Soft-tissue injury refers to injury of muscles, ligaments and tendons. Ligaments are connective bands that connect bone → bone, while tendons connect muscle → bone.
Soft-tissue injuries can be classified as:
- Strains
- Sprains
- Contusions
- Tendonitis
- Bursitis
Strains
A strain is an injury to muscle/musculotendinous junction.
This is due to:
- Overuse
- Stretching
- Force
They typically involve superficial muscles that work across 2 joints, for example, rectus femoris, semitendinosus, gastrocnemius.
The management is RICE:
- Rest
- Ice
- Compression
- Elevation
However, if the muscle is torn, then surgical repair is needed.
Sprains
A sprain is a partial ligament tear due to sudden/violent twisting of the ligament.
The most commonly affected areas affected are ligaments near the ankles, wrists and knees.
We can classify sprains into 3 degrees:
1º - mild tenderness
2º - moderate tenderness and swelling
3º - severe pain, swelling and joint instability
The management is RICE:
- Rest
- Ice
- Compression
- Elevation
However, if the ligament is torn, then surgical repair is needed.
Contusions
A contusion is a soft-tissue injury due to blunt force.
It results in pain, tenderness, swelling, bruising (internal bleeding).
The management is RICE:
- Rest
- Ice
- Compression
- Elevation
Tendonitis
Tendonitis, as the name implies, is the inflammation of the tendon due. It often occurs due to overuse of the tendon with repetitive motions.
Some common conditions involving tendonitis are:
- Tennis elbow (lateral epicondylitis) - inflammation of the extensor tendon.
- Golfer’s elbow (medial epicondylitis) - inflammation of the flexor tendon.
- Swimmer’s shoulder (subacromial impingement/painful arc) - inflammation of the rotator cuff tendons.
- Jumper’s knee (patellar tendonitis) - inflammation of the patellar tendon.
Management includes:
- Rest
- Compression
- Anti-inflammatory drugs - NSAIDS or steroids.
Bursitis
Bursae are fluid-filled sacs that are filled with synovial fluid. These sacs lubricate joints to reduce friction and facilitate movement.
Bursitis also occurs due overuse or due to direct trauma.
Management also is RICE and anti-inflammatories.
It may also be sometimes caused by infection. Antibiotics will also be warranted if this is the case.
🔍 Investigations
Soft-tissue injuries are diagnosed clinically based on history and presentation. They are then confirmed using imaging.
- X-ray - to exclude other pathologies.
- 🏆 MRI - this is the gold-standard, especially for ligamentous injuries.
- USS - for non-ligamentous injuries it may be good. It is first-line in the groin and musculotendinous areas.