Abstract
Purpose: To describe the characteristic examination findings post whiplash injury of relevance to the shoulder surgeon and an injection test, which can be used to abolish these signs and distinguish neck from shoulder pathology.
5A large amount has been written about whiplash injuries of the neck, but many of these patients are often referred to shoulder units for assessment either acutely or years after the accident because of continuing symptoms. Although neck pain is the commonest complaint tenderness on examination is sided and within the trapezius muscle in virtually all cases. Pain referred to the shoulder is also reported in 36 – 67% whilst interscapular pain occurs in 20 – 72%, depending on the time from injury.
We have reviewed a personal series of the senior author of over 700 cases. The consistent finding in these patients is tenderness localised to a specific part of the trapezius in the base of the neck, which is sided. Tenderness on the same side is also present along the vertebral border of the scapula to its lower pole in over 90%, provided the scapula is protracted. A further finding in some patients is a high arc of pain on abducting the arm, thus simulating an acromioclavicular joint problem, but in these cases the pain is localised to the trapezius. These findings are in addition to those of the neck, which may show some restricted movement due to pain.
The trapezius tenderness can be abolished by the injection of local anaesthetic into the trigger spot at the base of the neck (whiplash injection test), which also resolves most of the above signs and allows further assessment of the shoulder without the referred pain from the injected area.
Conclusions: Shoulder examination in patients who have suffered whiplash injuries is often difficult due to referred pain. Knowledge of the signs specifically due to the whiplash injury is required so that shoulder pathology is not assumed. A new whiplash injection test not previously described has been found very useful in abolishing the whiplash signs to enable accurate shoulder assessment in our practice.
The abstracts were prepared by David Stanley. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
