MECHANISMS OF AUTO ACCIDENTS

Every year, many tens of thousands of persons are involved in automobile accidents. Many of these accidents may have been "fender benders," which often result in modest structural damage to the care, but people are not made of steel, and the damage to the human body can be considerably greater than the damage to the car.

Soft-tissue injuries that can result from motor vehicle accidents may include: muscle stretch and tear in the neck, shoulder, upper and lower back; ligament and tendon injury, epicondylitis, and chest wall contusion.

Seat belt use has decreased mortality in automobile accidents, but as a result of increased seat belt use, there is a change in the nature of the soft-tissue injuries that result from automobile deceleration injury. Whiplash, or extension/flexion, is less common with modern head rests. Rather than the predominant problem resulting from extension of the neck, soft tissue injuries of the neck now more commonly result from FLEXION of the neck.

After rear-end impact, the motor vehicle occupant is initially thrown backward, against the seat and head rest, but is then violently thrown forward, toward the steering wheel and windshield. The forward flexion can injure the ligaments in the posterior neck, as a result of ripping forces that tear or avulse the posterior supporting ligaments of the cervical spine. The muscles of the neck are often stretched, and muscle spasm can result from the ligament tear, joint injury or as a primary result of the trauma.

The patient will often complain of headaches with tenderness and spasm over the splenius capitus area. These headaches are often described as sharp pains behind the eye on the affected side, with spasm and tenderness in the shoulder or shoulders.

The forceful flexion movement can compress the ribs, resulting in compression of the costochondral joints, facet joints, and rib articular joints. The pain that results is often described as sharp and stabbing pain in the rib area, and the pain can often mimic cardiac pain. Use of oral anti-inflammatories topical anti-inflammatories, and peripheral injections are often effective in the treatment of these pain problems.

The victim of an automobile accident resulting from side-impact may complain of neck pain. The side to side flexion injuries can result in asymmetric injury to the cervical and thoracic facet joints. The superficial muscles and tendons can become inflamed due to the stretch and tear.

Epicondylitis, inflammation of the muscular attachments at the elbows, can result from the driver extending and locking his or her arms on the steering wheel, while bracing for the oncoming impact. The forces of impact damage the epicondyle areas. Often, symptoms do not appear for days to weeks following impact. An injection of local anesthetic and anti-inflammatory accompanied by oral non-steroidal anti-inflammatories are beneficial in the treatment of this problem.

The key to optimal pain relief is early detection of these injuries and early intervention. Failure to adequately treat these problems can result in chronic pain, chronic ligament weakness, instability and degeneration.