What are Soft-Tissue Injuries?

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Soft tissue injuries and disorders affect structures such as muscles, tendons and their sheaths, ligaments, bursae, fascia, and cartilage. They may occur suddenly from an acute event, develop gradually from repetitive stress and degeneration, or from a combination of both.

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Bursitis

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A bursa is a small fluid-filled sac that reduces friction between structures such as tendons, muscles, skin, and bone. Bursitis occurs when a bursa becomes irritated or inflamed. It may develop from repetitive pressure or movement, an injury, or occasionally infection.

 

Common locations include:

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• Shoulder: Pain when raising the arm or lying on the affected shoulder

• Outer hip: Pain over the side of the hip, particularly when lying on that side

• Elbow: Swelling over the back of the elbow

• Knee: Pain or swelling around the kneecap or inner knee

 

Treatment of noninfectious bursitis may include activity modification, avoiding repetitive pressure, ice, appropriate pain medication, rehabilitation, and occasionally a corticosteroid injection depending on the location and diagnosis.

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Some bursae, particularly those over the elbow and kneecap, can become infected.

Increasing redness, warmth, swelling, significant tenderness, drainage, fever, or feeling ill should prompt medical evaluation. Septic bursitis may require drainage and antibiotics.

 

Muscle Strains/Tears

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A muscle strain occurs when muscle fibers are overstretched or torn. Their tears range from grades 1-3, encompassing microscopic tearing to partial and complete muscle tears.

 

Tendon Tears

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Tendons connect muscle to bone and transfer the force produced by muscles to move a joint. Their tears range from grades 1-3.

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Ligament Sprains/Tears

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Ligaments connect bone to bone and stabilize joints. Their tears range from grades 1-3. 

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Tenosynovitis

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Some tendons travel through lubricated tendon sheaths that allow them to glide smoothly. Tenosynovitis is inflammation or irritation involving a tendon sheath.

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• De Quervain tenosynovitis — pain along the thumb side of the wrist

• Trigger finger — catching or locking of a finger as the tendon has difficulty gliding normally

 

A tendon sheath can also become infected. Infectious flexor tenosynovitis of the hand requires urgent evaluation and treatment.

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Iliotibial Band Syndrome

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The iliotibial (IT) band is a thick band of connective tissue along the outside of the thigh.

IT band syndrome is an overuse condition particularly associated with repetitive running and cycling. Symptoms include:

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• Pain on the outside of the knee

• Pain that worsens during repetitive activity

• Localized tenderness

• Symptoms that improve with rest but return with activity

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Treatment generally focuses on temporarily reducing aggravating activity and correcting contributing training, strength, or biomechanical factors.

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Meniscus Tears

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The menisci are cartilage structures inside the knee that help distribute forces and contribute to joint stability. A meniscus may tear suddenly during a twisting injury or develop degenerative changes gradually over time. Symptoms include:

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• Pain along the knee joint line

• Swelling

• Pain with twisting or squatting

• Clicking or catching

• Reduced motion

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Labral Tears

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The labrum is a rim of cartilage that helps stabilize and deepen certain joints, particularly the shoulder and hip. A larbral may tear suddenly during injury or develop degenerative changes gradually over time.

 

Shoulder Labral Tears:  Symptoms may include deep shoulder pain, clicking or catching, and feelings of instability.

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Hip Labral Tears: Symptoms may include groin or deep hip pain, clicking or catching, pain with hip rotation, or pain during certain activities or prolonged sitting

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Imaging

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X-rays are useful for identifying fractures but generally do not directly show most soft tissue injuries. MRI, and sometimes ultrasound, may be appropriate when a significant injury is suspected or when the diagnosis would change treatment. Sometimes MRI arthrogram (contrast injected into joint), rather than a conventional MRI, is used to better visualize smaller defects. 

 

*MRI is very sensitive and frequently identifies structural abnormalities that may have existed before a patient's symptoms began. Findings such as tendon degeneration or tears, meniscus tears, labral abnormalities, cartilage wear, and spinal disc degeneration are commonly found in people who have little or no symptoms. These incidental findings become increasingly common with age. Therefore, finding an abnormality on an MRI does not automatically mean that it is the source of the patient's pain.

When Is Surgery & Imaging Needed?
 

Surgery may be considered for certain:
 

• Complete tendon ruptures

• Significant acute injuries

• Injuries that cause significant impairment and fail to respond to appropriate nonsurgical treatment, usually for at least 4-6 weeks

Whether surgery is beneficial depends on the specific structure injured, severity of the injury, patient's functional needs, and expected outcome with nonsurgical treatment.

 

Treatment 

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Most soft tissue injuries are initially treated with protection, physical therapy, and gradual return to activity. Surgery may also be considered for certain cases. 

                                                 References & Guidelines
 

• American Academy of Orthopaedic Surgeons (AAOS)

• American College of Radiology (ACR) Appropriateness Criteria

• American Medical Society for Sports Medicine (AMSSM)

• American Physical Therapy Association (APTA)