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PubMed2006

Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department.

OBJECTIVES: To evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor. METHODS: The ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF-36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured. RESULTS: The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long-term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance. CONCLUSION: Adding an ESP service to the interdisciplinary team achieves higher levels of patient satisfaction than for either doctors or ENPs. Further outcomes research, conducted in a wider range of emergency departments and integrated with an economic analysis, is recommended.

Adult↗
PubMed1994

Exercise and soft tissue injury.

Once the almost exclusive domain of the orthopaedic surgeon, sports injuries are now being seen with increasing frequency by other specialists, including rheumatologists. It is therefore important for rheumatologists to be able to diagnose and manage the various musculoskeletal conditions that are associated with physical activity. Soft tissue injuries are a very common cause of morbidity in both competitive and recreational athletes. Most of these conditions are provoked by muscle-tendon overload (or overuse) that is usually the result of excessive training or improper training techniques. However, despite an emerging literature on the natural history of soft tissue overuse syndromes, relatively little is known about the causes, incidence and outcome of many of these injuries. Of the methodologically robust epidemiological studies that have been done, most have focused on habitual distance runners. In this population, it has been reported that the incidence of injury can be as high as 50% or more, and that overtraining and the presence of previous injury are the most significant predictors of future injury. In other popular forms of exercise, such as walking, swimming, cycling, aerobics and racquet sports, injuries are also reported with high frequency but, to date, no prospective studies have examined actual incidences in these populations, and risk factors for injury in these activities remain speculative. Several of the more commonly occurring soft tissue injuries (such as rotator cuff tendinitis, lateral and medial epicondylitis, patellar tendinitis, the iliotibial band friction syndrome, Achilles tendinitis and plantar fasciitis) exemplify the overuse concept and are therefore highlighted in this review. The management of these, and most other, exercise-related soft tissue injuries is directed towards promptly restoring normal function and preventing re-injury.

Exercise↗
PubMed1993

Ketoprofen 2.5% gel versus placebo gel in the treatment of acute soft tissue injuries.

A parallel, double-blind, placebo controlled and randomized study in a single center was done with ketoprofen 2.5% gel to treat acute soft tissue injuries. Patients applied the gel twice a day for seven days, corresponding to 250 mg of ketoprofen per day. Assessments were made on the third and seventh day by VAS, subjective evaluation and pain threshold algometry. The study group consisted of 29 patients and the control group 27 patients. Pain at rest was significantly relieved in the ketoprofen group, whereas in the placebo group the difference was not significant. In terms of side-effects, no difference between the groups was noticed. In both groups, local dermal irritation was found. Our results suggested that ketoprofen 2.5% gel was safe and superior to placebo in the treatment of soft tissue injuries.

Administration, Topical↗
PubMed2004

Early management and outcome following soft tissue injuries of the neck-a randomised controlled trial.

A total of 108 consecutive patients presenting to our hospital following a soft tissue injury of the neck from a road traffic accident were included in a prospective trial. Each patient was randomised to either early mobilisation using an exercise regime or 3 weeks treatment in a soft collar followed by the same exercise regime. Patients were assessed clinically at 3, 12 and 52 week intervals from injury. No differences were found between the two groups for pain, range of movement or activities of daily living at any of the follow up intervals. The collar treatment group took significantly longer to return to work after injury (17 days) compared with the early mobilisation group (34 days), P < 0.05. Treatment with a soft collar was found to have no obvious benefit in terms of functional recovery after neck injury and was associated with a prolonged time period off work. This study supports the use of an early mobilisation regime following soft tissue injuries of the neck.

Accidents, Traffic↗
PubMed1997

[Soft tissue injuries of the face].

Traumatic lesions of the soft tissues of the face may have an important social impact in affecting vital functions of the face as well as esthetics. Despite of some tolerance in adapting to tissue loss, major tissue of the face needs to be reconstructed at all levels. Primary treatment is most successful if reconstructions are performed atraumatically, using well vascularized tissues and respecting the esthetic units of the face. Functional structures such as the eye lids, the lips, the facial nerve and the parotid duct should be repaired as a primary procedure. Scar maturation is a prerequisite before performing secondary corrections.

Esthetics↗
PubMed1991

Evaluation of soft tissue injury by Tc-99m bone agent scintigraphy.

