Soft tissue injuries

Soft Tissue Injuries. Some of the more common soft tissue injuries are sprains, strains, contusions, tendonitis, bursitis, and stress injuries, caused by damaged tendons, muscles, and ligaments. A sprain is a soft tissue injury to the ligaments. Certain sprains are often associated with small fractures. This type of injury is normally associated with a localized trauma event. The severity of the sprain depends on how much of the ligament is torn and to what extent the ligament is detached from the bone. The areas of the human body that are most vulnerable to sprains are ankles, knees, and wrists. 

Tissue Conditioners. Tissue conditioners are gels designed to alleviate the discomfort from soft-tissue injury, eg, extractions. Under a load, they exhibit viscous flow, forming a soft cushion between the hard denture and the oral tissues. The polymer in tissue conditioners is often the same as that used for resilient liners. The liquid is a plasticizer containing an alcohol of low volatility (219,220). 

The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living may lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1-3 While tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.3,4 Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chap. 54) or osteoarthritis (see Chap. 55), are discussed elsewhere in this text. 

Inflammation is a common pathway in soft-tissue injury of musculoskeletal disorders. Inflammatory processes lead to two outcomes swelling and pain. Inflammatory processes... 

Signs and Symptoms of Acute Soft-Tissue Injury (Strains,... 

Topical NSAIDs are available commercially in Canada and Europe. In the United States, these agents may be compounded in specialty pharmacies.35 These agents exert a local anti-inflammatory and analgesic effect.36-38 In soft-tissue injury such as strains and sprains, topical NSAIDs are superior in efficacy to placebo and similar to oral NSAIDs.36,37 Tissue concentrations of topical NSAIDs are high enough to produce anti-inflammatory effects, but systemic concentrations after application remain low.36-38... 

It is indicated in rheumatoid and osteoarthritis, ankylosing spondylitis, mild to moderate pain including dysmenorrhoea, soft tissue injuries, fractures and postoperative analgesia. 

It is indicated in osteoarthritis, rheumatoid arthritis, inflammatory conditions and soft tissue injuries. 

Diclofenac Transdermal patch For osteoarthritis soft tissue injury... 

Wang, M. C, Pins, G. D., and Silver, F. H. (1994). Collagen fibers with improved strength for the repair of soft tissue injuries. Biomaterials 15,507-512. 

IVIaxillofacial Assess for fractures and soft-tissue injury. Management may be delayed until the patient is safely stabilized. Place a gastric tube orally in patients with suspected or confirmed facial fractures. Reassessment is necessary as facial fractures may not be identified early during the primary and secondary surveys. 

Musculoskeletal All extremities, the pelvic ring, peripheral pulses, and thoracic and lumbar spine should be assessed. If necessary. X-rays should be obtained when the patient is stabilized. Hemorrhage from pelvic fractures is not uncommon. Hand, foot, and wrist fractures and soft tissue injuries may be missed. Frequent reevaluation should take place to identify these. 

Falls are common in the elderly and are often multifactorial.There is a concern about patients who fall because the complications are significant. Complications include fractures, soft tissue injuries, immobilization and hospital-acquired illness, institutionalization, and even death from additional complications such as pneumonia. ° It is difficult to determine the percentage of patients who fall because many falls do not result in injury and are never reported. 

BerteUi G, Gozza A, Forno GB, Vidili MG, Silvestro S, Venturini M, Del Mastro L, Garrone O, Rosso R, Dini D. Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs a prospective clinical study. J Chn Oncol 1995 13(ll) 2851-5. 

Local venous effects, including erythema, tenderness, and discomfort, can occur at the injection site during paclitaxel infusion (13). Inflammation is evident within hours and usually resolves within 21 days. Inflammation occurs in areas of drug extravasation along with prolonged soft tissue injuries, and necrotic changes have been reported in one patient at the site of extravasation (41). Inflammation is most likely to be due to the drug, but the Cremophor EL vehicle may be implicated, as it produces mild inflammation in animals (41). 

There is little information on the treatment of extravasation of paclitaxel, as it has not been common during clinical trials. However, a soft-tissue injury occurred in one patient at the site of previous extravasation after treatment with paclitaxel in a different Umb (42). This resolved within 7 days. 

Ajani JA, Dodd LG, Daugherty K, Warkentin D, Uson DH. Taxol-induced soft-tissue injury secondary to extravasation ... 

Shapiro J, Richardson GE. Pachtaxel-induced recall soft tissue injury occurring at the site of previous extravasation with subsequent intravenous treatment in a different hmb. J Clin Oncol 1994 12(10) 2237-8. 

When used at recommended doses, naproxen appears to be an effective NSAID in horses but the clinical effects are slow to develop, often requiring a number of days of therapy (Table 14.1) (Plumb 1999). In one study, naproxen was shown to be more efficacious than either placebo or phenylbutazone in the treatment of experimentally induced myositis (Jones Hamm 1978). Although the evidence is not compelling, anecdotal reports indicate that naproxen may be particularly effective in the treatment of soft-tissue injuries and myositis. 

Soft-tissue injury is often brought on by an event involving lifting or twisting. 

Methylprednisolone has recently (November 2006) been added to the list of drugs that registered podiatrists can administer by injection into soft tissue injury. Registered physiotherapists can administer corticosteroids by injection according to patient group directions. 

