Soft tissue injury

A Soft tissue injury (STI) 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 (Lovering, 2008).

Healing Phases

-Inflammatory Response Phase: Starting from time of injury to 4 days post-injury

-Fibroblastic Repair Phase: Overlapping the inflammatory response phase, typically starts at 4 days post-injury and continues for up to 6 weeks

-Maturation-Remodeling Phase: Starts around the 6th week post-injury and can last for 2-3 years

(Prentice,2011)

Commonly Injured Tissues

With examples of each

Parentheses indicate location in body

-Ligaments

Anterior Cruciate Ligament (Knee), Medial Collateral Ligament (Knee), Ulnar Collateral Ligaments (Wrist/Hand), Interspinous Ligaments (Vertebrae)

-Muscles

Biceps Brachii (Upper Arm), Rectus Femoris (Thigh), Tarnsverse Abdominus (Abdominals)

-Tendons

Patellar Tendon (Knee), Calacaneal/Achilles Tendon (Foot/Lower Leg), Biceps Tendon (Shoulder/Elbow)

-Nerves

Brachial Plexus (Shoulder), Ulnar Nerve (Elbow/Hand), Peroneal Nerve (Ankle/Foot), Cranial Nerves I-XII(Head)

-Bones

Femur (Leg), Humerus (Arm), Ribs (Torso), Metatarsals I-VI (Foot), Metacarpals I-VI (Hand)

-Cartilage

Menisci (Knee), Intervertebral discs (Spine), Acetabulum (Hip)

Management

Immediately after the injury occurs one should apply the PRICE principle to minimize the local tissue damage and reduce inflammation. "P"rotection "R"est "I"ce "C"ompression "E"levation

’PROTECTION’ Protect the individual from further injury by preventing them from moving and keep further hazards away from the individual (Flegel, 2004).

‘REST’ Rest the individual from any activity that causes pain. If simple movements such as bending, straightening or walking are causing pain ‘’rest’’ means immobilizing the injury by splinting or preventing weight bearing with crutches is essential (Flegel, 2004). If walking does not cause any pain, continue to walk for short distances as comfort allows (Lindsay, Watson, Hickmott, Broadfoot & Bruynel, 1994).

’ICE’ During the first 72 hours following an injury, ice can be applied to help minimize pain and control swelling caused by bleeding and fluid loss from the injured tissue (Flegel, 2004). Icing is recommended for 15 minutes every 4 hours to help control the swelling and pain (Subotnick, 1991).

‘COMPRESSION’ Compression is the application of pressure over the injured area with the use of a bandage, elastic wrap or compression tape (Lindsay et al., 1994). This is to control the initial bleeding of joint or limb tissues, or to reduce residual swelling (Flegel, 2004). It is vital that compression is applied within the first few minutes following the injury to see the benefits (Lindsay et al., 1994).

‘ELEVATION’ Used in combination with ice and compression, elevation can also minimize initial tissue bleeding and swelling. Elevate the injured part above the level of the heart as much as possible for the first 72hours, or longer if the swelling persists. (Flegel, 2004).

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 (Flegel, 2004). These are some of the tools that a professional can use to help make a full diagnosis;

Nerve conduction studies may also be used to localize nerve dysfunction (e.g., carpal tunnel syndrome), assess severity, and help with prognosis. 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.

References

Flegel, M.J. (2004). Sport first aid: A coach’s guide to preventing and responding to injuries. Hong Kong, Japan: Human Kinetics.

Lindsay, R., Watson, G., Hickmont, D., Broadfoot, A., & Bruynel, L. (1994). Treat your own strains sprains and bruises. New Zealand: Spinal Publications.

Lovering, R.M. (2008). Physical therapy and related interventions. In P.M. Tiidus (Eds.), Skeletal muscle damage and repair (pp. 219–230). United States of America: Human Kinetics.

Prentice, William E. "Tissue Response to Injury." Principles of Athletic Training: A Competency Based Approach. 14th ed. New York: McGraw Hill Companies, 2011. 260-277. Print.

Subotnick, S. (1991). Sports & exercise injuries. California, United States of America: North Atlantic Books.

Trauma

Principles

Assessment

Clinical prediction rules	Revised Trauma Score Injury Severity Score Abbreviated Injury Scale NACA score

Investigations	Diagnostic peritoneal lavage Focused assessment with sonography for trauma

Management

Principles	Advanced trauma life support Trauma surgery Trauma center Trauma team Damage control surgery Early appropriate care

Procedures	Resuscitative thoracotomy

Pathophysiology

Injury	MSK Bone fracture Joint dislocation Degloving Soft tissue injury Resp Flail chest Pneumothorax Hemothorax Diaphragmatic rupture Pulmonary contusion Cardio Internal bleeding Thoracic aorta injury Cardiac tamponade GI Blunt kidney trauma Ruptured spleen Neuro Penetrating head injury Traumatic brain injury Intracranial hemorrhage

Mechanism	Blast injury Blunt trauma Burn Penetrating trauma Crush injury Stab wound Ballistic trauma Electrocution

Region	Abdominal trauma Chest trauma Facial trauma Head injury Spinal cord injury

Demographic	Geriatric trauma Pediatric trauma

Complications

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