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soft tissue injury

Soft tissue injury

Soft tissue injury is the damage of muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes throughout the body. Soft tissue refers to tissues that connect, support, or surround other structures and organs of the body. Soft tissue injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause a soft tissue injury. Common soft tissue injuries usually occur from bumps and bruises (contusions), small tears of muscles (strains), ligaments and tendons near joints (sprains) or overuse of a particular part of the body. Soft tissue injuries can result in pain, swelling, bruising and loss of function.

A soft tissue injury generally involves one or more of the following structures via sprain, strain or direct blows:

  • Muscle – muscles are made up of fibres that shorten and lengthen to produce movement of a joint. Muscles are attached to bone by tendons.
  • Tendon – tendons are tough bone of slightly elastic connective tissue that connect muscle to bone.
  • Ligament – ligaments are strong bands of inelastic connective tissue that connect bone to bone.

The biggest risk factor for soft tissue injury is a previous injury. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.

A player returning from injury or illness should refrain from activity until declared fit to play by a sports medicine professional.

Soft tissue injury key points:

  • Compartment syndrome and injuries that disrupt arterial supply threaten limb viability and may ultimately threaten life; these problems are very rare with sprains and strains.
  • Check for fractures and dislocations, and consider spontaneously reduced dislocations, as well as ligament, tendon, and muscle injuries; sometimes part of this evaluation is deferred until fracture is excluded.
  • Consider referred pain and examine the joints above and below the injured area, particularly if physical findings are normal in a joint that patients identify as painful (eg, shoulder pain in patients with a sternoclavicular joint injury).
  • X-rays are not necessary for many ankle sprains.
  • MRI can be used to diagnose soft-tissue injuries.
  • Immediately treat serious associated injuries and splint unstable injuries, and as soon as possible, treat pain.
  • Treat most minor injuries with PRICE (protection, rest, ice, compression, elevation).
  • Encourage patients, especially the elderly, to do the recommended exercises to maintain range of motion and muscle strength.
  • Many partial tears in ligaments, tendons, or muscles heal spontaneously.
  • Complete tears often require surgery to restore anatomy and function.
  • Prognosis and treatment vary greatly depending on the location and severity of the injury.

Soft tissue injury causes

Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.

  • Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples of an acute injury include sprains, strains, and contusions.
  • Overuse injuries occur gradually over time, when an athletic or other activity is repeated so often, areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.

Sprains

A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.

Sprains are classified by severity:

  • Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.
  • Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
  • Grade 3 sprain (severe): Complete tear of the ligament (all fibers are torn). This causes significant instability and makes the joint nonfunctional.

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for mild sprains includes PRICE (Protection, Rest, Ice, Compression, and Elevation) and sometimes physical therapy exercises. Moderate sprains often require a period of bracing. The most severe sprains may require surgery to repair torn ligaments.

Strains

A strain is an injury to a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to the bone. Strains often occur in your foot, leg (typically the hamstring) or back.

Tendon tears can be partial or complete:

  • With complete tears, the motion produced by the detached muscle is usually lost.
  • Partial tears can result from a single traumatic event (eg, penetrating trauma) or repeated stress (chronically, causing tendinopathy). Motion is often intact, but partial tears may progress to complete tears, particularly when significant or repetitive force is applied.

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon combination. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for strains, as do sports that feature quick starts, such as hurdling, long jump, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping, have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more serious tear.

Contusions (Bruises)

A contusion is a bruise caused by a direct blow or repeated blows, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. The discoloration of the skin is caused by blood pooling around the injury.

Most contusions are mild and respond well with the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Common Overuse Soft-Tissue Injuries

Tendinitis

Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulders and arms. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their legs and feet.

Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.

Bursitis

Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa in the shoulder, elbow, hip, knee or ankle to swell. Many people experience bursitis in association with tendinitis.

Bursitis can usually be relieved by changes in activity and possibly with anti-inflammatory medication, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually work well to relieve pain and swelling.

Although surgery is rarely necessary for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursitis returns after all nonsurgical treatments have been tried, your doctor may recommend removal of the bursa.

Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and surgical instruments. Your doctor will talk with you about the best procedure for your medical needs.

Soft tissue injury healing

Many partial tears in ligaments, tendons, or muscles heal spontaneously.

Complete tears often require surgery to restore anatomy and function.

Prognosis and treatment vary greatly depending on the location and severity of the injury.

