Article

Adolescents who have chronic pain after common orthopedic
injuries such as ankle sprains may present a multidimensional clinical problem
stemming from both physical and psychological issues. A traumatic incident such
as a motor vehicle accident can produce clinical issues ranging from a specific
tissue injury to multisystem complications such as complex regional pain syndrome
(CRPS) or posttraumatic stress disorder (PTSD). The purpose of this retrospective
case report on an adolescent with chronic ankle pain stemming from a motor
vehicle accident is to demonstrate how reflection and the evidence base
influenced the modification of the plan of care. Description of the screening
methods, clinical findings, interventions, and outcomes of the case may help
physical therapists identify and improve the quality of care in cases of
suspected CRPS and PTSD. CASE DESCRIPTION: The patient was a 12-year-old girl
with a medical diagnosis of recurrent right ankle sprain and with signs of
potential CRPS and PTSD. Poor initial response to ankle sprain management led to
reflective reconsideration of the diagnosis and plan of care. The revised plan of
care supported by the evidence base emphasized empathetic consideration of the
traumatic motor vehicle accident and focused on CRPS prevention and management of
potential non-physical pain via mirror therapy and motor imagery therapy.
OUTCOMES: Pain was relieved, behavior improved, and functional movement began to
normalize after 3 sessions of mirror therapy and motor imagery therapy.
DISCUSSION: Patient symptoms were inconsistent with the medical diagnosis, and
the clinical outcome of the original plan of care was unsuccessful. Reflection
inspired a more-detailed history and systems review, which led to greater
understanding and more-effective care.

Langue : ANGLAIS