Soft tissue injury

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A soft tissue injury is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain, a one-off blow resulting in a contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain, swelling, bruising and loss of function. [1]

Contents

Signs and symptoms

Sprains

A sprain is a type of acute injury which results from the stretching or tearing of a ligament. Depending on the severity of the sprain, the movement on the joint can be compromised since ligaments aid in the stability and support of joints. Sprains are commonly seen in vulnerable areas such as the wrists, knees and ankles. They can occur from movements such as falling on an outstretched hand or a twisting of the ankle or foot. [2]

The severity of a sprain can be classified:

Strains

A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back. [2]

Bruising (contusion)

A contusion is the discoloration of the skin, which results from underlying muscle fibers and connective tissue being crushed. This can happen in a variety of ways such as a direct blow to the skin, or a fall taken against a hard surface. The discoloration in the skin is present when blood begins to pool around the injury.

Tendinitis

Tendinitis is a type of overuse injury to the tendons, which demonstrates signs of inflammation of tendons around a joint. Tendinitis is the most common cause of shoulder pain and also leg pain . Tendinitis occurs when there is repetitive stress on the subacromial bursa, which causes the bones to make contact with the tendons and irritate them.

Diagnosis

Classifications

Acute injuries

Bruising is a type of acute soft tissue injury Bruising.JPG
Bruising is a type of acute soft tissue injury

Any type of injury that occurs to the body through sudden trauma, such as a fall, twist or blow to the body. A few examples of this type of injury would be sprains, strains and contusions. [4]

Overuse injuries

An overuse injury occurs when a certain activity is repeated frequently and the body does not have enough time to recover between occurrences. Examples include bursitis and tendinitis. [4]

Commonly injured tissues

With examples of each. Parentheses indicate location in body

Anterior cruciate ligament (knee), medial collateral ligament (knee), ulnar collateral ligaments (wrist/hand), interspinous ligaments (vertebrae)
Biceps brachii (upper arm), rectus femoris (thigh), transverse abdominis (abdominals)
Patellar tendon (knee), calcaneal/Achilles tendon (foot/lower leg), biceps tendon (shoulder/elbow)
Brachial plexus (shoulder), ulnar nerve (elbow/hand), peroneal nerve (ankle/foot), cranial nerves I-XII(head)
Femur (leg), humerus (arm), ribs (torso), metatarsals I-VI (foot), metacarpals I-VI (hand)
Menisci (knee), intervertebral discs (spine), acetabulum (hip)

Management

RICE method

The RICE method is an effective procedure used in the initial treatment of a soft tissue injury.

Rest
It is suggested that the patient take a break from the activity that caused the injury in order to give the injury time to heal.
Ice
The injury should be iced on and off in 20 minute intervals, avoiding direct contact of the ice with the skin.
Compression
Bandaging the injury will compress it, and prevent any further bleeding or swelling from occurring.
Elevation
Elevating the injury above the heart while resting will aid in the reduction of swelling.

No HARM protocol

This mnemonic indicates what not to do within the first 48–72 hours after the injury in order to speed up the recovery process.

Heat
Applying heat to the injured area can cause blood flow and swelling to increase.
Alcohol
Alcohol can inhibit the ability to feel if the injury is becoming more aggravated, as well as increasing blood flow and swelling.
Re-injury
Avoid any activities that could aggravate the injury and cause further damage.
Massage
Massaging an injured area can promote blood flow and swelling, and potentially cause more damage if done too early. [3]

Treatment

If severe pain persists after the first 24hours it is recommended that an individual consult with a professional who can make a diagnosis and implement a treatment plan so the patient can return to everyday activities. [5] To make a full diagnosis, a professional may use nerve conduction studies to localize nerve dysfunction (e.g. carpal tunnel syndrome), assess severity, and help with prognosis. Electrodiagnosis also helps differentiate between myopathy and neuropathy. Using the RICE method can somewhat be controversial as the science behind using ice is not necessarily very clear. On one hand, ice diminishes pain, metabolism, and muscle spasms.  It also minimizes the inflammatory process and edema, which helps one recover from a soft-tissue injury. [6] However, creatine kinase-MB isoform and myoglobin levels circulating in the blood increased after exercising. Ice impedes the recovery process by keeping the Creatine kinase-MB isoform and myoglobin levels increased 2–3 days post exercise. [7] It is therefore important to weigh the pros and cons before applying any treatment, including the use of ice.

Ultimately, the best method of imaging soft tissue is magnetic resonance imaging (MRI), though it is cost-prohibitive and carries a high false positive rate.

Related Research Articles

Human leg Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh and even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle, also known as the crus or, especially in non-technical use, the shank. Legs are used for standing, and all forms of locomotion including recreational such as dancing, and constitute a significant portion of a person's mass. Female legs generally have greater hip anteversion and tibiofemoral angles, but shorter femur and tibial lengths than those in males.

Sports injury Physical and emotional trauma

Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three million athletes age 14 years and under experience a sports injury annually. According to a study performed at Stanford University, 21 percent of the injuries observed in elite college athletes caused the athlete to miss at least one day of sport, and approximately 77 percent of these injuries involved the lower leg, ankle, or foot. In addition to those sport injuries, the leading cause of death related to sports injuries is traumatic head or neck occurrences.

Shoulder problem Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

Achilles tendon Tendon at the back of the lower leg

The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and flexion at the knee.

