Management of soft tissue injury

บทคัดย่อ:

Soft tissue injury is an acute connective tissue injury that may involve muscle, ligament, tendon, capsular structures and/or cartilaginous structures. Knowing relevant pathophysiology of a healing process is important in developing an appropriate treatment. In general, soft tissue injuries can be categorized into three degrees, depending on the severity of injury. The first degree is a mild stretch or minor tear of soft tissue with mild hemorrhage. The second degree is a moderate tear with some restrictions of movement.
The most severe damage, the third degree, is an excessive stretch of soft tissue, causing a complete tear of the injured structure. After injury, the healing process is classified into three continuous, overlapping phases. They are inflammation, proliferation, and remodeling phases. Treatment is aimed to aid recovery and get the patients back to their normal activities as soon as possible without risks of re-rupture and chronic musculoskeletal impairments. The inflammatory phase composes of extremely complex vascular and cellular responses that take three to five days to complete. The aims of treatment for this phase are to minimize inflammation and to provide optimal healing conditions. These aims can be achieved by applying “PRICE”: protection, rest, ice, compression, and elevation, immediately after injury. Once inflammation has ceased the development and growth of new blood vessels and granulation tissue occur in the proliferation phase. Generally, this phase lasts two to four weeks. The aim of treatment for this phase is to provide optimal environment for a new tissue growth and orientation. Early mobilization is recommended
to provide mechanical load on regenerating tissue. Mechanical load causes cellular adaptation to external stress; thus, stimulates new fiber regeneration and orientation. In remodeling phase, the weak type III collagen is replaced by the strong type I collagen. The aim of treatment for this phase is directed towards quick and complete return to normal activities. Stretching and strengthening exercises within a limited degree of pain, are encouraged. With proper management for each stage of soft tissue healing, the risks of re-injury, time off work, and costs of treatment will be reduced. Read the rest of this entry »