Distinguishing Soft Tissue Dysfunction from Soft Tissue Injuries

Differentiate between the soft tissue injury and dysfunction:

Soft tissues are the type of tissues that are not calcified and hardened that connect and support bones as well as many internal organs (Peebles and Jonas, 2017).

Common example of soft tissues are muscles, tendons, ligaments, fascia, fibrous tissues nerves, synovial membrane, blood vessels and fats.

The two soft tissues dysfunction and the soft tissues injuries sound more less same, but there are potential differences between them.

Soft tissue dysfunction:

Soft tissue dysfunction can be referred as the mechanical derangement of soft tissues in which there is absence of any injury in the tissue (Warner et al. 2018). The possible causative factors associated with causing the soft tissue dysfunction are impaired or altered function of body framework or system, having postural impacts, bad biomechanics, neural compression and the excessive shortening that causes weakness or inhibition.

Soft tissues injuries:

Soft tissues injuries are fractures that occur in the cartilaginous, bony and soft tissues. The common example of soft tissue injuries are strains, tears and fractures (Peebles and Jonas, 2017).

1.2 Explaining the type of soft tissues injuries:

There are different kinds of soft tissue injuries:

Time dependent injuries:

Time dependent injuries are of the following types:

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Acute:

Acute soft tissues injury is the sudden injury that is associated with possible a trauma event (Meijer et al. 2018)

This type injury is associated with short duration and recent onset

This type of soft tissues injuries needs to be determined and diagnosed quickly for providing the immediate clinical support and treatment to patients with this type of injuries (Kim et al. 2017).

Through timely recognition and response to acute soft tissue injuries it is possible to reduce the pain and resolve the underlying issues

Chronic:

This type of soft tissues injures are considered as the long-term health condition that develop slowly and persist longer than the reasonable times for healing an soft tissue injury (Adolfsson et al. 2017).

Patients with chronic soft tissues injuries may experience frequent pain at the end of the year as well as month or patients may feel continuous pain

Here the emphasis of treatment shifts from curing process to effective pain management and rehabilitation of the patient

Fracture associated soft tissue injuries:

In this type of fracture, the associated soft tissue gets injured.

Ex: puncturing open fracture, nerve damage

Bursitis:

Sac is filled with fluid between tendon/muscle/bone, assisted with a smooth glide. This fluid filled sac is termed as bursae that are located around the joint (Lindau, 2017).

This type of fracture affects the bursae. Presences of bursae is associated with providing protection to the two joints friction while moving the bones.

Bursitis is the condition in which severer inflammation occurred in bursae thereby increasing the chances of friction between the two joints during the reportative movements (Kim et al. 2017).

EX; Bursitis generally occurs in elbow, hips and shoulders

Contusion:

Injuries occur in the ligament, bone and tendon.

It leads to the development a lump or bruise in the area if injury with discoloration od the skin (Patel et al. 2018).

The discoloration occurs due to blood pooling

This injury is associated with stiffness, swelling and muscle pain

Ex: blow to forehead leads to development of black eye

Dislocation:

Subluxation or complete out of location of the injured ligaments, tendon and bones

Dislocated joints cause severe damage in the blood vessel before they realign quicky and fairly.

Laceration:

Development of irregular tear on the sin

Puncture wounds:

The penetration of the skin occurred in this kind of injury

Compartment syndrome:

In this injury the swelling poses pressure on adjacent blood vessels thereby preventing or restricting the blood flow into the damaged limb. The injury immediate needs the clinical treatment and pain management otherwise the condition may be chronic and then it leads to fatal condition thereby increasing health risks for injured person.

1.3 Describing the common causes of soft tissues injuries:

There are different causes of soft tissues injuries such as:

Intrinsic:

Damage and injuries are caused from within the joints, tendons and ligaments (Kwak et al. 2017).

Ex: uncontrolled internal stress, over contracting and over stretching of muscles, repetitive overuse

Extrinsic:

Injury occurs due to the collision with the blunt or sharp objects that hurt the internal muscles, tendons, cartilages and ligaments (Abdullajanov et al. 2021).