Sprain Damage to one or more ligaments in a joint

A sprain, also known as a torn ligament, is an injury resulting in the stretching or tearing of ligaments within a joint, often caused by a sudden movement abruptly forcing the joint beyond its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

Bruise Type of localized bleeding in tissues outside blood vessels

A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises are not very deep under the skin so that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone. Bruises are not to be confused with other similar-looking lesions. (Such lesions include petechia, purpura, and ecchymosis.

Diseases of the foot

Diseases of the foot generally are not limited, that is they are related to or manifest elsewhere in the body. However, the foot is often the first place some of these diseases or a sign or symptom of others appear. This is because of the foot's distance from the central circulation, the heart and its constant exposure to pressures from the ground and the weight of the body.

Achilles tendinitis Medical condition of the ankle and heel

Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon’s structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.

Bowed tendon

Tendinitis/tendonitis is inflammation of a tendon, often involving torn collagen fibers. A bowed tendon is a horseman's term for a tendon after a horse has sustained an injury that causes swelling in one or more tendons creating a "bowed" appearance.

Ligamentous laxity Medical condition

Ligamentous laxity, or ligament laxity, means loose ligaments. Ligamentous laxity is a cause of chronic body pain characterized by loose ligaments. When this condition affects joints in the entire body, it is called generalized joint hypermobility, which occurs in about ten percent of the population, and may be genetic. Loose ligaments can appear in a variety of ways and levels of severity. It also does not always affect the entire body. One could have loose ligaments of the feet, but not of the arms.

Strain (injury) Injury due to slight tearing of a muscle or tendon

A strain is an acute or chronic soft tissue injury that occurs to a muscle, tendon, or both. The equivalent injury to a ligament is a sprain. Generally, the muscle or tendon overstretches and partially tears, under more physical stress than it can withstand, often from a sudden increase in duration, intensity, or frequency of an activity. Strains most commonly occur in the foot, leg, or back. Immediate treatment typically includes five steps abbreviated as P.R.I.C.E.: protection, rest, ice, compression, elevation.

Flexor hallucis longus muscle One of the three deep muscles of the posterior compartment of the leg that attaches to the plantar surface of the distal phalanx of the great toe

The flexor hallucis longus muscle (FHL) is one of the three deep muscles of the posterior compartment of the leg that attaches to the plantar surface of the distal phalanx of the great toe. The other deep muscles are the flexor digitorum longus and tibialis posterior; the tibialis posterior is the most powerful of these deep muscles. All three muscles are innervated by the tibial nerve which comprises half of the sciatic nerve.

Sprained ankle Medical condition

A sprained ankle, also known as a twisted ankle or rolled ankle, is an injury where sprain occurs on one or more ligaments of the ankle. It is the most common injury to occur in ball sports, such as basketball, volleyball, football, and racquet sports.

Cold compression therapy, also known as hilotherapy, combines two of the principles of rest, ice, compression, elevation to reduce pain and swelling from a sports or activity injury to soft tissues and recommended by orthopedic surgeons following surgery. The therapy is especially useful for sprains, strains, pulled muscles and pulled ligaments.

RICE (medicine) Medical acronym

RICE is a mnemonic acronym for four elements of treatment for soft tissue injuries: rest, ice, compression, and elevation. RICE is considered a first-aid treatment rather than a cure for soft-tissue injuries. The aim is to manage discomfort.

Musculoskeletal injury Medical condition

Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity. In one study, roughly 25% of approximately 6300 adults received a musculoskeletal injury of some sort within 12 months—of which 83% were activity-related. Musculoskeletal injury spans into a large variety of medical specialties including orthopedic surgery, sports medicine, emergency medicine and rheumatology.

The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.

The most common injuries in the sport of cricket occur in the lower back, thighs, shoulders, and hands. They can be classified as direct injuries or indirect injuries. Direct injuries are due to impact with the cricket ball, bat, or ground. Indirect injuries occur mostly due to repetitive movement causing overuse of muscles. Fast bowlers have the highest injury prevalence rate followed by batsmen.

Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.

Ankle problems Medical condition

Ankle problems are of frequent occurrence and feature symptoms which include pain or discomfort experienced in the ankles.

References

  1. Lovering, 2008
  2. 1 2 "Soft Tissue Injuries (Sprains and Strains)". Victoria State Government.
  3. 1 2 "Sprains, Strains, and Other Soft Tissue Injuries". American Academy of Orthopedic Surgeons.
  4. 1 2 "Soft Tissue Injuries". Sports Medicine Australia.
  5. Flegel, 2004
  6. Park, Young Hwan; Song, Jong Hyub; Kim, Tae Jin; Kang, Seong Hyun; Chang, An Seong; Kim, Hak Jun (October 2019). "Comparison of the use of evaporative coolants and ice packs for the management of preoperative edema and pain in ankle fractures: a prospective randomized controlled trial". Archives of Orthopaedic and Trauma Surgery. 139 (10): 1399–1405. doi:10.1007/s00402-019-03222-7. ISSN   1434-3916. PMID   31203381. S2CID   189863579.
  7. Tseng, Ching-Yu; Lee, Jo-Ping; Tsai, Yung-Shen; Lee, Shin-Da; Kao, Chung-Lan; Liu, Te-Chih; Lai, Cheng-Hsiu; Harris, M. Brennan; Kuo, Chia-Hua (May 2013). "Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage". Journal of Strength and Conditioning Research. 27 (5): 1354–1361. doi:10.1519/JSC.0b013e318267a22c. ISSN   1533-4287. PMID   22820210. S2CID   25628446.

Sources