Soft tissue injury prevention

Soft tissue injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning, training, and equipment. Other prevention tips include:

  • Use proper equipment. Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat.
  • Warming up, stretching and cooling down.
    • Warm up to prepare to exercise, even before stretching. Run in place for a few minutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow. Warming up increases your heart and blood flow rates and loosens up other muscles, tendons, ligaments, and joints.
    • Cool down. Make cooling down the final phase of your exercise routine. It should take twice as long as your warm up. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely. This phase of a safe exercise program should conclude when your skin is dry and you have cooled down.
    • Stretch. Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 10 to 20 seconds, then slowly and carefully release it. Inhale before each stretch and exhale as you release. Do each stretch only once. Never stretch to the point of pain, always maintain control, and never bounce on a muscle that is fully stretched.
  • Undertaking training prior to competition to ensure readiness to play.
  • Including appropriate speed work in training programs so muscles are capable of sustaining high acceleration forces.
  • Including appropriate stretching and strengthening exercises in weekly training programs.
  • Gradually increasing the intensity and duration of training. Avoid the “weekend warrior” syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks.
  • Rest. Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons to not exercise.
  • Balanced fitness. Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.
  • Maintaining high levels of cardiovascular fitness and muscle endurance to prevent fatigue.
  • Allowing adequate recovery time between workouts or training sessions.
  • Wearing appropriate footwear that is well fitted and provides adequate support and traction for the playing surface.
  • Wearing protective equipment, such as shin guards, mouthguards and helmets.
  • Ensuring the playing surface and the sporting environment is safe and clear of any potentially dangerous objects.
  • Drinking water before, during and after play. Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise.
  • Avoiding activities that cause pain.

Whether an injury is acute or due to overuse, if you develop symptoms that persist, contact your doctor.

Soft tissue injury signs and symptoms

Contusions, mild strains, and mild sprains cause mild to moderate pain and swelling. The swelling can become discolored, turning purple after a day and becoming yellow or brown days later. The person usually can continue using the body part. People with more severe symptoms, such as deformity, an inability to walk or use an injured part, or severe pain, may have a complete separation of bones that were attached within a joint (dislocation), partial separation of bones that were attached within a joint (subluxation), fracture, severe sprain or strain, or other severe injury. People with severe symptoms usually need medical care to determine the nature of the injury.

Types of soft tissue injuries include:

  • Acute injury: Injuries that occur from a known or sometimes unknown incident. Signs and symptoms develop rapidly.
  • Bruise (contusion, cork): Bruises are caused by a direct force applied to the body such as being kicked or making contact with a player and result in compression and bleeding into the soft tissue (hematoma). Signs and symptoms of contusion include swelling and/or discoloration.
  • Sprain: Sprains are caused when the joint is forced beyond its normal range of motion resulting in overstretching and tearing of the ligament that supports the joint. Signs and symptoms of sprains include swelling, loss of power or ability to bear weight, possible discolouration and bruising and/or sudden onset of pain.
  • Strain: Strains are caused by muscles over-stretching or contracting too quickly, resulting in a partial or complete tear of the muscle and/or tendon fibers.Signs and symptoms of strain include swelling, possible discolouration and bruising and/or pain on movement.
  • Overuse Injury: Overuse injuries occur as a result of repetitive friction, pulling, twisting, or compression that develops over time. Signs and symptoms of overuse injury will develop slowly, includes inflammation and pain.

Soft tissue injury complications

Serious complications of sprains, strains, and tendon injuries are unusual but may cause permanent limb dysfunction.

Acute complications (associated injuries) include the following:

  • Bleeding: Bleeding (eg, bruising, ecchymoses) accompanies all significant soft-tissue injuries.
  • Vascular injuries: Rarely, what appears to be a severe sprain may be a spontaneously reduced dislocation (eg, of the knee), which may be accompanied by a limb-threatening arterial injury.
  • Nerve injuries: Nerves may be injured when stretched or damaged by associated injuries such as fractures or dislocations or by blunt blows or crush injuries. When nerves are bruised (called neurapraxia), nerve conduction is blocked, but the nerve is not torn. Neurapraxia causes temporary motor and/or sensory deficits; neurologic function returns completely in about 6 to 8 weeks. When nerves are crushed (called axonotmesis), the axon is injured, but the myelin sheath is not. This injury is more severe than neurapraxia. Depending on the extent of the damage, the nerve can regenerate over weeks to years. Usually, nerves are torn (called neurotmesis) in open injuries. Torn nerves do not heal spontaneously and may have to be repaired surgically.
  • Compartment syndrome: Rarely, swelling under a cast is severe enough to contribute to compartment syndrome. Tissue pressure increases in a closed fascial space, disrupting the vascular supply and reducing tissue perfusion. Untreated compartment syndrome can lead to rhabdomyolysis, hyperkalemia, and infection. It can also cause contractures, sensory deficits, and paralysis. Compartment syndrome threatens limb viability (possibly requiring amputation) and survival.

