What Are Soft Tissue Injuries?

The Difference Between Acute Traumatic Injuries and Overuse Injuries

Twisted ankle
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Soft tissue injuries are trauma to any skin, muscle, tendon, or ligament in the body. These are neither fractures, which would be injuries of hard (bone) tissue, nor are these injuries to internal organs (brain, heart, stomach, intestines, etc.).

The mechanisms of injury (MOI) can be acute trauma (external force applied to the body) or an overuse injury, which can be from physical activity, such as in sports or industrial settings.

Acute trauma is always a sudden onset, but overuse injuries come on during repetitive use. Even though overuse injuries are not from direct force, we still consider this a form of repetitive trauma rather than illness.

Types of Soft Tissue Injuries

The most common soft tissue injuries from acute trauma are lacerations, avulsions, abrasions, and contusions. Lacerations, avulsions, and abrasions are forms of open soft tissue injuries, where the tissue has been separated and leads to a loss of blood and open wounds that can become infected. Bleeding can be severe enough to lead to shock. Lacerations and avulsions often require sutures to heal properly, without scarring.

Contusions, on the other hand, do not have open wounds. Bleeding, if present, is trapped within the tissues and can lead to swelling and can also create pressure on other blood vessels, which reduces blood flow to tissues surrounding the injury.

Sprains are a form of acute traumatic injury that come from applying leverage rather than striking a blow to the tissues. It's still trauma, but it's different than lacerations or contusions.

Strains and tendinitis are typical overuse injuries. There isn't a unique traumatic incident to indicate the onset of the injury.

Overuse injuries come on through stressing muscle or other connective tissues through their limits until there is an irritation or injury that reduces functionality and requires healing, with or without treatment, before the tissue can be used again to its full capacity.

Signs and Symptoms of Acute Traumatic Soft Tissue Injuries

  • Lacerations have jagged, uneven edges and the wound is open to the layers of soft tissue below the surface of the skin. Open wounds are the easiest injuries to identify.
  • Abrasions only affect the layers of skin and are like burns. First degree affects only the epidermis. Second degree affects the epidermis and the dermis. Third degree affects all three layers of the skin. Abrasions can also be referred to as friction burns, since that's basically what they are.
  • Avulsions take out chunks of skin and potentially muscle. One way to picture an avulsion is to picture a flap of skin that is only attached to the body on one side, but is otherwise completely disconnected.
  • Contusions are clear because of their discoloration (bruising) and often because of their swelling.
  • Sprains happen at joints (ankles, wrists, elbows, shoulders, etc.) and look like contusions with swelling and bruising. Unlike contusions, however, there isn't a direct force trauma. Instead, some sort of leverage trauma incident causes an acute over-stress of the connective tissues (ligaments and tendons) of the joint. Twisting or rolling an ankle is one of the most common types of sprains. In some cases, pain is the primary indicator of injury for a sprain.

    Signs and Symptoms of Overuse Soft Tissue Injuries

    There are several examples of common overuse injuries. Most of these are irritations related to tendinitis (inflammation of a tendon), bursitis (inflammation of the bursa, fluid-filled cushion pads in the joints), epicondylitis (irritation of the epicondyle, which surrounds the rounded parts of the bones in a joint), muscle strains, or muscle tears. Tennis elbow (lateral epicondylitis) is an example of one of the more well-known overuse injuries.

    Overuse injuries can occur all over the body and it's very hard to pin down one set of signs and symptoms.

    Here are a few things to look for:

    • Pain
    • Limited range of motion
    • "Popping" or "snapping" feelings
    • Swelling
    • Bruising

    In some cases, overuse injuries can be treated with RICE or METH depending on your personal preference pending more evidence to clearly pick a winner between these two treatment options. The one thing both treatment regimens agree on is elevation. The biggest difference between the two is cold or heat.

    Source:

    Marušic, A. Citius, altius, fortius: overuse injuries of the musculoskeletal systemThe Lancet , Volume 363 , Issue 9408 , 577

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