Types and Treatment of Soft Tissue Injuries
Closed (skin intact) soft tissue injuries are a common problem for patients seen in healthcare clinics. There are two basic types of soft tissue injuries. Those that occur from acute sudden trauma or injuries due to repetitive overuse. Both types result in inflammation of the tissue involved.
Inflammation is the standard initial response of the body’s immune system to injury. The purpose of the inflammatory response is to limit the extent of damage from the injury and to initiate the sequence of physiologic events that begin repair and regeneration of the cells of the damaged tissue. The four cardinal signs of inflammation are pain, redness, swelling and local heat.
Upon tissue trauma, the damaged cells release chemicals that cause vasodilatation; that is, arteries in the area of trauma enlarge, increasing blood flow to the area. The increased blood flow is to bring more immunologic cells and chemicals into the area to begin the healing process. Of course, the increased blood flow causes the redness and heat. These arteries also become more permeable in order to release inflammatory substances to the areas of the damaged cells. This process results in edema (swelling) and the swollen tissue compresses nerves causing pain. Pain also results from the irritating effects of the biochemicals that are released from the traumatized cells.
Specialized cells from the immune system function to “clean-up” the debris from the damaged cells. In the repair phase, stem cells are directed to the area and evolve to duplicate and replace the cells that were damaged. Frequently, the immune response is “over-done” and treatment involves the use of anti-inflammatory measures.
Many activities can lead to closed soft tissue injury. Some result from overzealous physical activity and others occur gradually from seemingly harmless repetitive tasks. The most common structures affected by soft tissue injuries are muscles, tendons, bursa, and ligaments. The types of injury are contusions (bruises), sprains, and strains.
A contusion (bruise) results from trauma that causes blood to leak from small blood vessels into the surrounding tissue. A sprain is over-stretched or torn ligaments. Ligaments are fibrous bands of tissue that connect and stabilize bones, most commonly around joints where one or more bones are in proximity. A very common example is an ankle sprain that occurs when one or more of the joint ligaments are stretched or torn.
A strain involves trauma to muscles or tendons. A tendon is a band of tissue that connects muscle to bone. The tendon acts as a pulley that causes movement of a bone when a muscle contracts. A common area of strain involves the large para-spinal muscles of the lower back.
The most common conditions that result from over use from repetitive motion are tendonitis and bursitis. An example of tendonitis is tennis elbow whereby the tendon on the outside of the elbow becomes inflamed from repetitive use of the muscles of the forearm. A frequently occurring bursitis occurs with rotator syndrome of the shoulder. Bursa are fluid filled sacs that function as cushions between muscles, tendons and adjacent bone.
To treat any of these conditions it is important to follow the four-step treatment protocol known by the mnemonic RICE:
· Rest – Stop any exercise or physical activities that requires use of the traumatized tissue. If the injury involves the lower extremities, limit weight bearing.
· Ice – Ice constricts the dilated blood vessels thus reducing swelling and pain. An ice pack, or frozen vegetables, should be applied for 20 minutes every 1-2 hours during the first 24 hours and every 2-4 hours for the next 48-72 hours.
· Compression – Wrap the affected area with an elastic bandage to reduce swelling and pain and for immobilization.
· Elevation – Keep the injured area elevated to heart height. If the area is kept dependent, the effects of gravity increase swelling.
Medications that reduce the inflammation and the pain and possibly hasten healing are NSAIDS (non-steroidal anti-inflammatory drugs). These medications help pain if taken sporadically but have anti-inflammatory effects if taken routinely in higher doses. We recommended ibuprofen OTC 200 mg 3 tabs three times daily with food (meal times). If pain remains intolerable, 2 tablets of Tylenol (acetaminophen) OTC 500 mg can be taken simultaneously with the ibuprofen. Studies have shown that this combination renders more effective analgesia than narcotics.
After 72 hours, at the beginning of the day, apply moist heat for 20-30 minutes. Heat restores circulation to the area and promotes healing. After any activity, return to ice packs. Reapply heat at bedtime.
Mild to moderate sprains or strains should show signs of recovery in 1-2 weeks but several weeks may be required to return to normal function. Occasionally,
corticosteroid injections and the assistance of physical therapy are required for full recovery.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers, a concierge internal medicine practice located at 1210 Commerce Dr. Suite 106, Greensboro, Ga. 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com