Late Whiplash Syndrome Complicated by Ehlers-Danlos
Diagnosis & Diagnostic Equip

Late Whiplash Syndrome Complicated by Ehlers-Danlos

James Lehman, DC, DIANM

This article discusses a case of a young man who presented for evaluation and management following a motor-vehicle incident, illustrating a problematic presentation by a whiplashed patient with an Ehlers-Danlos syndrome. Hopefully, this putative case presentation utilizing SOAP notes prepares chiropractors to professionally manage patients with hypermobility of joints that have been whiplashed.

Subjective Findings

Chief Concern: “I have a terrible headache.” The patient has been experiencing severe headaches for the past week. He pointed to the left occipital region and said the pain was behind the left eye. Palpation of the left occipital region did not increase the pain, which he described as a deep, aching pain.

The pain started at a hair stylist salon after having a shampoo. Nothing seems to relieve the headache, which he rated 8-9 of 10. Extending the neck and turning to the left did increase pain in the neck, which started four weeks ago following a motor-vehicle incident. He was rear-ended while stopped at a light. His head was turned to the left at the time of the impact.

He denied any radiating pain into the extremities or down the spine. The headache was worse at presentation and constant. He denied any previous spinal injuries, diseases or surgeries. He was not taking any medications other than ibuprofen, which did not reduce the severity of the headaches. He did mention that as a younger person, his pediatrician said his joints were very flexible.

Objective Findings

Vital signs: Height 72 inches, weight 180 pounds, BP 180/100, pulse 92/minute, respirations 16/minute.

Gait: unsteady heel-to-toe walk.

Neurological examination: Three-part peripheral nervous examination revealed no signs of deficits. DTR 2+ bilateral and brisk for the upper and lower extremities, sensory intact and motor 5/5 for both upper and lower extremities.

Romberg: swaying with eyes closed.

Hoffman’s sign: present.

Palpation of the cervical spine revealed pain at the C2-3 facet joints on the left, hypertonicity of the paravertebral muscles bilaterally at the upper and lower cervical spine, and pain over the ligamentum nuchae at C2-3 and C5-6.

Testing for hypermobility of the elbow, thumb and fifth finger were positive (Beighton scale 1, 2 and 3).

Active cervical range of motion: The patient demonstrated reduced range of motion in all directions with anxiety.

Rust sign: present via active ROM testing.

Assessment / Plan

  • Post-traumatic whiplash-associated disorder (Grade 3 or 4)
  • Cervical artery dissection suspected
  • Ehlers-Danlos suspected

Referred the patient to the emergency department for specialized imaging to determine if cervical artery dissection was present. Recommended digital-motion radiographic examination of the cervical spine to evaluate instability if imaging was negative for cervical artery dissection.

Discussion

The whiplash-associated disorder at grade 3 or 4 is supported by the history of trauma and the signs and symptoms.1 Patients with Ehlers-Danlos are more prone to experience a post-traumatic cervical artery dissection.2 The neurological signs and symptoms were indicative of an upper motor neuron lesion, possibly a cervical artery dissection.3 Cervical spine manipulation is contraindicated with either a cervical artery dissection or an unstable cervical spine.4

Chiropractic physicians should perform a thorough history of present illness and physical examination following cervical injuries, and recognize neurological signs and symptoms due to cervical artery dissection.5

Quiz Time

  1. Could whiplash injury to a patient with Ehlers-Danlos cause a cervical artery dissection? True or False
  2. Could a thorough history of present illness/injury and a physical examination, including orthopedic and neurological examinations, reveal the signs and symptoms of a post-traumatic cervical artery dissection? True or False

Answers: 1. True. 2. True.

References

  1. Alektoroff K, Papanagiotou P. Schleudertrauma der Halswirbelsäule [Whiplash injury of the cervical spine]. Radiologe, 2021;61(8):710-713.
  2. Keser Z, Chiang CC, Benson JC, et al. Cervical artery dissections: etiopathogenesis and management. Vasc Health Risk Manag, 2022;18:685-700.
  3. Kacprzynski G, Bucher J. Delayed vertebral artery dissection after mild trauma in a motor vehicle collision. Am J Emerg Med, 2021;45:678.e1-678.e2.
  4. Futch D, Schneider MJ, Murphy D, Grayev A. Vertebral artery dissection in evolution found during chiropractic examination. BMJ Case Rep, 2015;2015:bcr2015212568.
  5. Thomas LC. Cervical arterial dissection: an overview and implications for manipulative therapy practice. Man Ther, 2016;21:2-9.
March 2026
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