Soft tissue injuries occur from blunt trauma (blow, kick, fall) that rupture small vessels, causing bleeding in soft tissues → ecchymosis (bruising) and swelling.
Key terms:
Contusion: bruising from direct impact with vessel rupture.
Strain: injury to a muscle group or tendon from overuse, overstretching, or excessive stress (commonly called a pulled muscle).
Sprain: injury to ligaments surrounding a joint.
Purpose of management across contusions, strains, and sprains: protect the area and prevent further injury; support the joint; control bleeding and edema; monitor neurovascular status.
Strain vs sprain (definitions and distinctions)
Strain:
Injury to muscle or tendon from overuse, overstretching, or excessive stress.
Degrees (grades) of strain: I, II, III (described in class; know what strain is and how it differs from sprain).
Sprain:
Injury to ligaments (not tendons) surrounding a joint.
Mechanism: twisting motion or hyperextension of a joint.
Ligaments connect bone to bone; tendons connect muscle to bone.
Result: joint instability when ligament is injured.
A note on grading (sprain):
Grade I: stretch or slight tearing of ligament fibers.
Grade II: more severe with partial tearing.
Grade III: complete tear/rupture.
Contusions, strains, and sprains: acute management
General approach: protect, rest, and gradually mobilize; use PRICE or RICE principles.
RICE: Rest, Ice, Compression, Elevation (no explicit protection component).
Ice/cryotherapy:
Ice/cold packs: use for no longer than 20 ext{ minutes} at a time.
Protect skin with a barrier (towel) to avoid cold injury.
Compression:
Use appropriately fitted compression bandages; avoid excessive tightness that could cause circulatory compromise.
Elevation:
Elevate the affected part at heart level to reduce swelling.
Splinting/immobilization:
Use a sling, brace, or splint to immobilize the affected area and protect from further injury.
Medications:
NSAIDs commonly used; monitor for bleeding (e.g., in stool).
Document any decrease in sensation or motion or an increase in pain; report immediately due to risk of compartment syndrome.
Monitoring and documentation:
Neurovascular checks at baseline and with any change; document changes and alert primary provider promptly.
Sudden increases in pain despite analgesia, numbness/tingling, edema escalation: red flags.
Joint dislocations and subluxations
Dislocation: articular surfaces of distal and proximal bones are out of anatomic alignment.
Subluxation: partial, incomplete dislocation.
Medical emergency: delayed reduction can risk avascular necrosis (AVN) due to ischemia of the bone.
Signs/symptoms: acute pain, abnormal joint position, reduced range of motion; bilateral assessment often reveals abnormalities.
Diagnosis: X-ray to confirm; do not reduce without imaging if possible.
Reduction: often performed in the ER with analgesia/sedation (e.g., twilight anesthesia); follow with repeat X-ray and immobilization.
Pre/post-reduction assessment:
Assess peripheral pulses and capillary refill before reduction and again after.
Nursing/medical priorities:
Immobilize joint at scene and during transport; obtain informed consent; provide analgesia.
Neurovascular status every 15 minutes during acute management until stable.
Be vigilant for signs of deterioration (e.g., diminishing pulses) and escalate immediately.
Rotator cuff tears
Anatomy: rotator cuff consists of four muscles that stabilize and move the shoulder; tears may be acute or chronic from repetitive stress.
Symptoms: insidious aching pain worsened by use; tenderness on palpation; reduced ROM and strength.
Evaluation: bilateral joint assessment; may require imaging (X-ray, MRI; ultrasound/MUS).
Management:
Initial/conservative: physical therapy, NSAIDs, activity modification, and surveillance.
Corticosteroid injections into the shoulder joint for symptom relief.
Surgery if conservative management fails.
Postoperative immobilization: sling or shoulder immobilizer for 4 ext{ to } 6 ext{ weeks}; some devices immobilize the arm to the torso to prevent lifting.
Rehab: long course, typically 3 ext{ to } 6 ext{ months}; success depends on patient commitment to therapy.
Education: importance of PT, realistic expectations, and adherence to rehab plan, especially in elderly patients to prevent atrophy and loss of function.
Knee ligament injuries: MCL/LCL, ACL, PCL, and meniscal injuries
Collateral ligaments (MCL/LCL):
Presentation: acute onset of pain, joint tenderness, instability, inability to bear weight.
Management: PRICE or PRICE-like protocol; analgesia; protect joint; evaluate for fracture.
Healing: 8 ext{ to } 12 ext{ weeks}; possible surgical intervention if persistent instability.
Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL):
Classic signs: a popping sensation during injury, rapid swelling within 2 ext{ hours}; joint effusion.
Immediate management: PRICE/PRICE, NSAIDs, stabilization until fracture ruled out.
Treatment decisions: active younger patients often opt for surgical reconstruction; older/less active patients may pursue non-surgical therapy.
Meniscal injuries (medial/lateral menisci)
Anatomy: crescent-shaped cartilage (discs) between femur and tibia; acts as shock absorbers.
Mechanism: twisting, squatting, impact leading to tear/detachment; can cause