The audit for Q2 2017 reflects shoulder injuries after road traffic accidents. Often, people develop symptoms in their shoulder joints. "Shoulder" can be misguiding, as the author defines it as the "shoulder joint". As such, injuries to the shoulder joint are rare.

As from October 2016 to December 2017, "whiplash" cases were investigated that occurred with shoulder symptoms. The audit focused on the site of the injury, sex, age, time to presentation, resolution at the time of examination, the most likeliest pathology, treatment, the job role, and the possible need for investigations.

Injuries to the wrist are a common sighting in casualty. The diagnosis is usually based on the patient’s history, a physical examination and X-rays. Once a bony injury can be excluded, the patient is discharged. However, a number of patients remain symptomatic thereafter. We reviewed Clients with persisting symptoms after wrist injuries in a medico legal setting. Injuries of the SL ligament were by far the most common finding. Their share was 50% in wrists with persisting symptoms. The relevance for a delayed diagnosis is the risk of premature arthritis and an advanced collapse of the carpus.

Road traffic accidents with an acceleration/deceleration pattern to the neck can lead to associated pain in the shoulder. More specifically, patients can develop symptoms suggesting impingement. The mechanism is unclear. 62 patients with impingement symptoms after a whiplash injury in a medico legal setting were recruited for a retrospective study to determine the findings after a rear-end collision. Magnetic resonance imaging (MRI) or Ultrasound could be obtained in 34 patients. A differentiated view excludes the idea that the common whiplash injury can result in structural damage of the shoulder joint. Findings suggest pre-dating conditions. The most likely explanation is an altered proprioception leading to a muscular dysbalance which makes pre-dating conditions symptomatic

The audit continued with the Q1 2019 Audit and focused on reasonable explanations why shoulder joints can develop signs of an impingement. It was concluded that their symptoms after whiplash injuries of the neck are less frequent than referred pain from the neck into the shoulder. Findings suggest that predating conditions can become clinically apparent due to an altered scapulothoracic rhythm as a result of an altered proprioception. It appears as if the acceleration/deceleration of the shoulder joint creates its own "whiplash", which should respond well to specific physio treatment.

The audit for Q1 2021 dealt with the clinical impression that neck and back symptoms as a result of of a "whiplash" can be modulated by associated injuries if they have a certain relevance. It could be demonstrated that the recovery from WAD symptoms usually takes place within 6 months whereas they continue in patients without associated injuries beyond 12 months. We explain this phenomenon by certain inhibitory functions in the pain process.

Symptoms to the lower back after low velocity road traffic accident are common. Symptoms generally occur together with neck pain after an acceleration/deceleration trauma. Both can become chronic and problematic to explain in a medico legal setting. We reviewed Clients from our medico legal clinic that suffered from back pain after more than 12 months following their accident. The Client's past medical history or their images suggest a high incidence of predating or constitutional conditions. Without evidence of a relevant substantial damage, data suggest that in the ongoing litigation process further investigations, e.g. MRI scans, are not required.