal pathology of importance for understanding long term disability after whiplash neck sprain injuries.
As part of a prospective study, cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents.
The imaging was done with two days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected.
The MRI findings from the patients were both correlated to report symptoms six months after the accident and compared to a control group of 20 volunteers.
The MRI of both the brain and neck revealed no significant differences between the patients and the control group.
When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at six months in the groups with disc pathology or spondylosis when compared to the group with no pathology.
MRI scan within two days of the whiplash neck sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.
In conclusion, pain residuals, which may last for months or even years, may be due to the scar tissue which has replaced the previous normal tissue. Its inelastic quality can cause pain with certain movements. The lengthy period of healing may be explained by the fact that it takes a long time for soft tissue to heal and mend.
D R Ford
10 March 2017