Ex: damage or injury caused due to collision with the racquet or ball.

Acceleration:

Injuries are caused due to the explosive power

EX: power lifting and step aerobics.

Deceleration

The injury that is associated with whiplash that involved the transfer of the deceleration ad acceleration forces.

Ex: this type of injury occurs during car accident in which body moved forward

Stretching:

This type of injury involves the strains due to the stretched or torn tendon or muscles (Zhu et al. 2018).

This stretching includes stretching cold, bouncing, over stretching of muscles and tendons.

Torsional stress:

This type of injury occurs due to the rotary forces on ligaments, joints and bones.

Ex: spiral fracture

Tensile strength:

The stress or pressure that a muscle can pose on the bones, ligaments and tendon throughput its stretching before getting injured.

Ex: inversion sprain

Overuse:

Injury caused due to over training, over starching and over contracting of muscles. Poor exercising techniques and structural anomalies are associated with occurring this injury

Blow compression:

Crising force, squeezing and direct forces.

1.5 Differentiate between severity of injuries:
Sprains:

This type of soft tissue injury occurs due to the awkward and disproportionate stretching in the ligaments (Lambert et al. 2017). Ligaments are associated with joints and bones thereby providing the flexibility to them. ligaments hold the bones and joints together thereby providing them the strength and support that is needed for conducting the necessary movement. Sprain is one of the most common types of soft tissue injury that can be categorised into different types based on thte severity of the pain.

Grade 1:

in this condition a few ligaments are damaged or affected by the overstretching or awkward movement of the ligaments thereby causing mild to low pain and discomfort (Sultan et al. 2017).

Grade 2:

Tear occurs in the ligaments which is more severe than that of the grade 1.

It causes the swelling in the injured muscles, discomfort and lessening in the joints and ligaments.

Grade 3:

This is the most severe soft tissue injury in which the complete tear occurred in the ligaments thereby causing the apparent swelling at the injured areas.

Injured person feels severe pain which is intolerable (Kurup et al. 2017)

Bruising and discoloration of skin also occur in the injured area

The swollen areas become sensitives to touch

The injured person needs the immediate clinical treatment otherwise the condition may be fatal.

Fracture:

Bones are broken down in many ways which poses severe stress and pressure on muscles. as muscles try to hold the broken bones together, the injured person experiences severer muscle pain and muscle spasm (Tang, 2017).

Different type of breakage in the bones can be caused such as partial and complete. Depending in the strength of the external forces the breakage of bones can range from shatter to crack which cause severe pain and discomfort (Peebles and Jonas, 2017).

Trauma, recurrent fall (in case of older people), underling pathology, medication overdose, immobility and lack of ability in maintaining proper body balance can be associated with causing this type of soft tissue injury

Partial:

Partial or incomplete breakages occurred in the bones which cause mild to moderate ranges of pain and discomfort (Warner et al. 2018).

Ex: hairline or greenstick

Complete:

The complete dislocation or departure of soft tissue structure thereby causing severe pain, swelling and discoloration of skin at the injured area

The complete structural breakages result into two or more parts

Severe pain, and discomfort.

Need immediate treatment and clinical support

Open:

Pierces occur on the skin

There is chance of skin infection due to bacterial colonisation at the injured area (Meijer et al. 2018)

Close:

Broken structured are still placed into the original location by ligament

Minimum movement and flexibility of the broken structure

No puncture and end alignment.

Comminute:

The injured soft tissue is shattered into three or more pieces.

1.5 Describe the common cause of soft tissues dysfunction:

Different causative factors are associated with causing soft tissue dysfunctions such as:

Posture, inactivity, work, severe stress, abnormalities in body composition, muscles hypotonicity and hypertonicity, recurrent falls, underlying pathology, habitual behaviours, overstretching and over contracting of muscles and ligaments, impaired joint mechanism, impaired tissue structure, impaired circulation, abnormalities in muscles and ligaments activities, lifestyle, postural; deformity and improper ways and irrelevant techniques of exercise (Kim et al. 2017).

