A soft tissue injury is the damage of

muscles Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of musc ...

ligaments A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal ...

and

tendons A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its abilit ...

throughout the body. Common

soft tissue Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ...

injuries usually occur from a

sprain A sprain, also known as a torn ligament, is an acute soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fiber ...

strain Strain may refer to: Science and technology * Strain (biology), variants of plants, viruses or bacteria; or an inbred animal used for experimental purposes * Strain (chemistry), a chemical stress of a molecule * Strain (injury), an injury to a mu ...

, a one-off blow resulting in a

contusion A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

or overuse of a particular part of the body. Soft tissue injuries can result in

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

, swelling,

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...

and loss of function.

Signs and symptoms

Sprains

is a type of acute injury which results from the stretching or tearing of a

ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal l ...

. Depending on the severity of the sprain, the movement on the joint can be compromised since ligaments aid in the stability and support of

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

s. Sprains are commonly seen in vulnerable areas such as the wrists, knees and ankles. They can occur from movements such as falling on an outstretched hand or a twisting of the ankle or foot. The severity of a sprain can be classified: * Grade 1: Only some of the fibers in the ligament are torn, and the injured site is moderately painful and swollen. Function in the joint will be unaffected for the most part. * Grade 2: Many of the ligament fibers are torn, and pain and swelling is moderate. The functionality of the joint is compromised. * Grade 3: The soft tissue is completely torn, and functionality and strength on the joint is completely compromised. In most cases, surgery is needed to repair the damage.

Strains

A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back.

Bruising (contusion)

A contusion is the discoloration of the skin, which results from underlying muscle fibers and connective tissue being crushed. This can happen in a variety of ways such as a direct blow to the skin, or a fall taken against a hard surface. The discoloration in the skin is present when blood begins to pool around the injury.

Tendinitis

Tendinitis Tendinopathy, a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder (rotator cuff tendinitis, biceps tendinitis), elbow (tennis elbo ...

is a type of overuse injury to the tendons, which demonstrates signs of inflammation of tendons around a joint. Tendinitis is the most common cause of shoulder pain and also leg pain . Tendinitis occurs when there is repetitive stress on the subacromial bursa, which causes the bones to make contact with the tendons and irritate them.

Diagnosis

Classifications

Acute injuries

Any type of injury that occurs to the body through sudden trauma, such as a fall, twist or blow to the body. A few examples of this type of injury would be sprains, strains and contusions.

Overuse injuries

An overuse injury occurs when a certain activity is repeated frequently and the body does not have enough time to recover between occurrences. Examples include

bursitis Bursitis is the inflammation of one or more bursae (fluid filled sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae ...

and tendinitis.

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), transverse abdominis (abdominals) * Tendons :Patellar tendon (knee), calcaneal/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

RICE method

The RICE method is an effective procedure used in the initial treatment of a soft tissue injury. ; Rest : It is suggested that the patient take a break from the activity that caused the injury in order to give the injury time to heal. ; Ice : The injury should be iced on and off in 20 minute intervals, avoiding direct contact of the ice with the skin. ; 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.

No HARM protocol

This mnemonic indicates what to do within the first 48–72 hours after the injury in order to speed up the recovery process. ; Heat : Applying heat to the injured area can cause blood flow and swelling to increase. ; Alcohol : Alcohol can inhibit the ability to feel if the injury is becoming more aggravated, as well as increasing blood flow and swelling. ; Re-injury : Avoid any activities that could aggravate the injury and cause further damage. ; Massage : Massaging an injured area can promote blood flow and swelling, and potentially cause more damage if done too early.

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. To make a full diagnosis, a professional may use

nerve conduction studies A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical spec ...

to localize

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the ...

dysfunction (e.g.

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

), assess severity, and help with prognosis. Electrodiagnosis also helps differentiate between

myopathy In medicine, myopathy is a disease of the muscle in which the muscle fibers do not function properly. This results in muscular weakness. ''Myopathy'' means muscle disease ( Greek : myo- ''muscle'' + patheia '' -pathy'' : ''suffering''). This me ...

and

neuropathy Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or o ...

. Using the RICE method can somewhat be controversial as the science behind using ice is not necessarily very clear. On one hand, ice diminishes pain, metabolism, and muscle spasms. It also minimizes the inflammatory process and edema, which helps one recover from a soft-tissue injury. However, creatine kinase-MB isoform and myoglobin levels circulating in the blood increased after exercising. Ice impedes the recovery process by keeping the Creatine kinase-MB isoform and myoglobin levels increased 2–3 days post exercise. It is therefore important to weigh the pros and cons before applying any treatment, including the use of ice. Ultimately, the best method of imaging soft tissue is

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

(MRI), though it is cost-prohibitive and carries a high

false positive A false positive is an error in binary classification in which a test result incorrectly indicates the presence of a condition (such as a disease when the disease is not present), while a false negative is the opposite error, where the test resul ...

rate.

References

Sources

* Flegel, Melinda 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 (ed.), ''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. * Subotnick, Steven (1991). ''Sports and Exercise Injuries: Conventional, Homeopathic and Alternative Treatments''. California, United States of America: North Atlantic Books. {{Authority control Injuries Soft tissue disorders