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How is Whiplash Diagnosed, part three.

How is whiplash diagnosed after a car accident or truck collision?  After the physical examination and any x-rays, and more detailed imaging studies, the doctor may order a relatively new diagnostic test, a digital motion x-ray.

Digital motion x-ray (DMX)

DMX is a new fluoroscopic based x-ray system designed to objectively detect and document soft tissue/ligament injury most commonly associated with whiplash injuries of the spine. DMX evaluates biomechanical relationships and abnormal movements of the cervical spine. Specifically, DMX:

Shows abnormal movement of vertebral bodies, facets, and other spinal elements

Shows joint hypermobility, hypomobility, or restriction

Shows normal or abnormal initiation of cervical motion

Connecting the vertebrae to each other in the back, facet joints allows freedom of neck movement as you bend forward and back.  Whiplash motion can injure the facet joints.  Sometimes, facet joint injections are used to determine if the facets are causing neck pain.  Facet joints in the spine allow movement in flexion, extension, and rotation. Degeneration of these joints can (but doesn't always) cause pain.  The common consensus from all the studies reviewed is that injury or overstretching of the joint capsule may be the most likely source of chronic pain after a whiplash injury. High strains cause nociceptors to fire with after shocks. Damaged nerve endings in the capsule may lead to pain that doesn't go away.

After all imaging studies, the doctor may use a scale to determine the diagnosis.

Grading the Severity of Injury

The physical exam combined with the imaging studies help determine the severity or grade of the injury. There is more than one way to assign a grade to a patient's whiplash. Here are two examples of the more commonly used models used to classify or grade whiplash injuries:

Croft Guidelines

Grade I: Minimal - No limitation of motion, no ligamentous injury, no neurological findings

Grade II: Slight - Slight limitation of motion, no ligamentous injury, no neurologic findings

Grade III: Moderate - Limitation of motion, ligamentous instability, neurologic symptoms present

Grade IV: Moderate-to-Severe - Limitation of motion, some ligamentous injury, neurological symptoms, fracture or disc derangement

Quebec Whiplash Classification

Grade 0: No complaint or physical sign

Grade I: Neck complaint of pain, stiffness or tenderness, no physical signs

Grade II: Neck pain and musculoskeletal signs

Grade III: Neck pain and neurological signs

Grade IV: Neck pain and fracture or dislocation

At McCormick Law Office in Milwaukee, Wisconsin our attorneys take motor vehicle accident whiplash damages very seriously.  The diagnosis of neck hyperextension and flexion injuries is very dependent on a good physical examination and patient history, supplemented by imaging studies such as x-rays and MRI.

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