1.6 Describe the signs and symptom soft tissues dysfunctions;

Following are the symptoms and signs of soft tissue dysfunction

Symptoms:

Postural deformity (Adolfsson et al. 2017)

Atrophy and muscles weakness:

Ranges of motion and impaired quality:

Local and radicular pain:

Referred pain:

Muscle imbalance

Posture defects

Bruising deformation

Reduced mobility

Tenderness on the palpation

Changes in the tissue texture

Myofascial hypotonicity or hypertonicity

Signs:

Weakness, tightness and stiffness of soft tissues, aches, discoloration of skin at the injured site, swelling of skin and apparent lump on the injured area

2.1 Describing the process of soft tissues repair:

Soft tissues repair occurs in four phases such as bleeding phase, inflammatory phase, the proliferation phase and remodelling phase

Bleeding phase:

Bleeding is the first phase of the soft tissues repair and remodelling process.

Its is the shortest of all the other phases of soft tissue repair (Kim et al. 2017).

In case of others tissues it is not necessary that bleeding will occur after the injury, but in case of soft tissue, immediate after the injury bleeding occurs.

The potential reason behind bleeding after the injury in soft tissues is the tearing in the blood vessels that surround the soft tissue.

The duration of bleeding varies in in different types of soft tissue. The clinical intervention shows that generally the soft tissue that are highly vascularised bleed longer than no-vascular tissues.

The normal duration of the soft tissue bleeding of 4-6 hours. Whereas there are some vascularised tissues that can bleed more than this duration.

Inflammatory phase:

Inflammatory phase is considered as the essential part of soft tissue repair process.

This phase; leads to development of the appropriate reaction to the injury (Lindau, 2017)

Many indicators are associated with initiating the inflammatory reaction such as mechanical irritation and minor trauma.

This phase has rapid onset that leads to increase its maximum reaction to injury

In case of vascularised soft tissue, the onset and resolution are faster and in case of the non-vascularise tissue the process is slower

Proliferation phase:

This is the most important phase which is associated with production of the repairing materials.

In case of the musculoskeletal injuries, this phase is associated with developing the scar or collagen fibres which are used in repairing the broken or damaged soft tissue (Patel et al. 2018)

Although the proliferative phase is associated with rapid onset of repairing process, it takes log times for reaching its peak level.

Clinical intervention suggests that the more vascularisation in the soft tissue, the less times needed to the body system to reach the peak proliferation level.

At the peak stage, there is huge production of scar or collagen which then attach to the broken or injured soft tissue thereby involving in the repairing of soft tissue

Remodelling phase:

This phase is associated with proper rehabilitation of damaged or injured soft tissue thereby bringing them back to their normal position.

This phase is neither very reactive nor slower but this phase is strong associated with production of the organised and huge amount of collagen/scar that are used in remodelling of the injured soft tissue.

It takes 2-3 weeks to complete this phase

2.2 Describing the factors associated with soft tissue repair:

Different factors are associated with fastening the process of soft tissue repair. There factors are as follows:

Treatment: Undertaking proper surgery and following a proper medication regimen (Kwak et al. 2017)

Activity: proper movement of arms and leg under the instruction of physiotherapist

Timely diagnosis and response to the acute and chronic soft tissue injury

Sufficient rest

Correct and controlled stretches of muscles that are made under the instruction of physiotherapist

Rehabilitation programmes that can provides proper knowledges to client regarding how to manage their injuries independently

Compliance of clients by improving the self-management and self-help skill in them

Proper nutrition on regular basis, and a good dietary intake

Systematic and regular lifestyle

2.3 Explaining the importance of inflammatory processes:

Inflammatory process is most important process in the soft tissue repairing system (Abdullajanov et al. 2021). Inflammatory process is strongly associated with developing the host mechanism inside the body thereby preparing body to take proper safety measures to resists the adverse impacts of injuries and damages.

