Module 9.1 - Soft Tissue Injuries Flashcards
What is a soft tissue injury?
Trauma/injury which occurs beneath the skin, or mucous membrane, but the surface remains intact, Includes injury to:
- Muscles
- Ligaments
- Tendons
- Bursas
- Cartilages
- Skin, especially over bones and joints.
What are closed injuries?
trauma which results in injury to the tissues beneath the skin, but overlying skin/mucous membranes remain intact
What are some examples of closed injuries?
- Contusion - result of trauma to tissues beneath skin, but epidermis stays intact, cells and blood vessels damaged
- Hematoma - blood collected within the skin, muscles or in a body cavity
- Ecchymosis (bruising) - discoloration under the skin caused when blood leaks out into the surrounding soft tissues
- Crush injuries (with no open wound) - force is transmitted from exterior to internal structures
- Muscle strain - stretching or tearing of a muscle
-
Ligament sprains – joint injury involving damage to supporting ligaments and partial or temporary dislocation of bone ends
- First degree: mild; joint function intact
- Second degree: moderate; joint functionality is compromised
- Third degree: severe, complex, unstable –refer to orthopedic surgery
-
Rupture
- Characterized by instability, inability to move injured extremity, and swelling
What are open wound injuries?
Trauma which results in an injury where the surface of the skin/mucous membrane is broken, exposing underlying deeper tissue.
What are some examples of open wound injuries?
- Laceration – a cut in the skin
- Abrasions – damage to the superficial layer of skins as a result of rubbing or scraping across a rough or hard surface
- Avulsions- soft tissue that is either torn completely loose or is hanging as a flap
- Penetrating injuries
- Amputations
What are the predisposing factors for a soft tissue injury?
A. Trauma
- Blunt
- Penetrating
- Rotational
- Shear forces
B. Exercise
C. Overuse syndromes
D. Sports
E. Autoimmune diseases such as systemic lupus erythematosus (SLE), scleroderma and rheumatoid arthritis (RA)
F. Soft tissue injury commonly seen in all age groups- most frequent in ages 35 or less due to sports /trauma in this age group
G. Obesity
H. Age: Elderly with increased risk of skin tears related to thinning of skins and associated co-morbidities
What are the subjective/physical exam findings associated with a muscle tear/rupture?
- Decreased or absent ROM of joints affected by the muscle
- Swelling with hematoma formation almost immediately after injury
- Ecchymosis of skin over muscle
- Palpable discontinuity of muscle belly with obvious defect on palpation
- Complete instability of joint
- Inability to perform examination because of pain/guarding by patient
- Neurovascular integrity should be monitored closely due to potential vascular disruption
What are the subjective/physical exam findings associated with a sprain (ligament)?
- Pain on palpation and ROM
- Moderate swelling with decreased ROM
- Potential hematoma formation
- Lachman’s test: potential knee laxity of the anterior/posterior cruciate ligaments
What are the subjective/physical exam findings associated with a strain (muscles/tendons)?
- Swelling with possible hematoma formation
- Limited exam due to pain and patient guarding
- Decreased or absent ROM of affected joint
What are the subjective/physical exam findings associated with damage to the cartilage?
- Moderate swelling of joint, usually several hours after injury
- Palpable or audible ‘click’ during McMurray test
- Pain on palpation over joint lines
- Limited examination due to pain and patient guarding
What are the subjective/physical exam findings associated with damage to the bursa?
- Swelling of bursa with ‘boggy’ feeling on palpation
- Erythema over bursa
- Possible decreased ROM due to swelling
How do you work-up a patient with a soft tissue injury?
A. CBC
- Possible WBC elevation (> 10,000/mm) especially in bursitis
- Hgb/Hct may be decreased in massive soft tissue injury
B. Joint aspiration of synovial fluid
- WBC elevation – infection or inflammation
- RBC present – bleeding within joint
- Crystals present – gout
C. X-rays- plain films may reveal soft tissue swelling
D. Magnetic resonance imaging (MRI) of joint- especially knee and shoulder, is imaging modality of choice for location and degree of injury
How do you initially manage a patient with a soft tissue injury?
- RICE- Rest, Ice, Compression, Elevation
- Immobilization may be necessary, dependent on location, severity and type of injury
- Splints
- Casts
- Immobilizers
- Slings
Physical Therapy for muscle strengthening and ROM is also done
When is surgery indicated with soft tissue injuries?
- Rupture of tendons, muscles, or ligaments
- Grade III ligament sprain with joint instability
- Septic bursa
- Wound closure with open, soft tissue injury
What medications are used to manage soft tissue injuries?
- NSAID’s
-
Skeletal muscle relaxant for severe spasms
- Diazepam (Valium) 2-10 mg po q 6-8 hours prn
- Cyclobenzaprine (Flexeril) 10mg pot id prn
- Methocarbamol (Robaxin) 500-750mg po q 6-8 hours prn
- Opioids for short term use
- Hydrocodone/Acetaminophen (Vicodin, Norco, Lortab)
- Codeine/Acetaminophen (Tylenol # 3 or # 4)
- Oxycodone/Acetaminophen (Tylox, Percocet)
- Patient controlled analgesia (PCA) pump for inpatients and/or consult Pain Management Services
