SOFT TISSUE INJURY BY : DR SANJEEV

SOFT TISSUE INJURY CLASSIFICATION : STRAINS SPRAINS RUPTURES CONTUSION

STRAIN : Definition: Injury to the muscle and tendons. Reasons : Direct trauma Overstretching of muscles Sudden movement

TYPES: Acute strain :due to sudden violent force or direct trauma Chronic trauma :due to injury existing since a long period leading to muscle ischaemia and fibrosis. Pathophysiology: injury pain spasm painfibre stimulation enhanced spasm pain

SEVERITY OF STRAIN : FIRST DEGREE STRAIN (MILD CONTUSION): Due to blunt injury Due to direct trauma of low intensity PATHOLOGY: Few muscle fibres - torn Bleeding - minimal Fascia - intact

CLINICAL FEATURES : Localised pain and tenderness Pain and spasm prevents muscle stretching Function is not impaired to a greater extent Tenderness : affected muscle MANAGEMENT: Cryotherapy(by application of ice)for a period of 20 minutes Compression bandaging with optimum presssure Gentle massaging of the surrounding area.

Second degree strain : Cause:trauma is more serious Pathology : Greater number of muscle fibres – torn Bleeding – more Fascia - intact Haematoma - localised

Clinical features: Pain – more severe Tenderness – severe Muscle spasm – severe Movement – restricted THIRD DEGREE STRAIN : Cause : due to trauma of a greater magnitude Pathology : Muscle fibres –larger area and greater number Group of muscle involved Fascia – partiallly torn Bleeding – intra muscular and intermuscular SYMPTOMS: All the above symptoms are of greater intensity.

Treatment in second and third degree strain: For first 24 hrs: Cryotherapy Compression bandage Limb elevation Limb immobilised in splint Active exercises to unaffected joints No active movements to the affected muscle

Cont.. During the next 24 to 48 hours : Pressure bandage is removed and active exercise Stretching within the limits of pain Thermotherapy :ultrasound , short wave diathermy Nonweight bearing on crutches is slowly started.

Cont.. Between 48 – 72 hours : Active movements are encouraged Partial weight bearing After 72 hours : Pressure bandage – totally removed Progressive resisted exercise by taking 10 to 12 repetition maximum (RM) , is practised Full weight bearing After full movement is regained , the patient is allowed to walk and jog Full functional activity regained by 4 – 6 weeks.

GRADE FOUR STRAIN : Cause : By severe trauma PATHLOGY : Muscle – complete tear Fascia – torn Bleeding – more Swelling - gross

Clinical feature : Pain – excruciating Tenderness – severe Snapping sound – present Palapable gap between the muscle Severe loss of function Muscle contraction – absent Muscle spasm – severe Joint function – not lost

TREATMENT: Surgery : involbes opening the rupture site , evacuating the haematoma , and suturing the fascial sheath. Direct muscle repair is not done Compression bandage and immobilised for 2 -3 weeks Active exercise to the unaffected joints Slow rhythmic isometric exercise to the affected muscles Non weight bearing after 48 hours.