soft tissue injury

1. Soft Tissue Injuries
Dr Irfan Malik

2. Divided into
• Acute extrinsic. Lacerations, bruises, factures
• Acute Intrinsic. Muscle, tendon, ligament
injuries.
• Chronic. Joint erosions

3. Injuries to muscles, ligaments and
tendons
• Very common as sports injuries
• Common as injuries of RTA, domestic and
work- site accidents
Acute Injuries and Overuse Injuries
• Acute injuries occur suddenly
• Overuse injuries occur gradually

4. • Terminology
• Sprains. ligaments
• Strain. muscles

5. Injury classification
• 1st Degree, Grade 1 or mild injury
• 2nd Degree, Grade 2 or moderate injury
• 3rd Degree, Grade 3 or severe injury

6. • 1st Degree, Grade 1 or mild injury
• Microscopic structural damage
• Slight local tenderness

7. • 2nd Degree, Grade 2 or moderate injury
• Partial rupture of tissue
• Visible swelling
• Notable tenderness
• Do not affect joint stability

8. • 3rd Degree, Grade 3 or severe injury
• Complete rupture of tissue
• Significant swelling
• Significant instability

9. Ligament Injuries
• Diagnosis:
• Clinical Signs and Symptoms
• Brusing, swelling tenderness
• Pain on movement or loading, pain on
palpation
• Instability ± depending on the severity
• MRI scan for confirmation of injury type

11. Muscle and Tendon Injuries
• Muscles and tendons function together
• Injury may affect the muscle’s
• Origin
• Belly
• muscle – tendon junction
• tendon
• tendon-periosteum junction

12. Types of Muscle Injuries
• Strains
• Contusions

13. Strains (1st, 2nd or 3rd degree)
• Caused by overstretching
• often at the muscle – tendon junction
• occur as a result of the intrinsic force
generated by the muscle during the change
between eccentric and concentric traction;
either in rapid acceleration or deceleration
actions or combinations of acceleration and
deceleration.

14. • Strains (Clinical features) 1ST degree strains
• – Minimum strength loss and movement
restriction
• – Pain around the damaged area on active
movement or passive stretch
• – In the case of an athlete it can be as
distressing as a more severe injury

15. • 2nd and 3rd degree strains
• – More significant functional loss
• – Pain will be aggravated by any attempt to
contract the muscle
• – Defects may be palpable
• – In 3rd degree the muscle may bunch up
resembling a tumour

16. Grade Description
0 Normal muscle
1 Subtle muscle abnormality/sprain
2 Definite muscle disruption without muscle retraction
3 Complete muscle tear with retraction

17. • (Diagnosis)
• – History suggesting acceleration / deceleration
• – Sharp pain felt at the moment of injury
• – Pain ↓with rest and ↑ or reproduced by
attempted contraction
• – Palpable defects on superficial muscles
• – Local tenderness and swelling
• – Loss of active movement
• – Bruising after 24 hrs with spasm

18. Contusions
• Caused by direct blow on a muscle
• The muscle is pressed against the bone
• The muscle tears; heavy bleeding*
• deep within muscle → Muscular haematoma

19. • (Clinical features)
• Depend upon the size and site of haematoma
produced
• When superficial
• – Same as in strains
• Intramuscular heamatoma
• – Bleeding is within the fascia covering the muscle
• – The intramuscular pressure builds up and
counteract further bleeding
• – Resultant swelling lasts > 48hrs, accompanied
tenderness, pain, impaired mobility

20. • Tendon Injuries
• • Acute injuries to tendons
• – classified according to 1st ,2nd and 3rd
degree
• – are common in sports; superficial tendons are
susceptible to penetrating trauma
• – caused by rapid acceleration / deceleration
• – Injured tendons may have had a
predisposition to injury due to overuse or disease

21. • Tendons are most susceptible to
overuse injury
– Tendinitis (tendon
inflammation)
– Tenosynovitis (tendon sheath
inflammation)
– Tenoperiostitis (tendon
attachments’ inflammation)

22. • Tendon Injuries (Diagnosis)
• • History suggesting acute or overuse types
• • Clinical examination to evaluate continuity
• • US or MRI scans → precise diagnosis

23. • Treatment Principles
• Common to all acute injuries are internal bleeding and
likely acute inflammation. Therefore: prevent bleeding
and pain as first aid by following PRICE
• principle
• P - Protection
• R - Rest
• I – Ice for cooling
• C – Compression
• E - Elevation

24. Treatment of Ligament Injuries
• Grade 1 and 2 ligament injuries can be treated
with pain relief, splinting and gentle
mobilization to avoid stiffness.
• Grade 3 injuries may require surgical repair to
bring together the torn ends of the ligament..

25. Treatment of Ligament Injuries

26. Treatment of Ligament Injuries
•PRICE
• The doctor’s role:
• – determine the stability
• – exclude possible #; establish diagnosis (type of injury)
• – if the joint is stable →
• • early mobilisation
• • supportive taping
• • rehabilitation
• – if the joint is unstable →
• • decide whether surgery is necessary?
• • protection and rehabilitation

27. Treatment of Ligament Injuries
• Rehabilitation (aim to:)
• – identify any predisposing cause with a view to
remove it
• – prevent adhesion formation
• – strengthen muscles related to the ligament
• – re-educate proprioception
• – restore full mobility of the ligament and
corresponding joint
• – restore patient’s confidence
• – restore full functional activity

28. Treatment of Acute Muscle Injury
• Immediately start PRICE; be strict on P, R and E up
to 36 hrs
• No massaging the hurt muscle within 48 -72 hrs.
• Close observation for possible compartment
syndrome
• Decrease in swelling and rapid recovery of
function may be expected in intermuscular
bleeding
• Persistent or increasing swelling with poor
function suggest intramuscular bleeding

29. Treatment of Acute Tendon Injury
• PRICE as in all other injuries administered
initially
• A wide range of approaches to management
based on tendon damaged, age, the degree of
disability and handicap etc. Theoretically all
severed tendons need to be sutured to restore
continuity and allowed to heal.
• Early (within 2 weeks) mobilisation favours
functional recovery.

30. • After initial acute treatment:
• Gr 1 and 2 strains, intermuscular haematomas and minor
intramuscular haematomas are treated with
• Elastic support bandage
• Local application of heat, contrast treatment with heat and
cold
• Exercises are started after 2-5 days rest; progression as
follows:
• Static without load → with load →free dynamic → PRE
→stretches
• Proprioceptive training → functional / sport specific training
• Gr 3 strains and severe intramuscular haematomas demand
surgical intervention or conservative treatment over a
prolonged period