It is associated with resisting the spread of damage or injury into the body system thereby protecting the entire body system

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This phase is associated with disposing different pathogen and debris from the body by producing and secreting cytokines and other immune agents

Inflammatory process leads to the initiation of the remodelling process by instigating the production of scar and collagen fibre thereby healing other damages and injuries in the soft tissue.

Reference list:

Abdullajanov, B.R., Yusupov, K.A., Sadikov, R.A. and Yusupov, J.K., 2021. Results of Planimetric Studies in Treatment of Long-Term Non-Healing Purulent Wounds of Soft Tissue. Annals of the Romanian Society for Cell Biology, pp.5690-5698.

Adolfsson, L.E., Nestorson, J.O. and Scheer, J.H., 2017. Extensive soft tissue lesions in redislocated after simple elbow dislocations. Journal of shoulder and elbow surgery, 26(7), pp.1294-1297.

Agrawal, A., Kumar, P., Singhal, R., Singh, V. and Bhagol, A., 2017. Animal bite injuries in children: review of literature and case series. International journal of clinical pediatric dentistry, 10(1), p.67.

Kim, J., Sung, D.J. and Lee, J., 2017. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), p.12.

Kurup, A.N., Schmit, G.D., Morris, J.M., Atwell, T.D., Schmitz, J.J., Weisbrod, A.J., Woodrum, D.A., Eiken, P.W. and Callstrom, M.R., 2017. Avoiding complications in bone and soft tissue ablation. CardioVascular and Interventional Radiology, 40(2), pp.166-176.

Kwak, Y.G., Choi, S.H., Kim, T., Park, S.Y., Seo, S.H., Kim, M.B. and Choi, S.H., 2017. Clinical guidelines for the antibiotic treatment for community-acquired skin and soft tissue infection. Infection & chemotherapy, 49(4), p.301.

Lambert, M., Hitchcock, R., Lavallee, K., Hayford, E., Morazzini, R., Wallace, A., Conroy, D. and Cleland, J., 2017. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews, 22(1-2), pp.76-85.

Lindau, T., 2017. Arthroscopic evaluation of associated soft tissue injuries in distal radius fractures. Hand Clin, 33(4), pp.651-658.

Meijer, H.A., Graafland, M., Goslings, J.C. and Schijven, M.P., 2018. Systematic review on the effects of serious games and wearable technology used in rehabilitation of patients with traumatic bone and soft tissue injuries. Archives of physical medicine and rehabilitation, 99(9), pp.1890-1899.

Patel, S., Caldwell, J.M., Doty, S.B., Levine, W.N., Rodeo, S., Soslowsky, L.J., Thomopoulos, S. and Lu, H.H., 2018. Integrating soft and hard tissues via interface tissue engineering. Journal of Orthopaedic Research®, 36(4), pp.1069-1077.

Peebles, R. and Jonas, C.E., 2017. Sacroiliac joint dysfunction in the athlete: diagnosis and management. Current sports medicine reports, 16(5), pp.336-342.

Sultan, A.A., Piuzzi, N., Khlopas, A., Chughtai, M., Sodhi, N. and Mont, M.A., 2017. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert review of medical devices, 14(12), pp.925-927.

Tang, P., 2017. The effect of ligament injuries on outcomes of operatively treated distal radius fractures. Am j orthop, 46(1), pp.E41-E46.

Warner, S.J., Garner, M.R., Schottel, P.C., Fabricant, P.D., Thacher, R.R., Loftus, M.L., Helfet, D.L. and Lorich, D.G., 2018. The effect of soft tissue injuries on clinical outcomes after tibial plateau fracture fixation. Journal of orthopaedic trauma, 32(3), pp.141-147.

Zhu, Y., Matsumura, Y., Velayutham, M., Foley, L.M., Hitchens, T.K. and Wagner, W.R., 2018. Reactive oxygen species scavenging with a biodegradable, thermally responsive hydrogel compatible with soft tissue injection. Biomaterials, 177, pp.98-112.


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