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Soft Tissue Injury

Soft Tissue Injuries of the Knee

Soft tissue injury is a very broad term encompassing injury to muscles, tendons, ligaments, blood and lymphatic vessels, peripheral nerves and subcutaneous tissues. Various forms of trauma are usually the cause, and the diagnosis mandates a thorough physical examination and additional procedures to assess the extent of the injury.


Presentation

Blunt or penetrating trauma, most frequently seen in motor vehicle accidents, sports activities, and intentional injuries are the predominant causes of soft-tissue injury, which includes many forms and subtypes. Localized pain may be a shared feature of all soft tissue injuries, but signs and symptoms somewhat depend on the tissue involved [1]:

  • Skin and subcutaneous tissue - In the setting of injury that does not penetrate the skin, main forms of injury are contusions, abrasions, and lacerations, which are more frequently encountered in milder forms of trauma. On the other hand, skin trauma extending into deeper layers of the skin and subcutaneous tissue (cuts, slashes, gunshot wounds, etc) are considered as penetrating [1]. Burns are also an important form of skin injury, while signs such as erythema and ecchymoses may also develop from trauma, especially in child abuse [2].
  • Muscles, tendons, ligaments, bursae - Ligamental (sprains) or muscle strains are very common among athletes and their severity can range from mild to complete, resulting in joint instability and immense pain [1] [3]. Virtually any joint can be affected, but the knees, shoulders, ankles and wrists are most common. Overuse injuries, seen in runners, cyclists, and other athletes that put a significant amount of exertion on the musculoskeletal system [4], are particularly common and can lead to bursitis, tendinitis, sprains, tears, etc.
  • Blood and lymphatic vessels - Similarly to skin and subcutaneous injuries, blunt trauma can lead to intimal injuries, the formation of arteriovenous fistulas and spasms, all predisposing to potentially severe ischemia.
  • Peripheral nerves - Loss of either sensory and/or motor function are typical for peripheral nerve injury.
Wound Infection
  • No patients developed wound infections of either the medial traumatic or lateral surgical wounds, although, as noted above, 1 of the patients with a nonunion required medial free-flap coverage as a component of the nonunion repair because of incompetent[ncbi.nlm.nih.gov]
Ankylosis
  • Soft tissue injuries of the TMJ can potentially lead to internal derangement, osteoarthrosis, and possibly fibrous ankylosis, which should be considered during follow-up.[ncbi.nlm.nih.gov]
  • The presence of a portion of the disc between the residual condyle and the fossa prevented the development of osteoarthritis and ankylosis.[ncbi.nlm.nih.gov]
Myalgia
  • Specific names include: carpal tunnel syndrome (nerves going through wrist); degenerative disk disease (backbone); epicondylitis (tennis or golfer's elbow); myofascial pain/myalgia (tissue covering muscles); rotator cuff syndrome (shoulder tendons); sciatica[cwhn.ca]
Distractibility
  • METHODS: MRI was performed before surgery in 81 patients that had experienced a distractive-extension injury during the past 5 years. Severities of soft tissue injury were subdivided into 5 stages.[ncbi.nlm.nih.gov]
Withdrawn
  • Since a study of a selective COX-2 inhibitor NSAID (valdecoxib) that was subsequently withdrawn from the market dominates the evidence for this comparison (706 participants included in the analyses for pain, function and gastrointestinal adverse events[ncbi.nlm.nih.gov]
Neglect
  • Concerns are raised regarding lengthy duration from injury to diagnosis, claimants' high healthcare use, and neglect of mention of previous health status.[ncbi.nlm.nih.gov]
  • Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation.[ncbi.nlm.nih.gov]

Workup

The clinical presentation of soft tissue injuries is diverse, making patient history and the physical examination the most important parts in the diagnostic workup. Events that have led to injury, as well as its type, may provide sufficient clues to make an initial diagnosis and perform further procedures that can determine its severity. A detailed clinical examination of the affected joint or part of the body must be employed through adequate examinations (inspection, palpation, and various probes that estimate the range of joint motion, severity of pain, etc.), primarily to define the exact type of injury and decide which procedures can solidify clinical suspicion. Arteriography and doppler ultrasonography can be helpful in evaluating vascular injuries [5], while standard ultrasound and arthroscopy are the valuable methods for assessment of joint tissue [6]. More advanced imaging studies - computed tomography (CT) and magnetic resonance imaging (MRI) are useful for assessment of ligaments, joints, tendons and muscle injuries. Finally, electromyography (EMG) and nerve conduction studies can be employed in the case of peripheral nerve injury.