Long-term complications include the following:

  • Instability: Various ligament injuries, particularly 3rd-degree sprains, can lead to joint instability. Instability can be disabling and increases the risk of osteoarthritis.
  • Stiffness and impaired range of motion: Stiffness is more likely if a joint needs prolonged immobilization. The knee, elbow, and shoulder are particularly prone to posttraumatic stiffness, especially in the elderly.
  • Osteoarthritis: Injuries that result in joint instability predispose to repeated joint stresses that can damage joint cartilage and result in osteoarthritis.

Soft tissue injury diagnosis

Diagnosis of sprains, strains, and tendon injuries should include a thorough history and physical examination, which are often sufficient for diagnosis.

In the emergency department, if the mechanism of injury suggests potentially severe or multiple injuries (as in a high-speed motor vehicle crash or fall from a height), patients are first evaluated from head to toe for serious injuries to all organ systems and, if needed, are resuscitated.

Patients should be checked for fractures and dislocations as well as ligament, tendon, and muscle injuries; sometimes parts of this evaluation are deferred until fracture is excluded.

The joint above and below the injured joint should also be examined.

Medical history

Medical history focuses on the:

  • Mechanism of injury
  • Past injuries
  • Timing of pain onset
  • Extent and duration of pain before, during, and after activity

Clinicians should also ask about use of drugs (eg, fluoroquinolones, corticosteroids) that increase the risk of tendon tears.

The mechanism (eg, direction and magnitude of force) may suggest the type of injury. However, many patients do not remember or cannot describe the exact mechanism.

If a patient reports a deformity that has resolved before the patient is medically evaluated, the deformity should be assumed to be a true deformity that spontaneously reduced.

A perceived snap or pop at the time of injury may signal a ligament or tendon injury (or a fracture). Serious ligamentous injuries usually cause immediate pain; pain that begins hours to days after the injury suggests minor injury.

Physical examination

Physical examination includes:

  • Vascular and neurologic assessment
  • Inspection for deformity, swelling, ecchymoses, open wounds, and decreased or abnormal motion
  • Palpation for tenderness, crepitus, and gross defects in bone or tendon
  • Examination of the joints above and below the injured area
  • After fracture and dislocation are excluded (clinically or by imaging), stress testing of the affected joints for pain and instability

If muscle spasm and pain limit physical examination (particularly stress testing), examination is sometimes easier after the patient is given a systemic analgesic or local anesthetic. Or the injury can be immobilized until muscle spasm and pain subside, usually for a few days, and then the patient can be reexamined.

Deformity suggests dislocation, subluxation (partial separation of bones in a joint), or fracture.

Swelling commonly indicates a significant musculoskeletal injury but may require several hours to develop. If no swelling occurs within this time, severe ligament disruption is unlikely.

Tenderness accompanies nearly all injuries, and for many patients, palpation anywhere around the injured area causes discomfort. However, a noticeable increase in tenderness in one localized area (point tenderness) suggests a sprain (or fracture). Localized ligamentous tenderness and pain when the joint is stressed are consistent with sprain. With some complete muscle or tendon tears, a defect may be palpable in the affected structure.

Gross joint instability suggests severe ligamentous disruption (or dislocation, which may have spontaneously reduced).

Stress testing is done to evaluate the stability of an injured joint; however, if a fracture is suspected, stress testing is deferred until x-rays exclude fracture. Bedside stress testing involves passively opening the joint in a direction usually perpendicular to the normal range of motion (stressing). Because muscle spasm during acutely painful injuries may mask joint instability, the surrounding muscles are relaxed as much as possible, and examinations are begun gently, then repeated, with slightly more force each time. Findings are compared with those for the opposite, normal side but can be limited by their subjective nature.

Findings can help differentiate between 2nd- and 3rd-degree sprains:

  • 2nd-degree sprains: Stress is painful, and joint opening is limited.
  • 3rd-degree sprains: Stress is less painful because the ligament is completely torn and is not being stretched, and joint opening is significant.

If muscle spasm is severe despite use of analgesia or anesthetic injection, the examination should be repeated a few days later, when the spasm has subsided.