Six patients with soft tissue injury secondary to different etiologic factors are presented. The degree and extent of tissue necrosis was precisely identified by scintigraphy. In two of these, radionuclide imaging helped to establish accurately the level of amputation that resulted in appropriate wound healing.

Adult↗
PubMed1992

Cognitive deficits in patients after soft tissue injury of the cervical spine.

Fifty-one patients suffering from soft tissue injury of the cervical spine underwent clinical and psychometric examination. Clinical interview evaluated subjective complaints and formal testing of self-estimated cognitive impairment, divided attention, and speed of information processing. Results indicated at least two different syndromes: 1) the "cervicoencephalic syndrome," characterized by headache, fatigue, dizziness, poor concentration, disturbed accommodation, and impaired adaptation to light intensity; and 2) the "lower cervical spine syndrome," which is accompanied by cervical and cervicobrachial pain. When comparing patients with either of these two syndromes, those suffering from cervicoencephalic syndrome had significantly poorer results when tested for divided attention. Speed of information processing was reduced to a comparable extent in both syndromes. These findings were not related to the length of the post-traumatic interval. Reduced processing of working memory is assumed, which may account for more global cognitive problems as well as secondary neurotic reaction.

Adult↗
PubMed2004

Oro-facial soft tissue injuries in Nigerian children: a five-year review.

A review of 64 soft tissue maxillofacial injuries in 50 children seen and managed at the University College Hospital, Ibadan over a five-year period was made. The age range was from 3months to 15years. The highest occurrence was in the 0-5 years old children (60%). The predominant type of soft tissue injuries was lacerations (75.0%). Falls (66.0%) were the most common aetiology followed by road traffic accidents (18.0%). There was a higher involvement of males, than females (M: F of 2.3:1). The tongue (31.3%) was the most commonly affected site of soft injury followed by the lips (29.7%) and cheeks (10.9%). Slightly less than half (46%) of the patients presented within 24 hours of injury. Direct suturing was done in 24% of the children while debridement and conservative management was carried out in 76%.

Accidental Falls↗
PubMed2004

Teleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study.

The purpose of this study was to examine the feasibility of teleconsultation using a mobile camera-phone to evaluate the severity of digital soft-tissue injury and to triage the injury with regard to management recommendations. With a built-in 110,000-pixel digital camera, pictures of the injured digit(s) or radiograph were taken by surgical residents in the emergency room and transmitted to another camera-phone to be viewed by the remote consultant surgeon. A brief medical and trauma history of each patient was relayed also by mobile phone. The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral. Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows: group I, the injury could be managed with conservative treatment, such as secondary intention wound healing, or primary closure with or without bone shortening; group II, skin grafting or local flap coverage was required for management of the injury; and group III, microsurgery such as replantation or free flap coverage was necessary to deal with the injury. Later, triaging was also performed individually by three junior plastic residents according to image review and patient referral information. Teleconsultation through a mobile camera-phone was performed for 45 patients with injuries of 81 digits from January to May of 2003. Of these 81 digital injuries, there were 12 cases (15 percent) where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon. In image reviewing, there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons; there was significant discordance in triaging in 20 cases (25 percent), and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low-resolution digital image and the situation of a bloody oozing wound. In some cases, the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes. Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation. The telemedicine system using a mobile camera-phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft-tissue injury in emergency cases, with on-line verbal communication and review of the transmitted captured image. This system has the advantages of ease of use, low cost, high portability, and mobility. With advances in hardware for digital imaging and transmission technology and the development of the third-generation advanced mobile phone system in the foreseeable future, this system has potential for future applications in telemedicine and telecare.

Cervicoplasty↗
PubMed1995

Magnetic resonance imaging assessment of acute soft tissue injuries to the temporomandibular joint.

PURPOSE: This study involves the use of magnetic resonance imaging (MRI) to document acute soft tissue injuries involving the temporomandibular joint (TMJ) after condylar fractures. MATERIALS AND METHODS: Patients with condylar fractures whose clinical and radiographic examinations, as well as the mechanism of their injury, suggested specific damage to the temporomandibular soft tissues underwent MRI scanning. Thirteen patients who met selected criteria were included in this study. RESULTS: Ten patients demonstrated disc avulsion, usually in the anterior or medial direction. Two patients had disruption of the lateral capsule, and one patient showed no MRI evidence of acute injury. Joint effusions were frequently demonstrated. CONCLUSIONS: MRI of condylar fractures in those patients with displacement, or in whom the mechanism of injury would predispose them to posttraumatic internal derangement, may assist the clinician in determining whether primary or delayed treatment is indicated. Furthermore, MRI may be a useful resource for enhancing the level of understanding regarding soft tissue changes that occur in the TMJ after acute condylar trauma.

