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Review Article: G. Bannister, R. Amirfeyz, S. Kelley, and M. Gargan Whiplash injury J Bone Joint Surg Br 2009; 91-B: 845-850 [Abstract] [Full text] [PDF]

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A new perspective on whiplash and chronic neck pain

Jerrold Gorski MD, Mineola, New York   (31 July 2009)

A new perspective on whiplash and chronic neck pain 31 July 2009
Jerrold Gorski MD, Orthopedic surgeon Winthrop University Hospital, Mineola, New York Send letter to journal: Re: A new perspective on whiplash and chronic neck pain jgorskimd{at}hotmail.com Jerrold Gorski MD, et al.	Sir, I read this paper with interest, however, Bannister et al have omitted reference to a promising new theory regarding the aetiology, diagnosis and treatment of whiplash and other chronic neck pains. In the Referred Shoulder Impingement Syndrome (RSIS), published in JBJS,1 subacromial impingement presents with neck pain but is asymptomatic in the shoulder. The excellent results in the first 34 patients after a minimum seven-year follow-up are described. Of these patients, 75% developed "whiplash" after a motor vehicle accident. Treatment of the shoulder cured their "neck" complaints. Subsequently, this syndrome is commonly diagnosed, and many patients with intractable neck pain have been cured.2 Symptomatic subacromial impingement is associated with whiplash as referenced by Bannister.3,4 Muddu et al5 also consider whiplash of the shoulder a distinct entity. Yamaguchi6 is the latest author to publish pathological findings regarding the "asymptomatic" variant of subacromial impingement. Macnab and McCulloch7 have histologically observed attenuation of nerve fibres in subacromial impingement and suggested that this may be asymptomatic. Perhaps the most compelling argument for wider attention is that, once suspected, RSIS is extremely easy to diagnose and treat by simple injection into the subacromial space. This syndrome fundamentally challenges the assumption that whiplash is a cervical condition. "Neck" pain is rarely defined precisely, as in the two sentences describing symptoms in this review. The most common location of chronic neck pain is not in the neck, but between the neck and the shoulder. This is the precise location of pain with RSIS, and it is considered to be within the supraspinatus muscle and related to its tendinous insertion in the shoulder. A promising new insight, and possibly a cure for whiplash, is worthy of reference8 so that further study may independently confirm the concept. J. Gorski, MD, Orthopaedic Surgeon, Winthrop University Hospital, Mineola, New York, USA. 1. Gorski JM, Schwartz LH. Shoulder impingement presenting as neck pain. J Bone Joint Surg [Am] 2003;85-A:635-8. 2. Gorski JM. A new "pain in the neck". AAOS Now Bulletin, August 2007. http://www.aaos.org/news/bulletin/aug07/clinical5.asp (accessed 31/07/2009). 3. Chauhan SK, Peckham T, Turner R. Impingement syndrome associated with whiplash injury. J Bone Joint Surg [Br] 2003;85-B:408-10. 4. Abbassian A, Giddins GE. Subacromial impingement in patients with whiplash injury to the cervical spine. J Orthop Surg 2008;3:25. 5. Muddu BN, Umaar R, Kim WY, et al. Whiplash injury of the shoulder: is it a distinct clinical entity? Acta Orthop Belg 2005;71:385-7. 6. Yamaguchi K, Ditsios K, Middleton WD, et al. The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg [Am] 2006;88-A:1699-704. 7. Macnab I, McCulloch J. Neck Ache and Shoulder Pain. Baltimore: Williams and Wilkins, 1983:318-19. 8. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash-associated disorders: an evidence-based approach. J Am Acad Orthop Surg 2007;15:596-606.