Some partial tendon tears escape initial clinical detection because function appears intact. Any of the following suggests partial tendon tears:

  • Tendon tenderness
  • Pain when the joint is moved through its range of motion
  • Dysfunction
  • Weakness
  • Palpable defects

Partial tendon tears may progress to complete tears if patients continue to use the injured part. If the mechanism of injury or examination suggests a partial tendon injury or if the examination is inconclusive, a splint should be applied to limit motion and thus the potential for further injury. Subsequent examination, occasionally supplemented with MRI, may further delineate the extent of injury.

Attention to certain areas during examination can help detect commonly missed injuries.

Table 1. Examination for some commonly missed soft-tissue injuries

SymptomCharacteristic HistoryFindingInjury
Shoulder painSeizure
Electric shock
Restriction of passive external rotation with the elbow flexedPosterior shoulder (glenohumeral) dislocation, possibly bilateral
History of shoulder dislocation in patients > 40Inability to maintain a position at 90° of abduction when slight downward pressure is applied (drop-arm test)Acute complete rotator cuff tear
Various mechanisms (eg, pile-on injury in football, direct blow to joint)Tenderness over the sternoclavicular jointSternoclavicular joint injury
Most often, fall on the point of the shoulderTenderness over the acromioclavicular areaAcromioclavicular strain or disruption (shoulder separation)
Knee pain or swellingVarious mechanismsWeak or absent active knee extension and normal knee x-raysQuadriceps tendon rupture
Patellar tendon rupture

If physical examination is normal in a joint that patients identify as painful, the cause may be referred pain. For example, patients with a sternoclavicular joint injury may feel pain in their shoulder. Thus, clinicians should always examine the joint above and below the injury.

Imaging studies

Not all limb injuries require imaging. Many ankle sprains do not require x-rays during the initial evaluation because the probability of finding a fracture that would require a change in treatment is acceptably low; for ankle sprains, explicit, generally accepted criteria for obtaining x-rays (Ottawa ankle rules) can help limit x-rays to patients that are more likely to have a fracture requiring specific treatment. If imaging is needed, plain x-rays are done first.

Plain x-rays, which show primarily bone (and joint effusion secondary to bleeding or occult fracture), may be done to check for dislocations and fractures; plain x-rays do not show direct evidence of sprains but may show abnormal anatomic relationships that suggest sprains or other soft-tissue injuries. X-rays should include at least 2 views taken in different planes (usually anteroposterior and lateral views).

Additional views (eg, oblique) may be done when:

  • The evaluation suggests fracture and 2 projections are negative.
  • Additional views are routine for certain joints (eg, a mortise view for evaluating an ankle, an oblique view for evaluating a foot).
  • Certain abnormalities are suspected.

For lateral views of digits, the digit of interest should be separated from the others.

MRI can be done to identify soft-tissue injuries, including ligament, tendon, cartilage, and muscle injuries.

MRI or CT may also be done to check for subtle fractures.

Soft tissue injury treatment

Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the PRICE protocol is usually very effective. PRICE stands for Protection, Rest, Ice, Compression, and Elevation, although this practice is not supported by strong evidence.

  • Protection. Protection helps prevent further injury. It may involve limiting the use of an injured part, applying a splint or cast, and/or using crutches.
  • Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin. Ice is enclosed in a plastic bag or towel and applied intermittently during the first 24 to 48 hours (for 15 to 20 minutes, as often as possible).
  • Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage. Injuries can be compressed by a splint, an elastic bandage, or for certain injuries likely to cause severe swelling, a Jones compression dressing. The Jones dressing is 4 layers; layers 1 (the innermost) and 3 are cotton batting, and layers 2 and 4 are elastic bandages.
  • Elevation. To reduce swelling, elevate the injury higher than your heart while resting for the first 2 days in a position that provides an uninterrupted downward path allows gravity to help drain edema fluid and minimize swelling.
  • After 48 hours, periodic application of warmth (eg, a heating pad) for 15 to 20 minutes may relieve pain and speed healing.

First-Aid Treatment

Contusions, mild strains, and mild sprains can be treated at home with protection, rest, ice, compression, and elevation (PRICE protocol), which speeds recovery and decreases pain and swelling. If a fracture, severe strain, severe sprain, subluxation (partial dislocation), or dislocation is a possibility, a splint should be applied until medical help is available. PRICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage within the joint.

In the first 48-72 hours, the No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

  • Heat: Applying heat to the injured area can cause blood flow and swelling to increase.
  • Alcohol: Alcohol can inhibit the ability to feel if the injury is becoming more aggravated, as well as increasing blood flow and swelling.
  • Re-injury: Avoid any activities that could aggravate the injury and cause further damage.
  • Massage: Massaging an injured area can promote blood flow and swelling, and potentially cause more damage if done too early.

