2. SOFT TISSUE
SOFT TISSUE – Soft tissue refers to those tissue which connect, support and
surrounds the other structures and organs of the body.
Soft tissue includes muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat,
blood vessels, and synovial membranes.
3. SOFT TISSUE INJURY
Soft tissue are the first target to face the ravage of direct or indirect trauma
4. Causes of SOFT TISSUE INJURY
There is to main cause of soft tissue injury .
1. direct, blunt or lacerative trauma – due to fall road traffic accident assault etc…
2. indirect trauma – due to sudden violent muscle pull when we are not aware of it .
6. MUSCLE & TENDON
Injury to muscle and tendon is classified into four categories on
the basis of damage to the muscle tissue.
1) Grade 1 strain ; superficial contusion
2) Grade 2 strain ; partial rupture of muscle or tendon .
3) Grade 3 strain ; complex rupture of muscle and tendon .
7. MUSCLE & TENDON
GRADE 1 SUPERFICIAL CONTUSION
This injury mostly result from blunt injury .
Pathology –
1. Intact fascia
2. Minimal intramuscular bleeding
Clinical features –
1. Localized pain and tenderness .
2. Reflex muscular spasm
3. Limitation of movement close to injury .
4. Typical signs of inflammation may be present .
Management –
1 .Treatment by applying RICE principle
8. MUSCLE & TENDON
GRADE 2 : Partial rupture
There is tearing of greater number of muscle fibres.
It may involve more than one muscle group .
Fascia may be partially torn.
Widespread intra- intermuscular bleeding may occur .
CAUSES
It is caused by incoordinated sudden violent muscle pull when the muscle is not
prepared for it
It can also caused by stabbing injury .
9. MUSCLE & TENDON
GRADE 2 : Partial rupture
MANAGEMENT
1 . During 1st 24hr
Immediate application of RICE principles .
Immobilization of the limb in a splint or a pressure isometric bandage .
2. From 48 to 72 hr
Pressure bandage is removed and pain free relaxed rhythmic movement are begun .
Light ADLs may be assisted with the normal limb are introduced
Non weight bearing crutch walking is started .
Ultrasound exposure are ideal to reduce pain as well as haematoma if present .
3. After 72 hr
Gradual introduction of self resistive exercise incorporating exercise patterns .
10. MUSCLE & TENDON
GRADE 3 : COMPLETE RUPTURE
CAUSES
It can caused by lacerative trauma or a violent stretching
It may occur through the tendon or close to its attachment to the bone
It can also caused by open fracture .
Clinical features
Severe localized pain and tenderness
A snapping sound may be heard by the therapist
A total loss of muscular contracture
Severe reflex muscular spasm
A visible gap in the continuity of a muscle at the site of rupture
Treatment
There is no alternative treatment of this except surgery
Initial management may include compression bandage elevation of limb etc…
11. LIGAMENTS
Injury to ligament is also known as sprain .
According to the degree of damage ligament injury is classified into 3 grade
1. GRADE 1 : minor sprain .
2. GRADE 2 : moderate sprain .
3. GRADE 3 : complete rupture.
12. LIGAMENTS
GRADE 1: MINOR SPRAIN
Grade 1 injury is mostly caused by sudden jerk or minor trauma .
CLINICAL FEATURES
1. Localised pain & tenderness
2. Slight swelling may be present .
3. Partial loss of function may be present due to pain .
TREATMENT
Application of RICE principle is most effective in acute phase
Limb elevation
After 48 hr cryotherapy must be replaced by thermotherapy
Full recovery is expected in 1 week or 10 days
13. LIGAMENTS
GRADE 2 MODERATE SPRAIN
In grade 2 injury ligament is either torn or detached from bone
CLINICAL FEATURE
1 moderate localized pain and tenderness .
TEST
1. Passive stress test is extremely painful with joint sepration .
2. This type of injury being common at the knee ‘walking or weight bearing is painful for the limb
TREATMENT
1. Application of rice principle
2. For compact immobilization cast is applied for 3-6 weeks
3. After removal of ROM exercise should be star in pain free range .
14. LIGAMENTS
GRADE 3 COMPLETE RUPTURE
It is more severe injury , in this type of injury ligament is completely break into two part
CLINICAL FEATURE
1. Profuse swelling with marked localised tenderness .
2. Unremitting pain and discomfort to the whole limb .
3. Positive stress test .
4. Marked joint instability .
5. Joint separation more than 10mm.
TREATMENT
1. Ultimate treatment is surgery
2. Physiotherapy treatment include isometric exercise , ROM exercises c
15. NERVES
Occasionally there may be injury or entrapment of the peripheral nerve as a result of soft tissue injury
CLASSIFICATION OF NERVE IJURY
Classification of nerve injury is based on the damage sustained by the nerve component , nerve functionality and the
ability of spontaneous recovery
1. ETIOLOGIC CLASSIFICATION ; 2. SEDDON’S CLASSIFICATION
Mechanical injury a. Neuropraxia
Crush| compression injury b. Axonotmesis
Laceration c. Neurotmesis
Stretched
High velocity trauma
Cold injury
Iatrogenic injury
Infectious
16. NERVES
NEUROPRAXIA
It is also known as grade 1 nerve injury .
Sustained compression
Intact axis cylinder
Reversible neural sign and symptoms
Intact nerve conduction
It do not show Wallerian degeneration
It show rapid and complete recovery
17. NERVES
AXONOTMESIS
It is also known as grade 2 nerve injury .
Axonal break down .
It shows Wallerian degeneration .
It shows good recovery but not complete.
18. NERVES
NEUROTMESIS
It is the grade 3 nerve injury
Complete section of the nerve takes place
Blocking of the nerve conduction
No recovery
20. NERVES
TREATMENT
Once the diagnosis and the extent of injury to the nerve are established the
following appropriate therapeutic procedure should be initiate
1. Adequate static or dynamic splint may be necessary to avoid over stretching
of the paralysed muscle
2. Reduction of muscle affected by the nerve injury should be started
3. Passive ROM movement
4. NMS should be applied
21. Blood vessel
Blood vessels and nerve are usually runs in close proximity to each other and at the certain site they are very
close to the bone . Therefore they always remain susceptible to injury ( fractures and dislocation are these
site )
CAUSES OF VASCULAR INJURY
Direct blunt injury
Compression by fractured bony fragment tight bandage or haematoma
Reflex vasospasm
Incomplete or partial tear
Rotic plaque
22. Blood vessel
CLINICAL FEATURES
Ecchymosis contusion ( a blunt injury of mild intensity causes damage to the capillaries with extravasation of
blood in the subcutaneous tissue
Haematoma
Localized cramp like pain
Rapidly increasing swelling
Pallor cold extremity
Muscle ischaemia
TREATMENT
Cold compression
Pressure bandage with limb elevation
Ligation of vessel
23. Bursa
A bursa is a thin membranous pouch or sac lined with the synovial membrane
It protect the tissue (especially the joint) from undue pressure trauma
It also protect from common expected repetitive frictional site like acromion , elbow, knee , heel .
CAUSES OF BURSITIS
1. Trauma
2. Infection
3. Metabolic disorder like gout
4. Abnormal external pressure
5. Inflammation disorder
CLINIAL FEATURES
1. Pain
2. decreased ROM
3. Redness
