After a Car Accident in Ajax: When Imaging Helps

Car accidents have a strange way of distorting time. The collision itself is over in a second, yet the hours and days afterward can feel long and confusing. You may walk away feeling fine and wake up the next morning unable to turn your head. You may be focused on the car, the tow truck and the phone calls, and only notice a sore wrist that evening.

With traffic on Highway 401, Harwood Avenue, Westney Road and the rest of the roads through Ajax and Pickering, many people in Durham Region will be involved in a collision at some point, most often a minor one. This article follows the typical timeline after a crash and explains where diagnostic imaging, such as X-ray and ultrasound, tends to fit in along the way.

It is about the medical imaging side only. It does not offer guidance on insurance, legal matters or claims. If you have questions about forms, reports or what an insurer needs, the people to ask are your health-care provider and your insurer or their representative.

In the first hour: decide whether this is an emergency

Right after a collision, adrenaline can mask pain. People with real injuries sometimes feel surprisingly normal for a while. That is one reason paramedics and emergency departments take crash injuries seriously, even when the person involved insists they are fine.

Call 911, or go to the nearest emergency department, if anyone involved has:

• Lost consciousness, even briefly, or is confused, drowsy, vomiting or has a worsening headache
• Neck or back pain, especially with numbness, tingling or weakness in the arms or legs. Someone with these symptoms should keep still and wait for paramedics
• Chest pain, shortness of breath or difficulty taking a full breath
• Abdominal pain, a tender or swelling belly, or bruising across the chest or abdomen in the shape of a seatbelt
• Dizziness, fainting or pale, clammy skin
• An obviously deformed limb, a bone through the skin, or heavy bleeding
• Severe pain anywhere, or inability to stand or walk
• A pregnancy, even if there are no obvious injuries; a pregnant person should be assessed promptly after any collision

Some of these injuries, particularly to the head, chest and abdomen, need hospital-based assessment and imaging that a community clinic does not provide. When in doubt, get checked in an emergency department.

In the first day or two: watch for symptoms that appear late

Even after a collision that seems minor, it is common for symptoms to develop or worsen over the following day or two. Muscles that tensed during the impact stiffen up, and soft tissue swelling builds gradually. People often notice:

• Neck stiffness and pain, sometimes spreading into the shoulders or upper back
• Headache
• Lower back pain
• Soreness across the chest or shoulder where the seatbelt held them
• Pain in the wrists or hands from bracing against the steering wheel
• Knee pain from contact with the dashboard or console
• Bruising that was not visible at the scene

Many of these symptoms are caused by strains and sprains of soft tissue, and many improve over time. But some can signal an injury that needs attention, and it is not always possible to tell which is which without an assessment. If you have new or worsening pain after a crash, see a health-care provider rather than waiting it out. If any of the emergency signs above appear later, they still mean 911 or the emergency department.

At the assessment: how a provider thinks about imaging

When you see your family doctor, a nurse practitioner, a walk-in clinic physician or an urgent care centre after a collision, expect questions about the crash itself: how fast the vehicles were moving, where you were sitting, whether you were wearing a seatbelt, whether the airbags deployed, and how you felt immediately afterward. These details help the provider understand what forces your body went through.

They will then examine the areas that hurt. Whether imaging is recommended depends on what they find. A few principles tend to guide that decision:

1. Imaging is used to answer a specific question, such as whether a bone is broken or a joint is out of position. It is not ordered simply because a crash happened.
2. Many soft-tissue injuries do not show on an X-ray. A strained neck muscle or sprained ligament usually looks normal on plain imaging, so an X-ray may not change what the provider recommends.
3. Providers use established clinical decision rules for some areas, particularly the neck, to decide when imaging is likely to be helpful and when it can safely be avoided.
4. Some imaging belongs in hospital. If a provider is worried about injuries to the head, spine, chest or abdomen, they will usually send you to a hospital where more detailed imaging is available.

It is completely reasonable to ask your provider why they are, or are not, recommending a particular test.

