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PubMed1998

Catastrophizing, pain, and disability in patients with soft-tissue injuries.

The present study examined the role of catastrophizing in predicting levels of pain and disability in a sample of individuals who had sustained soft-tissue injuries to the neck, shoulders or back following work or motor vehicle accidents. Participants were 86 (27 men, 59 women) consecutive referrals to the Atlantic Pain Clinic, a multidisciplinary treatment centre for the management of persistent pain disorders. Findings revealed that catastrophizing, measured by the Pain Catastrophizing Scale (PCS; Sullivan, M.J.L. et al., Psychol. Assess., 7 (1995) 524-532) was significantly correlated with patients' reported pain intensity, perceived disability and employment status. The results of a regression analysis further showed that catastrophizing contributed to the prediction of disability over and above the variance accounted for by pain intensity. In addition, catastrophizing was associated with disability independent of the levels of depression and anxiety. The rumination subscale of the PCS was the strongest predictor of pain and disability. Theoretical and clinical implications of the findings are discussed.

Accidents, Traffic↗
PubMed1990

A double-blind comparison of naproxen gel and placebo in the treatment of soft tissue injuries.

A double-blind study was carried out in 120 patients who had received soft tissue injuries within the preceding 48 hours to compare the effectiveness of naproxen gel (10%) with placebo gel (base alone). The injuries were predominantly synovitis and tendinitis. Standard clinical evaluations of the patients' condition were made by physicians and patients on entry and after 3 and 7 days of treatment. Both treatments resulted in a significant improvement in symptoms, but naproxen gel was significantly superior to placebo gel (p less than 0.05). The response produced by naproxen was more rapid; all symptoms were significantly improved by Day 3 (p less than 0.05). The greater efficacy of naproxen was reflected in a lower usage of active drug compared with placebo which was consistent throughout the study. While the physicians' global assessments of the two gels did not differ significantly, the patients showed a preference in favour of naproxen (p less than 0.05) Naproxen gel was well tolerated; only 1 adverse event of itching occurred. It is suggested that naproxen gel offers an effective and convenient alternative to systemic non-steroidal anti-inflammatory drugs for patients where side-effects are to be avoided or when oral administration is undesirable.

Adolescent↗
PubMed1990

Trigeminal sensory impairment after soft-tissue injury of the cervical spine. A quantitative evaluation of cutaneous thresholds for vibration and temperature.

The cutaneous sensibility for vibration and temperature in the trigeminal skin area was examined with quantitative methods in 30 patients with a previous soft-tissue injury of the cervical spine. Sixteen patients with chronic and disabling symptoms had significantly increased thresholds for vibration over the ophthalmic (p less than 0.001) and mandibular (p less than 0.01) divisions of the trigeminal nerve compared with 14 without symptoms. Temperature thresholds were measured in all three divisions of the trigeminal nerve, and were significantly increased in all three compared with controls (p less than 0.001 in ophthalmic division, p less than 0.01 in maxillary and p less than 0.05 in mandibular divisions). The impairment of vibration and temperature sensibility in the trigeminal skin area in patients with chronic symptoms after soft-tissue injury of the cervical spine indicates damage to the central trigeminal system in upper spinal cord segments and ponto-medullary levels of the brainstem.

Accidents, Traffic↗
PubMed2004

Incremental and single trauma produce equivalent subfailure soft tissue injury of the cervical spine.

BACKGROUND: Automotive collision simulations have been performed using either incremental or single trauma. In single trauma, a single impact is performed, while in incremental trauma, a series of impacts of increasing severity are executed. Equivalency of incremental and single trauma for soft tissue injury severity due to the final impact has not been established. Thus, the purpose of the present study was to investigate whether incremental and single trauma produced similar cervical spine subfailure injury severity due to simulated frontal impacts. METHODS: Porcine cervical spine specimens (C2-T1) of the incremental trauma group were subjected to five frontal impacts (2, 3.5, 5, 6.5, 8 g), while single trauma specimens were subjected to a single impact (8 g). Flexibility tests were performed on specimens while intact and following each impact. Intact and post 8 g flexibility parameters were compared within incremental and single trauma groups and between groups. FINDINGS: No significant differences (P < 0.05) were found between incremental and single trauma groups when either intact or post 8 g flexibility parameters were compared. Significant increases in flexibility parameters from intact to post 8 g were observed in both groups, indicating soft tissue injury. INTERPRETATION: Incremental and single trauma produced equivalent subfailure cervical spine injury in simulated impacts, for the experimental conditions studied. This study may facilitate greater use of the incremental trauma protocol in future experimental designs.