Cartilage, Articular↗
PubMed2004

Soft tissue injury protocol (STIP) using motion MRI for cervical spine trauma assessment.

The purpose of this study was to establish a noninvasive scoring method, using motion MRI, to determine the degree of clinical impairment in traumatized cervical spines. This method is called the soft tissue injury protocol (STIP) scoring method. The cervical spines of 100 adult accident victims were evaluated prospectively using motion MRI at 12 weeks following hyperflexion/hyperextension injury from rear, low-impact motor vehicle collisions. Subjects were scored for degree of functional impairment based on an eight-point scale derived from the following clinical criteria: hypolordosis, motion restriction, disk herniation, and spinal stenosis. Five classes of impairment, ranging from normal to severe impairment, were identified as a basis for therapeutic management. Using the STIP scoring method, 94% of patients (94 of 100) were determined to have nonsurgical injuries. Class 1 and 2 injuries indicated mild impairment and were found in 68% of patients, who were considered to have reached maximum medical improvement at 12 weeks after injury. A Class 3 injury indicated moderate impairment and was found 26% of patients, who required an additional 12 weeks of rehabilitative and medical treatment to achieve maximum medical improvement. Class 4 and 5 injuries indicated severe impairment; these were identified in 6% of patients and required surgical intervention. Five of the six patients requiring surgery (83%) achieved maximum medical improvement at 36 weeks after injury. The STIP scoring method is a practical, noninvasive method of determining the degree of clinical impairment, as a basis for distinguishing injury requiring medical treatment from injury requiring surgical treatment, in cases of subacute cervical spine trauma.

Accidents, Traffic↗
PubMed2005

Mycobacterial infections after kidney transplant.

We looked at mycobacterial infections occurring after a kidney transplant to determine incidence, risk factors, and outcomes. Of 3921 kidney transplants performed between 1984 and 2002, 18 (0.45%) (10 men, eight women; 11 cadaveric donor, seven living donor graft) were identified as having mycobacterial infection at some time posttransplant. Mean age at transplant was 38.3 years. Racial background was: Caucasian (n = 12), African-American (n = 2), Native Indian (n = 2), Hispanic (n = 1), and Middle Eastern (n = 1). The majority had a kidney alone (n = 14). Four recipients had simultaneous transplant of a second organ: pancreas (n = 2), islets (n = 1), and liver (n = 1). None of the 18 recipients had documented mycobacterial infection pretransplant. One recipient had a positive Mantoux test at the time of transplant and then developed pulmonary tuberculosis 4 months posttransplant; the remaining 17 patients had either negative (n = 10) or unavailable (n = 7) pretransplant Mantoux results. Mean time to infection was 3.2 years (range 1 week to 12 years). The most common site of infection was respiratory (n = 8). Other sites included musculoskeletal (n = 4), skin (n = 3), gyn (n = 1), and other (n = 2). Only three of the infections were with mycobacterial tuberculi; the others were with avium (n = 5), chelonae (n = 2), or other nontuberculous mycobacteria. Risk factors included previous TB exposure, occupational exposure, or accidental soft tissue injury. Soft tissue infections often presented as chronic unhealed wounds and required extensive surgical debridements. With mean follow-up of 12.5 years since transplant and 9.2 years since infection, 13 of the recipients are alive and well; causes of death included cardiovascular (n = 3) and sepsis (n = 2).

Adult↗
PubMed1991

Management of Soft Tissue Injuries.

This chapter is intended to help primary care physicians and other providers of health care to adolescents to become more knowledgeable about the management of soft tissue injuries. Discussion includes the pathophysiology of injury, the assessment of the degree of injury, and the rationale for the RICE (rest, ice, compression, and elevation) method of acute treatment. Principles of rehabilitation are also discussed along with objective criteria that can be used to make return-to-play decisions following a soft tissue injury.

