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 [5]

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. [6]

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. [7]

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. [8] 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. [9] 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. [10] 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

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula.

<span class="mw-page-title-main">Sports injury</span> Physical and emotional trauma

Sports injuries are injuries that occur during sports, athletic activities, and exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sports. Of those, about three million athletes 14 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 knee, lower leg, ankle, or foot. In addition to those sports injuries, the leading cause of death related to sports injuries is traumatic head or neck injuries.

<span class="mw-page-title-main">Tendinopathy</span> Inflammation of the tendon

Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.

<span class="mw-page-title-main">Achilles tendon</span> 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.

<span class="mw-page-title-main">Sprain</span> Damage to one or more ligaments in a joint

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed 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 may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. 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.

<span class="mw-page-title-main">Bruise</span> 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 occur close enough to the epidermis such 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.

<span class="mw-page-title-main">Diseases of the foot</span> Medical conditions affecting the human 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.

<span class="mw-page-title-main">Achilles tendinitis</span> Medical condition of the ankle and heel

Achilles tendinitis, also known as Achilles tendinopathy, is soreness the Achilles tendon. It is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the back of the ankle. 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.

<span class="mw-page-title-main">Bowed tendon</span>

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.

<span class="mw-page-title-main">Ligamentous laxity</span> Looseness of the ligaments

Ligamentous laxity, or ligament 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.

<span class="mw-page-title-main">Strain (injury)</span> 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 four steps abbreviated as R.I.C.E.: rest, ice, compression, elevation.

<span class="mw-page-title-main">Sprained ankle</span> Medical condition

A sprained ankle is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports such as basketball, volleyball, football, and tennis.

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 is recommended by orthopedic surgeons following surgery. The therapy is especially useful for sprains, strains, pulled muscles and pulled ligaments.

<span class="mw-page-title-main">Musculoskeletal injury</span> Damage of muscular or skeletal systems

Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. 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.

<span class="mw-page-title-main">Knee pain</span> Medical condition

Knee pain is pain in or around the knee.

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.

Injuries in rock climbing may occur due to overuse or falls. However, injuries due to falls are relatively uncommon; the vast majority of injuries result from overuse, most often occurring in the fingers, elbows, and shoulders. Such injuries are often no worse than torn calluses, cuts, burns and bruises. But overuse symptoms, if ignored, may lead to permanent damage.

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.

<span class="mw-page-title-main">Ankle problems</span> Medical condition

Ankle problems occur frequently, having symptoms of pain or discomfort 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. "Sprains, Strains, and Other Soft-Tissue Injuries - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 2024-07-31.
  6. "Effective RICE Method for Injury Recovery | Dr. Unnati's Physio Clinic". 2023-07-31. Retrieved 2024-07-31.
  7. "Soft Tissue Injuries". Sports Medicine Australia. Retrieved 2024-07-31.
  8. Flegel, 2004
  9. 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.
  10. 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