This regime should be used for all ligament sprains, muscle sprains and muscle bruises. Referral for bumps and bruises which occur in sport or physical activity, other than those which are minor is recommended.

Immobilization

Immobilization decreases pain and facilitates healing by preventing further injury.

First-degree sprains are immobilized briefly if at all. Early mobilization is best. Mild 2nd-degree sprains are often immobilized with a sling or splint for a few days. Severe 2nd-degree and some 3rd-degree sprains and tendon tears are immobilized for days or weeks, sometimes with a cast. Many 3rd-degree sprains require surgery; usually, immobilization is only adjunctive therapy.

A cast is usually used for injuries that require weeks of immobilization. Rarely, swelling under a cast is severe enough to contribute to compartment syndrome. If clinicians suspect severe swelling under a cast, the cast (and all padding) is cut open from end to end medially and laterally (bivalved).

Patients with casts should be given written instructions, including the following:

  • Keep the cast dry.
  • Never put an object inside the cast.
  • Inspect the cast’s edges and skin around the cast every day, and report any red or sore areas.
  • Pad any rough edges with soft adhesive tape, cloth, or other soft material to prevent the cast’s edges from injuring the skin.
  • When resting, position the cast carefully, possibly using a small pillow or pad, to prevent the edge from pinching or digging into the skin.
  • Elevate the cast whenever possible to control swelling.
  • Seek medical care immediately if pain persists or the cast feels excessively tight.
  • Seek medical care immediately if an odor emanates from within the cast or if a fever, which may indicate infection, develops.
  • Seek care immediately for progressively worsening pain or any new numbness or weakness.
  • Good hygiene is important.

A splint can be used to immobilize some stable injuries, including some suspected but unproven fractures, rapidly healing fractures, sprains, and other injuries that require immobilization for several days or less. A splint is noncircumferential; thus, it enables patients to apply ice and to move more than a cast does. Also, it allows for some swelling, so it does not contribute to compartment syndrome. Some injuries that ultimately require casting are immobilized initially with a splint until most of the swelling resolves.

A sling provides some degree of support and limits mobility; it can be useful for injuries that are adversely affected by complete immobilization (eg, for shoulder injuries, which, if completely immobilized, can rapidly lead to adhesive capsulitis [frozen shoulder]).

A swathe (a piece of cloth or a strap) may be used with a sling to prevent the arm from swinging outward, especially at night. The swathe is wrapped around the back and over the injured part.

Prolonged immobilization (> 3 to 4 weeks for young adults) of a joint can cause stiffness, contractures, and muscle atrophy. These complications may develop rapidly and may be permanent, particularly in the elderly. Some rapidly healing injuries are best treated with resumption of active motion within the first few days or weeks; such early mobilization may minimize contractures and muscle atrophy, thus accelerating functional recovery. Physical therapists can advise patients as to what they can do during immobilization to maintain as much function as possible (eg, elbow, wrist, and hand range-of-motion exercises if the shoulder is immobilized).

After immobilization, physical therapists can help patients regain or improve range of motion and muscle strength and can provide exercises to strengthen and stabilize the injured joint and thus help prevent recurrence and long-term impairment.

Figure 1. Joint immobilization

Joint immobilization

The elderly

The elderly are predisposed to musculoskeletal injuries in general because of the following:

  • A tendency to fall frequently (eg, due to age-related loss of proprioception, adverse effects of drugs on proprioception or postural reflexes, orthostatic hypotension)
  • Impaired protective reflexes during falls

For any musculoskeletal injury in the elderly, the goal of treatment is rapid return to activities of daily living.

Immobility (joint immobilization) is more likely to have adverse effects (eg, stiffness, contractures, muscle atrophy) in the elderly.

Early mobilization and physical therapy are essential to recovery of function.

Coexisting disorders (eg, arthritis) can interfere with recovery.

Rehabilitation and return to play

You can expect full recovery from most soft tissue injuries in one to six weeks. The length of time depends on your age, general health and the severity of the injury.

In significant injuries, a plaster cast or splint may be needed. Sometimes surgery is the best option.

Surgery

Many 3rd-degree sprains and tendon tears require surgical repair.

Arthroscopic surgery is sometimes used. This procedure is used most often to repair ligaments or menisci in the knee.

Health Jade Team

The author Health Jade Team

Health Jade