Journal Article↗
PubMed1995

Nonreamed interlocking nailing of closed tibial fractures with severe soft tissue injury.

Closed tibial shaft fractures with severe soft tissue trauma require urgent surgical treatment to minimize complications such as soft tissue necrosis, infection, compartment syndrome, and nonunion. Although time to union and complications are similar to open tibial fractures, these injuries often are treated as low energy closed fractures. The method of internal fixation depends not only on the fracture pattern, but also on the condition of the soft tissues. Unlike plate osteosynthesis, the authors believe that virtually all complex closed tibial fractures may be treated with an unreamed tibial nail if proximal and distal interlocking is possible. With severe closed soft tissue trauma (Grades 2 and 3), an unreamed nail may have biologic and mechanical advantages. In a prospective study, 21 closed tibial shaft fractures with severe soft tissue trauma (Grades 2 and 3) were treated with an unreamed nail. The mean followup was 29 months. All fractures healed in an average time of 23 weeks. However, 3 patients required a bone graft, and in 3 patients the fixation was revised. One infection occurred after an exchange reamed nailing. Because of the low infection and low nonunion rate, the authors recommend unreamed interlocking tibial nails for closed tibial shaft fractures with severe soft tissue trauma.

Adolescent↗
PubMed1986

Acute soft tissue injuries--a review of the literature.

The classification, pathology, and management of acute soft tissue injuries are reviewed. Classifications based on etiology and severity are outlined. The pathological processes at a cellular level are described in three phases: acute inflammatory, repair, and remodelling. the management of acute soft tissue trauma is embodied in the acronym RICE for rest, ice, compression, and elevation during the first 48 to 72 h. Additional benefit from anti-prostaglandin medications has not been clearly demonstrated in clinical trials, and if used, these medications should be restricted to the first 3 days. Cryotherapy (crushed ice) for 10 to 20 min, 2 to 4 times/day for the first 2 to 3 days is helpful in promoting early return to full activity. Early mobilization, guided by the pain response, promotes a more rapid return to full activity. Early mobilization, guided by the pain response, promotes a more rapid return to full functional recovery. Progressive resistance exercises (isotonic, isokinetic, and isometric) are essential to restore full muscle and joint function. Rehabilitation is complete when the injured and adjacent tissues are restored to full pain-free functional capacity under competitive conditions in association with the necessary level of cardiovascular respiratory fitness.

Acute Disease↗
PubMed1983

[Management of wounds in fractures with soft tissue injuries].

The results of fracture treatment are based mainly on the correct management of the soft tissues and the correct estimation of damage to muscles and skin. Depending on the extent of the soft tissue damage closed and open fractures are divided into four categories. The important principles in the management of fractures in connection with soft tissue injuries are: Reduction and splinting of fractures and sterile wound dressing at the scene of the accident avoids infection and posttraumatic damage of the soft tissues. Debridement must include the excision of all avascular and polluted skin, muscle and bone. Primary rigid internal or external fixation is considered as optimal for guaranteeing undisturbed healing of fracture and of soft tissues. Wound closure has to be absolutely strainless. In most cases the wound should remain open and be covered with artificial skin. Delayed closure may be done by means of split-thickness skin grafts, muscle transfer or free tissue transfer with microvascular anastomosis. In the future, the surgeon should pay close attention to closed fractures in connection with severe soft tissue damage. Likewise, these injuries demand an urgent and meticulous surgical procedure.

Anti-Bacterial Agents↗
PubMedDate not supplied

Topical nonsteroidal antiinflammatory drugs for acute soft tissue injuries.

The empirical evidence supporting the use of topical NSAIDs in acute soft tissue injuries is weak. However, patient ratings of improvement consistently favor NSAID treatment over placebo. Although it is very difficult to differentiate the placebo effect from the natural course of improvement in these patients, the overall impression given by these studies is that of superior efficacy of topical NSAIDs over placebo. The study by Akermark and Forsskahl suggests that indomethacin applied topically is as effective as therapeutic doses of oral indomethacin. Further studies need to be conducted to generalize this conclusion to other NSAIDs. Studies comparing the relative efficacy of topical NSAIDs with counterirritants available over-the-counter (e.g., menthol, camphor, methylsalicylate) also would be useful.

Administration, Oral↗