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.
Entire Body System
- Fatigue
However, soft tissue damage can also occur from excessive overuse or chronically fatigued structures, especially muscles and tendons. [thephysiotherapyclinics.com]
It can result in depression, moodiness, loss of energy, fatigue, anxiety, stress, loss of concentration and overall despair. [personalinjurylawyertoronto.com]
Maintaining high levels of cardiovascular fitness and muscle endurance to prevent fatigue. Allowing adequate recovery time between workouts or training sessions. [sma.org.au]
Fatigue and pain are good reasons to not exercise. Avoid the "weekend warrior" syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks. [orthoinfo.aaos.org]
[…] may include tendonitis, muscle pulls or strains, myofascitis, fibromyalgia, bursitis, trigger points, peripheral nerve entrapments, thoracic outlet syndrome, strength imbalances, poor flexibility, chronic muscle or joint pain and stiffness, chronic fatigue [midmichiro.com]
- Fishing
Injuries can happen with a fall, getting into a car accident, fishing on the Kenai River, and slamming your hand in a door. And, just because you're well-conditioned and athletic, doesn't mean you’re not susceptible to a soft tissue injury. [alaskafamilymedical.com]
- Arm Pain
Adhesions can develop between muscle group or muscle and nerve (example: Back pain, neck pain, carpal tunnel syndrome, arm pain or numbness, or sciatica to name a few symptoms) causing mild to severe pain. [midmichiro.com]
- Limb Pain
Support the limb with cushions or a sling to keep it raised when not walking or using the limb. Pain relief may also be required. If you are not sure what medication to use, your Specialist Physiotherapist, Pharmacist or GP can advise you. [thephysiotherapyclinics.com]
Gastrointestinal
- Vomiting
The most common adverse effects in oxycodone group were nausea, (13.3%); vomiting, (8.0%); dizziness, (5.3%); drowsiness, 3 (4.0%); and pruritis, (2.7%). [ncbi.nlm.nih.gov]
Whiplash is associated with pain in the neck, but it can also cause other side effects that you may not expect, including: Weakness in the arms or hands Dizziness or vomiting Ringing of the ears Blurred vision Muscle spasms in the back Problems with memory [dixoninjuryfirm.com]
Opioids are known to cause sedation, respiratory depression, nausea, vomiting, constipation, diuresis, and dysphoria, depending on which opioid receptors are most stimulated (Pathan 2012). [cochranelibrary.com]
- Nausea
The most common adverse effects in oxycodone group were nausea, (13.3%); vomiting, (8.0%); dizziness, (5.3%); drowsiness, 3 (4.0%); and pruritis, (2.7%). [ncbi.nlm.nih.gov]
Opioids are known to cause sedation, respiratory depression, nausea, vomiting, constipation, diuresis, and dysphoria, depending on which opioid receptors are most stimulated (Pathan 2012). [cochranelibrary.com]
Musculoskeletal
- Knee Pain
Accurate and timely diagnosis increases the likelihood of fully restoring normal and pain-free use of the affected knee. [emedicine.medscape.com]
Here are some to look out for: headaches/migraines hand/leg pain/numbness shoulder/knee pain herniated/ruptured disc neck stiffness joint/muscle tenderness whiplash muscle aches These injuries may not be immediately noticeable. [pepperodom.com]
Joint-specific tips See the following for ways to ease a specific joint problem: Ankle or heel pain Elbow pain Hip pain Knee pain Shoulder pain Wrist pain References Citations Hurt G, Baker CL (2003). Calcific tendinitis of the shoulder. [northshore.org]
- 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]
- Myopathy
Electrodiagnosis also helps differentiate between myopathy and neuropathy. 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. [en.wikipedia.org]
Neurologic
- Dizziness
The most common adverse effects in oxycodone group were nausea, (13.3%); vomiting, (8.0%); dizziness, (5.3%); drowsiness, 3 (4.0%); and pruritis, (2.7%). [ncbi.nlm.nih.gov]
Symptoms may include neck and shoulder pain, headache, numbness or tingling, neck stiffness or sensitivity, trouble swallowing, jaw discomfort, dizziness, blurry vision, memory problems, ear ringing and reduced hearing capacity, and arm weakness. [tallolaw.com]
Whiplash is associated with pain in the neck, but it can also cause other side effects that you may not expect, including: Weakness in the arms or hands Dizziness or vomiting Ringing of the ears Blurred vision Muscle spasms in the back Problems with memory [dixoninjuryfirm.com]
Neurological adverse effects were drowsiness or somnolence, dizziness or vertigo, headache, paraesthesia, seizure, and other, if reported. Early re‐injury We sought data on the recurrence of injury within three months, and time to re‐injury. [cochranelibrary.com]
- Stroke
PATIENTS: A total of 39 stroke patients with shoulder subluxation. METHODS: Shoulder subluxation was evaluated by physical examination, radiography and ultrasound. Soft-tissue injuries were assessed by ultrasound. [ncbi.nlm.nih.gov]
Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise. [orthoinfo.aaos.org]
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.
Treatment
Treatment recommendation was classified as nonoperative, operative, or equivocal. [ncbi.nlm.nih.gov]
Prognosis
Hohl, Soft Tissue Injuries of the Neck in Automobile Accidents: Factors Influencing Prognosis, J. [adlergiersch.com]
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]
Etiology
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]
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]
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]
Therefore, we analysed these outcomes at different time intervals from the onset of treatment, based on the pathophysiology of acute soft tissue injury, and pharmacology of interventions discussed above, to minimise the 'effect modification' of time on [cochranelibrary.com]
Prevention
How are soft tissue injuries prevented? Prevention is the best way to tackle any occupational health and safety problem. [cwhn.ca]
Prevent Sprains, Strains & Injuries Fortunately, many soft tissue injuries are preventable with strategies including: Balancing strength training, cardiovascular exercise and flexibility Cross-training with a variety of activities Scheduling periods of [southcoast.org]
Many soft-tissue injuries can be prevented through proper conditioning, training, and equipment. Other prevention tips include: Use proper equipment. Replace your athletic shoes as they wear out. [orthoinfo.aaos.org]
Whichever method you choose it is important that you wrap it in a damp towel to prevent burning the skin. Ice should be applied for 20 to 30 minutes every two hours. [hey.nhs.uk]
It needs to occur and there is nothing you can do (or should do) to prevent it. Follow these treatment principles to improve your recovery time – P.O.L.I.C.E : P rotect – don’t try to push through pain and swelling. [physiofitcambridge.co.uk]
References
- Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
- 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.
- Aster JC, Abbas AK, Robbins SL, Kumar V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
- 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.
- 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.
- Campbell RSD, Dunn AJ. Radiological interventions for soft tissue injuries in sport. Br J Radiol. 2012;85(1016):1186-1193.