Suppression
  • RESULTS: Fracture supernatants suppressed NKC function more rapidly than peripheral plasma. Fracture supernatants from 1 to 4 days after injury were most suppressive. Inactivation of complement and reactive oxygen species failed to restore lysis.[ncbi.nlm.nih.gov]
  • IWS means edema of the iliacus muscle attachment entering the iliac wing that is visualized as a linear high signal intensity on fat-suppressed T2-weighted MR images.[ncbi.nlm.nih.gov]

Treatment

  • CONCLUSION: Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.[ncbi.nlm.nih.gov]
  • Consistent with this treatment effect, median time to pain resolution was shortened by 2 days in the diclofenac epolamine topical patch group relative to the placebo group (p 0.007).[ncbi.nlm.nih.gov]
  • In this article, we review the available clinical trial data for this product in the treatment of pain caused by soft tissue injury. 2010 Blackwell Publishing Ltd.[ncbi.nlm.nih.gov]
  • BACKGROUND: Ibuprofen is used for the treatment of non-serious pain. This study assessed the efficacy and safety of a new ibuprofen plaster for the treatment of pain associated with acute sports impact injuries/contusions.[ncbi.nlm.nih.gov]
  • Treatment recommendation was classified as nonoperative, operative, or equivocal.[ncbi.nlm.nih.gov]

Prognosis

  • 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.[en.wikipedia.org]
  • Hohl, Soft Tissue Injuries of the Neck in Automobile Accidents: Factors Influencing Prognosis, J.[adlergiersch.com]

Etiology

  • Abstract Six patients with soft tissue injury secondary to different etiologic factors are presented. The degree and extent of tissue necrosis was precisely identified by scintigraphy.[ncbi.nlm.nih.gov]
  • Osteochondritis dissecans , an intra-articular disorder of unclear etiology, is most common in boys during late childhood or in male adolescents.[emedicine.medscape.com]

Epidemiology

  • ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they reported: male rugby union players, a clear definition of a rugby union injury, the amount of training volume undertaken by participants, and epidemiological data for soft-tissue[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Since one of the current AO principles emphasises respect for soft tissue when performing open reduction and internal fixation, this article further discusses the pathophysiology of soft-tissue injury and the specific concerns in treating compartment[ncbi.nlm.nih.gov]
  • The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with[ncbi.nlm.nih.gov]
  • Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis, Med. ‎ Página 99 - Adler R.[books.google.es]

Prevention

  • NSAIDs delay, but do not prevent the inflammatory response in injured tissue and may expose athletes to an increased risk of re-injury by delaying healing. Significant adverse effects do occur in previously healthy patients who receive NSAIDs.[ncbi.nlm.nih.gov]
  • These results may aid in the design of injury prevention systems and more precise diagnoses of whiplash injuries.[ncbi.nlm.nih.gov]
  • 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.[en.wikipedia.org]
  • Compression sleeve use prevented loss of elbow motion, decreased perceived soreness, reduced swelling, and promoted recovery of force production.[ncbi.nlm.nih.gov]
  • These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world.[ncbi.nlm.nih.gov]

References

Article

  1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  2. McMahon P, Grossman W, Gaffney M, Stanitski C. Soft-tissue injury as an indication of child abuse. J Bone Joint Surg Am. 1995;77(8):1179-1183.
  3. Aster JC, Abbas AK, Robbins SL, Kumar V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
  4. Gabbett TJ, Ullah S. Relationship between running loads and soft-tissue injury in elite team sport athletes. J Strength Cond Res. 2012;26(4):953-960.
  5. Park JJ, Campbell KA, Mercuri JJ, Tejwani NC. Updates in the management of orthopedic soft-tissue injuries associated with lower extremity trauma. Am J Orthop (Belle Mead NJ). 2012;41(2):E27-35.
  6. Campbell RSD, Dunn AJ. Radiological interventions for soft tissue injuries in sport. Br J Radiol. 2012;85(1016):1186-1193.

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Last updated: 2017-08-09 15:22