Accidents, Traffic↗
PubMedDate not supplied

The H-Wave small muscle fiber stimulator, a nonpharmacologic alternative for the treatment of chronic soft-tissue injury and neuropathic pain: an extended population observational study.

In a previous study, the H-Wave small-muscle fiber stimulator significantly reduced chronic pain and restored physical function among patients with pain in the lower and upper extremities and spine. In this extended population observational study, a cross-sectional,computer-administered 10-item survey was administered to 6774 patients (3367 men [49.7%], 3406 women [50.3%], and 1 sex not reported [<1%]; mean+/-SD age, 45.28+/-10.08 y; range, 18-65 y) with chronic soft-tissue injury or neuropathic pain to assess their therapeutic response. The mean+/-SE duration of self-administered H-Wave treatment before the survey was completed was 87.35+/-1.39 d. Sixty-five percent of study participants reported a reduced or eliminated need for pain medication; 79% reported improved functional capacity or activity; and 78% reported 25% or greater reduction of pain. This cross-sectional evaluation represents the largest outcome study on the benefits of the H-Wave device in patients with chronic soft-tissue injury or neuropathic pain. The results suggest that this nonpharmacologic approach may provide an important alternative to standard pharmacologic treatment.

Adolescent↗
PubMed1979

A comparison of indoprofen and indomethacin in the supportive treatment of soft-tissue injuries in football players: a pilot study.

Twenty-four professional footballers suffering from recent soft-tissue injuries were included in a double-blind pilot trial comparing the efficacy and tolerability of indoprofen 800 mg/day and indomethacin 80 mg/day. Twelve subjects were allocated at random to each of the two drugs. Mean reduction of pain and swelling by the 3rd day of treatment was greater in the indoprofen group, as was the rate of disappearance of these symptoms, calculated in terms of t 1/2. A statistically significant (p less than 0.05) superiority of indoprofen versus indomethacin was, however, reached only for pain elicited by active movement. No adverse reactions were recorded with either drug.

Adolescent↗
PubMed2001

Modified work: prevalence and characteristics in a sample of workers with soft-tissue injuries.

Modified-work programs are designed to facilitate the return to work for employees with a work-related injury. Although extensive published literature exists that describes and evaluates "ideal" programs, to date there is a paucity of data describing practice. To address this pertinent issue, we administered a survey to a large sample of 1833 workers with soft-tissue injuries in Ontario, Canada, and asked them detailed questions about modified work and employer contact. Our results reveal that most workers (66%) were contacted by someone from their workplace to check on how they were doing. However, only a minority (36%) were offered arrangements by their employer to help them return to work after developing a work-related soft-tissue injury. Most arrangements that were offered to injured workers consisted of such temporary modifications as reduced hours (24%), flexible work hours (25%), or a lighter job (57%) rather than more permanent changes to the way that work is conducted, such as changes to the work layout or equipment (8%). Merely being contacted by the workplace to check on how the worker was doing was not associated with reduced compensation benefit duration. Workplace offers of arrangements to help the worker return to work were associated with reduced compensation benefit duration but were not statistically associated with workers' pain grade.

Disability Evaluation↗
PubMed2004

Soft tissue injury threshold during simulated whiplash: a biomechanical investigation.

