675 - Male cyclist with cervical whiplash treated with platelet rich plasma injections using ultrasound guidance.

Case Diagnosis: Cervical whiplash.

Case Description: A 36-year old male cyclist presented to a sports medicine clinic after being involved in a head-on vehicle collision one month prior. He reported a gradual onset of left-sided neck pain radiating to his left interscapular area, neck stiffness, and ROM restriction. Of note, the patient reported no loss of sensation, weakness, or radicular symptoms. Physical exam revealed hypertonic muscles in the paraspinal and trapezius muscles, active and passive restriction with left cervical rotation, and positive Kemp's test. Cervical X-rays showed straightening of the cervical lordosis. Using a high-frequency linear US transducer, cervical facet capsule damage, muscular tears, and fascial disruption were identified; symptoms were reproduced with sono-palpation. Patient was treated with 7X LR-PRP injected under ultrasound guidance and at one month follow-up reported symptom relief of 80%.

Discussions: Injuries to the cervical spine and upper thorax are some of the most commonly encountered injuries in cyclists involved in collisions with vehicles. Due to the sudden acceleration-deceleration mechanism of injury, soft tissue injuries of the cervical spine, called whiplash, manifests as neck stiffness and pain, arm pain and paresthesias, and can persist beyond a period in which recovery is normally expected. X-rays often show slight loss of the normal lordotic curve. Platelet rich plasma injections have been shown to improve symptoms in patients with whiplash injuries when injected into damaged tissue.

Conclusions: Whiplash injuries can result in prolonged pain and debility. Precisely identifying damaged soft tissue remains challenging with physical exam and conventional imaging. With the adoption of high-frequency ultrasound, pinpointing areas has become reliable. PRP creates a pro-healing inflammatory cascade when injected into damaged tissue restoring normal tissue architecture and correlates with patient reported symptom relief. In our case, multiple areas of soft tissue damage were identified and treated, leading to a global reduction of symptoms and improved function.