Injuries where X-ray often comes into the conversation

The neck

Whiplash refers to a neck injury caused by the head moving rapidly back and forth, as often happens in rear-end collisions. Most whiplash injuries involve muscles and ligaments rather than bone. For many people with neck pain after a low-speed crash, a provider can decide based on the examination that an X-ray is not necessary. In other situations, such as older age, a higher-speed collision, numbness or reduced movement, they may recommend imaging. Some of that imaging is done in hospital.

Wrists, hands and fingers

Gripping the steering wheel or putting a hand out to brace can injure the wrist and hand, and airbag deployment can also bruise or injure the forearms and hands. An X-ray is the usual way to check for a fracture in these small bones.

Knees and lower legs

Knees can strike the dashboard or lower console. Feet and ankles can be injured if they are braced against the floor or pedals at the moment of impact. An X-ray helps show whether the kneecap, the lower leg bones or the bones of the foot and ankle are broken.

Shoulder and collarbone

The seatbelt crosses the collarbone and shoulder, holding you in place during a collision. That is exactly what it should do, but it can leave the area sore and bruised, and occasionally the collarbone can break. An X-ray can check the bones of the shoulder girdle.

Ribs and chest

Rib pain after a collision is common. Mild rib bruising is often managed without imaging, but chest pain with any difficulty breathing is an emergency. Your provider will decide whether a chest X-ray is useful in your case.

In the weeks that follow: when pain lingers

Most soft-tissue injuries from minor collisions gradually improve. When they do not, a provider may want to look more closely. Whether you live in Ajax, Whitby or Pickering, it helps to know what that next step can involve.

• A follow-up X-ray may be useful if a small fracture is suspected but was not visible at first, or to check how a known fracture is healing.
• A musculoskeletal ultrasound may be considered when the concern is a tendon, muscle or the fluid around a joint, such as a shoulder that has not regained its strength. Our post on ultrasound for sports injuries explains how that exam works; the same test is used for soft-tissue injuries from many causes.
• Referral to other services, such as physiotherapy, a specialist or other imaging, is part of many recovery plans.

Persistent or worsening symptoms deserve another visit to your provider, not just more patience. That includes headaches, difficulty concentrating, dizziness or mood changes after a collision, which can follow a concussion and should be assessed.

Having an X-ray at Rossland Diagnostic Clinic

If your provider recommends an X-ray and your injury is stable, the walk-in digital X-ray department at Rossland Diagnostic Clinic, Unit 102, 300 Rossland Road East in Ajax, is open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm. Because the department may close once daily capacity is reached, call 905-426-3111 for live availability, and ask what to bring for your particular exam.

A few practical notes for someone recovering from a collision:

• Arrange a ride if you can. Driving with a sore neck, wrist or knee can be difficult, and your vehicle may be out of service anyway.
• Wear clothing that is easy to adjust, especially if moving your neck or shoulder is uncomfortable. Front-opening tops are easier than pullovers.
• Remove necklaces, earrings and hair clips if your neck is being imaged, and jewellery near any other area being examined.
• Tell the technologist about any area that is especially painful, so they can help you into position gently. If there is any chance you might be pregnant, mention that before the X-ray.

The clinic offers free parking and ground-floor access. Images are captured digitally so physicians can access them quickly, a report goes to the provider who ordered the exam, and the clinic will promptly alert your physician to urgent findings. If you are referred to a specialist, images can be provided on CD when required.

About paperwork

After a collision, it is common to be dealing with several organizations at once. For anything to do with forms, documentation, reports or what an insurer requires, please ask your health-care provider and your insurer directly. The clinic’s role is to perform the imaging your provider has requested and send the results to that provider, who can then discuss them with you. For more on how that reporting works, see what happens after your scan.

Questions to bring to your provider

If you are seeing a provider after a car accident, these questions may help the conversation:

• Based on my examination, do you think imaging would help, and why or why not?
• Which symptoms should prompt me to go to the emergency department?
• If my X-ray is normal but I am still sore, what should I do next?
• When should I come back if things are not improving?
• Is there anything I should avoid while I recover?

Being involved in a collision is stressful, even on a quiet Ajax side street where nobody is badly hurt. Take care of the urgent things first, get assessed, and let your provider guide which tests are needed. When an X-ray is part of the plan, call Rossland Diagnostic Clinic at 905-426-3111 for walk-in availability, or request an appointment for an ultrasound or other booked exam your provider has ordered.