Subacromial impingement in patients with whiplash injury to the cervical spine
1 Specialist Registrar in Trauma & Orthopaedics, North-West Thames Training programme, Mayday University Hospital, 530 London Road, Croydon, CR7 7YE, UK
2 Consultant Orthopaedic and Hand Surgeon, Hand to Elbow Clinic, 29A James street west, Bath, UK
Journal of Orthopaedic Surgery and Research 2008, 3:25 doi:10.1186/1749-799X-3-25Published: 27 June 2008
Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine.
Methods and results
We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26%) had developed shoulder pain following the injury; of these, 11/220 (5%) had clinical evidence of impingement syndrome. Only 3/11 patients (27%) had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p < 0.03).
After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.