Soft Tissue Injury

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.

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.

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.