1. SOFT TISSUE INJURY
BY : DR SANJEEV

2. SOFT TISSUE INJURY
CLASSIFICATION :
STRAINS
SPRAINS
RUPTURES
CONTUSION

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

4. 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

5. 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

6. 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.

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

8. 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.

9. 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

10. 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.

11. 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.

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

13. 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

14. 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 weeks
Active exercise to the unaffected joints
Slow rhythmic isometric exercise to the affected muscles
Non weight bearing after 48 hours.