STUDY DESIGN: A newly developed biofidelic whole cervical spine (WCS) model with muscle force replication (MFR) was subjected to whiplash simulations of varying intensity, and the resulting injuries were evaluated through changes in the intervertebral flexibility. OBJECTIVES: To identify the soft tissue injury threshold based on the peak T1 horizontal acceleration and the association between acceleration magnitude and injury severity resulting from simulated whiplash using the WCS + MFR model. SUMMARY OF BACKGROUND DATA: Whiplash has been simulated using mathematical models, whole cadavers, volunteers, and WCSs. The measurement of injury (difference between prewhiplash and postwhiplash flexibilities) is possible only using the WCS model. METHODS: Six WCS + MFR specimens (C0-T1) were incrementally rear-impacted at nominal T1 horizontal maximum accelerations of 3.5, 5, 6.5, and 8 g, and the changes in the intervertebral flexibility parameters of neutral zone and range of motion were determined. The injury threshold acceleration was the lowest T1 horizontal peak acceleration that caused a significant increase in the intervertebral flexibility. RESULTS: The first significant increase (P <0.01) of 39.8% occurred in the C5-C6 extension neutral zone following the 5 g acceleration. At higher accelerations, the injuries spread among the surrounding levels (C4-C5 to C7-T1). CONCLUSIONS: A rear-end collision is most likely to injure the lower cervical spine by intervertebral hyperextension at a peak T1 horizontal acceleration of 5 g and above. These results may aid in the design of injury prevention systems and more precise diagnoses of whiplash injuries.

Aged↗
PubMed1982

Indication for surgical treatment of chronic soft tissue injuries.

Experience with surgical treatment of chronic soft tissue overuse syndrome in high-performance sportsmen shows full sporting performance can be restored in many cases. The risks of the various operation procedures are low, and their efficiency astonishingly reliable with correct establishment of indications. It therefore appears to be advisable to employ surgical therapy at an early stage in all cases with an unsatisfactory improvement after conservative treatment.

Athletic Injuries↗
PubMed2001

Salvaged limbs after tibial shaft fractures with extensive soft-tissue injury: a biopsychosocial function analysis.

BACKGROUND: The purpose of this study was to perform a biopsychosocial function analysis of the outcome in patients with a salvaged leg after tibial shaft fractures associated with extensive soft-tissue injury. METHODS: A retrospective review of 18 consecutive patients with tibial shaft fractures and extensive soft-tissue damage with a mean Injury Severity Score of 31 was undertaken. All patients were assessed for their physical function, psychological status, and general function. RESULTS: The range of motion and torque of the ankle joint were severely affected. The knee joint was affected, but only with regard to the torque during concentric muscular activities. Nottingham Health Profile scores showed that the general and social function for these patients were significantly affected. Five of 18 patients suffered from depression. CONCLUSION: Salvage procedures should be advocated if possible, but careful selection of patients on the basis of mental and social factors is crucial for the outcome.

Adaptation, Psychological↗
PubMed2005

A theoretical model for treatment of soft tissue injuries: treatment of an ankle sprain in a college tennis player.

OBJECTIVE: To present theories of manual treatment approaches to soft tissue injuries using an example case report. CLINICAL FEATURES: A college tennis player with an ankle sprain for 6 weeks, not responding to standard treatment, was unable to play tennis or compete in tournaments. INTERVENTION AND OUTCOME: Soft tissue treatment was applied to the ankle for 2 visits. The patient experienced complete resolution of the problem and returned to play without relapse during a 9-month follow-up period. Theories of myofascial distortion treatment are discussed. CONCLUSION: This treatment approach may have potential for soft tissue problems that are not amenable to current therapy approaches.

Adult↗
PubMed1989

Observations on clinical therapeutic effect in treating soft tissue injuries by acupuncture, with pain threshold and electromyography as parameters.

360 observations were made on 120 cases of soft tissue injury divided into groups. 1. Among the 100 patients in the acupuncture treatment group, 300 observations were made; among the 20 controls there were 60 observations. The effective rate in the acupuncture treatment group was 85.00%; in the control group it was 41.67%, a very significant difference (P less than 0.01). 2. Relationship between therapeutic course and effect. The effective rate for the first course was 74.00%; it was 90.50% when more than two courses were given, a very significant difference (P less than 0.01) indicating the marked effect of acupuncture treatment. 3. Based on the therapeutic theory of TCM syndrome differentiation and reinforcement method in the asthenia state, and reducing method in asthenia state, different manipulations were used for asthenia-heat and asthenia-cold types with good clinical results. There was no significant difference (P greater than 0.05) between the effective rate in these two types, pointing up the significance of the TCM syndrome differentiation theory in clinical acupuncture. 4. There was very significant difference (P less than 0.01) in the degree of pressed pain on the patient's tender spot before and after acupuncture treatment, also (P less than 0.01 and P less than 0.001 respectively) in the EMG amplitude on the affected side of the lumbar area before and after acupuncture treatment during light and heavy force in extension action of back muscles. Acupuncture treatment on soft tissue disease based on TCM syndrome differentiation theory is thus shown to be effective.

