Abstract
Whiplash is a contentious issue in the medico-legal field; opposing views are held about persisting symptoms.
The exact pathology is not known; but it is generally accepted to be ‘soft tissue injury’. The same clinical syndrome can occur without a road accident.
No one doubts the reality of the condition in the early stages when the symptoms and signs (of a ‘mechanical derangement’) are clear cut.
As with other soft tissue injuries, most ‘heal’ within a usual time span; some take longer to heal; and some have persisting problems giving rise to chronic pain, restricted movements & /or a feeling of ‘instability’. In this latter group the physical signs are less obvious but are still present, if sought. Imaging is rarely relevant.
The psychological reaction to any injury or illness will vary from individual to individual (the previous personality); or from time to time in the same individual. People with chronic pain may become depressed and may develop ‘excessive’ psychological reactions – often referred to as ‘chronic pain syndrome’ and, by some, as ‘abnormal illness behaviour’; this is exacerbated when litigation is involved with its attendant adversarial, confrontational approach which questions the ‘genuineness’ of both the patient and their symptoms and disability.
Where symptom persist beyond the ‘usual’ time for healing, and are consistent with the (albeit subtle) physical signs found, there can be no grounds for arguing that they are nor related to the accident.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom
