Download - instability / TRAUMATIc Syndrome
INSTABILITY / TRAUMATIC
SYNDROME
Outcomes Be familiar with the mechanism of a
instability / traumatic syndrome. To be familiar with the clinical presentation
of a typical patient with acute instability syndrome.
Be familiar with the most widely used medical as well as physiotherapy treatment protocols for a patient with a typical acute / sub-acute and chronic instability syndrome.
Be familiar with the possible pathological changes associated with an instability syndrome.
Outcomes Be familiar with the clinical presentation of
a typical patient with an instability syndrome.
Be familiar with the associated symptoms experienced by a patient with a typical instability syndrome.
Causes Trauma as a result of a motor-vehicle
accident or sport injury
Degenerative in the articular complex
Leads to irregular patterns of comparable signs and a variety of signs and symptoms
Hyperextension injuries Acceleration when a car is hit from behind
The seat with the lower body accelerates forwards
The neck is unstable and can not control the movement of the head
The neck moves into sudden extension – reflex contraction of the neck flexors causes the neck to go into flexion
Hyperflexion injuries Deceleration when a car is brought to a
stand still due to the collision
Head and neck continues to move forwards causing hyperflexion until the chin bumps against the chest
Reflex contraction of the extensors causes extension
General If the neck is rotated when the collusion
occurs an excessive amount of lateral flexion and rotation will take place
Normal physiological ranges is exceeded and this leads to damage and anatomical changes of the soft tissue
Structures that are damaged Ligaments
Intervertebral disc
Facet joints
Surrounding muscles
Haematoma of especially the m sternocleidomastoïd
Symptoms Pain during rest especially if the structures
are placed on stretch
Pain through entire range of movement
Muscles are painful during stretch and contraction
Ligaments are painful when placed on stretch (except the interspinal ligament which is painful during extension)
Treatment: Acute Total bed-rest for first 2-3 days Supportive, soft neck support (when patient is
in an upright position) Ice for first 24 hours Heat is contra-indicated for first 48 hours
(Afterwards damp heat) Anti-inflammatory medication and muscle
relaxants Careful, active non-weight bearing exercises
(except rotation and lateral flexion) Gentle massage
Treatment: Sub-Acute Symptoms become more specific Wean from neck support – still use support in a
vehicle of when neck feels tired Ultrasound and damp heat/ice Mobilisations – short of pain Cautious isometric exercises Increase active exercises (introduce flexion and
extension into exercise programme) Commence with PNF patterns if pain will allow Cautiously commence with distal neural
mobilisations
Treatment: Chronic Treat according to signs and symptoms Pain at end of range (6-8 weeks after injury) Totally wean from neck support Isometric exercises are progressed into
standing Evaluate for muscle imbalance and treat
accordingly Make use of combined movements and
neural mobilisation techniques for final rehabilitation
Possible pathological changes Ligament injuries: Anterior longitudinal Posterior
longitudinal Interspinal Disc herniation Fracture : Spinous process Vertebral bodies Tear of the capsule and facet joints with
acute synovitis Tear of the neck muscles
Possible pathological changes (cont)
Tempomandibular joint injuries Retropharingeal heamatoma Oesophageal haemorrhage Sympatic chain injuries Concussion and minor head injuries Vertebral artery damage Thoracic outlet syndrome
Clinical presentation Pain and tenderness over affected structures Referred pain – irritation of nerve root miofascial trigger points scleretome referral (deep
burning pain which feels like it is in the bone itself) Neck muscle spasm Headaches (experienced as a deep pressure
with pounding , nausea , vomiting and photophobia)
Normal range of movement restricted
Clinical presentation (cont) Dysphagia with hoarseness in the acute
phase
Sympathetic signs: Intermittent weak vision Headaches Horner’s syndrome Dizziness: Vertebral artery symptoms Middle ear injuries
Oedema
Horner’s syndrome Miosis (constriction of the pupil) Pytosis (drooping eye) Enophthalmia (sunken eye) Anidosis (loss of perspiration on the one
side of the face)
Clinical presentation (cont) Anterior chest pain: presents as angina becomes worse
with exercise
tender anterior nausea sleeps poorly becomes worse
with coughing and
sneezing Oedema
Associated symptoms Thoracic outlet syndrome Lower backache Head injuries such as concussion Tempromandibular joint injuries Fibromialgia (chronic pain and stiffness in
muscles with local tenderness) Psychosis Depression Difficulty with acceptance
Associated symptoms (cont)
Anxiety Rage Frustration (financial and family) Personality changes and interference in
daily living Post-traumatic stress syndrome
Treatment Analgesics Anti-depressants Surgery Psychiatric treatment