Makindo Medical Notes

📖 Definition

Soft tissue injuries involve damage to muscles, ligaments, tendons, or skin. They commonly result from trauma, overuse, or poor technique. Examples include sprains, strains, contusions, tendonitis, and bursitis.

🧾 Types of Soft Tissue Injuries

• 🦵 Sprains: Ligament injury (e.g., ankle sprain).
• 💪 Strains: Muscle or tendon injury (e.g., hamstring strain).
• 💥 Contusions: Bruising from blunt trauma.
• 🔥 Tendonitis: Overuse tendon inflammation (e.g., Achilles tendonitis).
• 🛑 Bursitis: Inflammation of bursae at joints.

⚡ Causes

• Direct trauma or impact (sports collisions, falls).
• Overuse or repetitive strain (e.g., runners, manual workers).
• Improper exercise technique or poor biomechanics.
• Sudden change in direction/speed (e.g., football, basketball).
• Weak conditioning or lack of flexibility.

👁️ Clinical Presentation

• Local pain and tenderness.
• Swelling and bruising (ecchymosis).
• Reduced range of motion.
• Weakness or difficulty weight-bearing.
• Sometimes deformity if severe tear/rupture.

🔎 Diagnosis

• 📝 History & exam: Mechanism, acute vs overuse, swelling, instability, ROM.
• 🦴 X-ray: Rule out fractures/avulsion injuries.
• 📡 Ultrasound: Muscle tears, tendon injuries.
• 🧲 MRI: Gold standard for severe ligament/muscle/tendon injury.

⏱️ Initial Management (First 24–48 hrs)

Traditionally RICE (Rest, Ice, Compression, Elevation). UK guidance now promotes POLICE: Protect, Optimal Loading, Ice, Compression, Elevation. This avoids prolonged rest, encouraging safe early mobilisation.

• 🛑 Protect: From further injury with support/splint if needed.
• 🏃 Optimal Loading: Gradual weight-bearing/movement as tolerated.
• ❄️ Ice: 15–20 min every 2 hrs to reduce swelling.
• 🩹 Compression: Elastic bandage to control swelling.
• ⬆️ Elevation: Above heart level when possible.
• 💊 Pain relief: NSAIDs (ibuprofen) or paracetamol.

📈 Ongoing Management

• 🧑‍⚕️ Physiotherapy: Rehab for strength, proprioception, ROM.
• 🔄 Gradual return: Low-impact → sport-specific activities.
• 🦿 Immobilisation: Braces/splints for severe ligament sprains.
• 🏥 Referral: Orthopaedics for full ruptures or non-healing injuries.

⚠️ Referral & Red Flags

• Complete ligament or tendon rupture (e.g., Achilles tear).
• Gross deformity or inability to bear weight.
• Neurovascular compromise (pallor, pulseless, paraesthesia).
• Recurrent instability despite conservative care.

🛡️ Prevention

• Warm-up and stretching before activity.
• Strength and conditioning programmes.
• Correct footwear/equipment.
• Good sports technique and gradual progression.

✅ Take-Home Messages

• Soft tissue injuries are common in sport/trauma and range from mild bruises to complete ruptures.
• Initial care = POLICE, not prolonged rest.
• Early physio input prevents chronic instability/weakness.
• Always look for red flags needing urgent ortho referral.