Acupuncture Therapy↗
PubMed1988

Femur fracture with associated soft-tissue injury produces hepatic ischemia. Possible cause of hepatic dysfunction.

Clinical studies demonstrate that early débridement and operative fixation of femur fractures in multiply injured patients lowers both the incidence and severity of hepatic failure. Perhaps the single most important determinant of hepatic function is nutrient hepatic perfusion. This study compares systemic and hepatic blood flow in rats that have sustained femur fractures with or without associated soft-tissue injury. Femur fracture without soft-tissue trauma resulted in a hyperdynamic state with normal blood flow distribution at 24 hours after injury and normal hemodynamics at 48 hours. When femur fracture was associated with soft-tissue trauma, the elevated cardiac output at 24 hours was not matched by a proportionately elevated hepatic blood flow. In this latter group, the cardiac output was normal at 48 hours, but the hepatic perfusion defect remained. Retained fracture fragments, hematoma, and injured and necrotic soft tissue may serve as a stimulus leading to a pathologic reduction in hepatic perfusion.

Animals↗
PubMed2001

Interventions for preventing lower limb soft-tissue injuries in runners.

BACKGROUND: Overuse musculoskeletal injuries occur frequently in runners. Suggestions for prevention have focused on stretching exercises, modifying training schedules and the use of protective devices such as braces and insoles. To date, no systematic analysis of the literature on the effectiveness of these strategies in the prevention of overuse injuries has been published. OBJECTIVES: The objective of the review was to evaluate the evidence from randomised controlled trials on the prevention of lower limb soft-tissue running injuries. SEARCH STRATEGY: An electronic database search included The Cochrane Musculoskeletal Injuries Group specialised register (date of last search October 2000), The Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 1999), MEDLINE (from 1966), EMBASE (from 1980), SPORT Discus (1975-2000), HERACLES (1975-2000), ATLANTES (1980-1996), BIOSIS, CINAHL, SCISEARCH, Current Contents, Index To Theses and Dissertation Abstracts. Date of last search for these databses: May 2000. SELECTION CRITERIA: Any randomised or quasi-randomised trials evaluating interventions to prevent lower limb soft-tissue running injuries. DATA COLLECTION AND ANALYSIS: All trials fulfilling the selection criteria were assessed by two reviewers independently. Data were also extracted independently by the two reviewers using a pre-derived data extraction form. Exploratory analyses, including pooling of results from groups of trials of similar designs were undertaken, using a fixed effects model. Results were reported as relative risks (RR) with 95 per cent confidence intervals (95% CI). MAIN RESULTS: Twelve trials with 8,806 participants were included. In one trial, a single control group was matched to three different included intervention groups. The effectiveness of stretching exercises (5 trials, 1944 participants in the intervention groups, 3159 controls), and of insoles and footwear modification (5 trials, 903 participants in the intervention groups, 3006 controls) in the prevention of lower extremity soft tissue injuries associated with running is unknown. Reducing the distance, frequency and duration of running may be effective in the prevention of lower extremity soft tissue injuries associated with running (3 trials, 514 participants in intervention groups, 1663 controls). Wearing a knee brace with a patellar support ring may be effective in the prevention of running-associated anterior knee pain (1 trial, 27 participants in the intervention group, 33 controls). REVIEWER'S CONCLUSIONS: This review provides some evidence for the effectiveness of the modification of training schedules, but there is insufficient evidence to determine the effectiveness of stretching exercises for major lower limb muscle groups in reducing lower limb soft-tissue running injuries. More studies are required to confirm that knee braces may prevent knee pain, to clarify the role of stretching, and to quantify optimal training loads. Generalisability of the results may be limited by the intensive nature of military training (the context for most of the studies) and the inclusion of only small numbers of women.

Cumulative Trauma Disorders↗