A 72-year-old female patient attends the Falls Clinic for investigation into the cause of falls she has been having recently. She has had three falls over the past 18 months and has sustained soft tissue injuries each time and a fractured wrist 12 months ago. 

The information that must be included in a PGD for a physiotherapist follows the same general rules that are listed in the podiatric example given earlier in this chapter. Specific examples of drugs that might be included in a physiotherapy PGD are triamcinolone acetonide lOmg/ml and methylprednisolone acetate 40 mg/lidocaine hydrochloride 10 mg/ml, which are administered by intra- or extra-articular injection. Both of these drugs are used for the treatment of inflammatory conditions such as soft tissue injuries and isolated joint inflammation (see Chapter 7). 

Mefenamic acid (Ponstel, Ponstan [United Kingdom], Dysman [United Kingdom]) and meclofenamate sodium [Meclomen] have been used mostly in the short-term treatment of pain in soft-tissue injuries, dysmenorrhea, and in rheumatoid and osteoarthritis. These drugs are not recommended for use in children or pregnant women. 

Clinical trials with nabumetone (Relafen) have indicated substantial efficacy in the treatment of rheumatoid arthritis and osteoarthritis, with a relatively low incidence of side effects. The dose typically is 1000 mg given once daily. The drug also has off-label use in the short-term treatment of soft-tissue injuries. 

Head Soft tissue injury Tender, thickened, or pulseless temporal artery Obliteration of flow through the trochlear artery with compression of the preauricular or supraorbital vessels Anhidrosis Tongue laceration Head trauma Temporal arteritis ICA occlusion or severe stenosis with retrograde ophthalmic flow CCA dissection with damage to sympathetic fibers or brainstem stroke with interruption of sympathetic tract Consider seizure as the cause of the neurologic deterioration... 

Two men, successfully treated with 100-mg doses of sildenafil for erectile dysfunction, experienced prolonged erections after orgasm while also taking dihydrocodeine 30 to 60 mg every 6 hours for soft tissue injuries. One of them had two erections lasting 4 and 5 hours, and this did not occur on subsequent occasions when the dihydrocodeine was stopped. The other had 2 to 3 hour erections on three occasions during the first week of dihydrocodeine use, but no problems over the next 2 weeks while continuing to take the dihydrocodeine. The reasons are not understood. 

A risk factor is defined as an attribute or exposure that increases the probability of a disease or disorder (Putz-Anderson, 1988). Biomechanical risk factors for musculoskeletal disorders include repetitive and sustained exertions, awkward postures, and application of high mechanical forces. Vibration and cold environments may also accelerate the development of musculoskeletal disorders. Typical tools that can be used to identify the potential for development of musculoskeletal disorders include conducting work-methods analyses and checklists designed to itemize undesirable work site conditions or worker activities that contribute to injury. Since most of manual work requires the active use of the arms and hands, the structures of the upper extremities are particularly vulnerable to soft tissue injury. WUEDs are typically associated with repetitive manual tasks with forceful exertions, such as those performed at assembly lines, or when using hand tools, computer keyboards and other devices, or operating machinery. These tasks impose repeated stresses to the upper body, that is, the muscles, tendons, ligaments, nerve tissues, and neurovascular structures. There are three basic types of WRDs to the upper extremity tendon disorder (such as tendonitis), nerve disorder (such as carpal tunnel syndrome), and neurovascular disorder (such as thoracic outlet syndrome or vibration-Raynaud s syndrome). The main biomechanical risk factors of musculoskeletal disorders are presented in Table 22. 

Shieh, S.J., Zimmerman, M.C., and Parsons, J.R., 1990. Preliminary characterization of bioresorbable and nonresorbable synthetic fibers for the repair of soft tissue injuries. J. Biomed. Mater. Res., 24 789-808. 

Currently, there are no universally accepted tolerance values for the neck for the various injury modes. This is not due to a lack of data but rather to the many injury mechanisms and several levels of injury severity, ranging from life-threatening injuries to the spinal cord to minor soft-tissue injuries that cannot be identified on radiographic or magnetic scans. It is likely that a combined criterion of axial load and bending moment about one or more axes will be adopted as a future FMVSS. 

Viano, D.C. and Lau, I.V., A Viscous Tolerance Criterion for Soft Tissue Injury Assessment, J. Biomeck, 21 387-399,1988. 

Butler, Durbin, and Helvacian (1996) use this distinction between diffieult-to-monitor and easy-to-monitor injuries to explore whether soft-tissue injury elaims correlate with level of benefits and spread of HMOs. They find in their 10-year, 15-state sample of workers compensation claims that the proportion of claims attributable to soft-tissue injuries rose from 44.7 percent of all claims in 1980 to 50.6 percent in 1989. Concurrently, the share of costs attributable to soft-tissue injuries rose from 41 pereent to 48.8 percent. The share of costs for injuries that crush or fracture a bone—easy-to-monitor claims—is the only category that declined between 1980 and 1989. Using a multinomial logit model, the authors determine that most of the increase in soft-tissue injury is attributable to the expansion of HMOs. Specifically, they ascribe the rise in such injuries to moral hazard response by HMO providers, who increase their revenue by classifying as woik-related injuries as many health conditions as possible. ... 

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