Acute Soft Tissue Injuries Research Articles

How Effective are Injections of Platelet-Rich Plasma (PRP) for the Treatment of Sports Injuries: a Critical Review of the Literature

Acute soft-tissue lesions and chronic overuse injuries in the sports medicine field are very frequent and in most cases, difficult to treat. Tissue repair in musculoskeletal lesions is often too slow and sometimes incomplete for a given athlete. The fastest, most complete recovery is of primary importance, and keeping the delay until return-to- field as brief as possible, a priority. Many bioactive proteins and growth factors amongst others influence healing processes. Administration of Platelet Rich Plasma enables the production, from the patient’s own blood, of natural, high concentrations of autologous growth factors. Basic research and animal studies are promising, but evidence- based studies examining the treatment of human musculoskeletal lesions by Platelet Rich Plasma are still lacking. Nevertheless, such treatment is increasingly used in sports medicine clinical practice and much is expected of growth factor injections. The aim of this non exhaustive review is to analyze the existing literature published in the fields of sports medicine. The results of this analysis do not permit us to recommend the systematic and generalized use of Platelet Rich Plasma injections in the management of sport injuries. Nevertheless, a few promising results have to be mentioned, but high-quality studies are needed to provide scientific evidence about these injections’ effectiveness.

Study strategies for bloodletting therapy in treatment of acute soft tissue injuries

Bloodletting therapy is one of the typical treatment modes of traditional Chinese medicine, and acute soft tissue injury (ASTI) is one of the most common indications for acupuncture therapeutics. In this paper, the current situation of treatments and pathological mechanisms of ASTIs, the existing problems of bloodletting therapy in the treatment of ASTIs and the study strategies are systematically analyzed, indicating that bloodletting therapy is significantly effective in the treatment of ASTIs. Breakthroughs in the treatment of ASTIs will be achieved with the application of bloodletting therapy both in clinical practice and experimental research.

A Comparative Study of the Effects of Bromelain and Fresh Pineapple Juice on the Early Phase of Healing in Acute Crush Achilles Tendon Injury

Bromelain, an enzyme extracted from the stem of the pineapple plant, has been reported to reduce pain and swelling in acute soft tissue injuries, but no study has been done to compare its effect with that of fresh pineapple juice on the healing of acute tendon injuries. This study compared the effects of commercial bromelain and fresh pineapple juice on tenocyte proliferation and the malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats. Twenty-four male rats were divided randomly into three groups of eight rats each; all the rats had induced crush injury to the Achilles tendon: Group 1 (control), no treatment; Group 2, oral bromelain treatment at a dosage of 7 mg/kg of body weight daily; and Group 3, fresh diluted pineapple juice at a dosage of 30 mg/kg of body weight. Treatment was given over the first 14 days post-injury. On day 15 post-injury, the animals were sacrificed, and the tendons were excised and processed for histological study and MDA assay. Results show a significant difference in the tenocyte population between the bromelain group and the control (P < .05), whereas pineapple juice also increased the tenocyte population, although not significantly (P = .36). Pineapple juice, however, significantly lowered the MDA level compared with both the control and bromelain-treated groups. Based on this study, 600 GDU bromelain given at a dosage of 7 mg/kg had a better effect on tenocyte proliferation than fresh pineapple juice given once daily in acute tendon injury.

Management of Acute Soft Tissue Injury to the Auricle

The external ear is commonly involved in facial trauma. Injuries to the ear can range from simple lacerations to complete avulsions. We review the normal auricular anatomy and vascular supply, as well as the initial management of any auricular injury. Furthermore, we review the literature on soft tissue injuries of the ear and present a simple algorithm for classifying injuries. The classification is based on whether or not cartilage is involved. Injuries to the lobule do not involve cartilage and thus are more easily repaired by simple closure or Z-plasty. Injuries involving cartilage are further classified into partial or complete avulsions. A complete avulsion is then categorized by having a wide or narrow pedicle. There is no standardized, definitive management for the various types of auricular trauma, and this schema may assist in deciding which of the various reconstructive options is most appropriate for a particular case.

Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch

The objective of this article is to review published clinical data on diclofenac epolamine topical patch 1.3% (DETP) in the treatment of acute soft tissue injuries, such as strains, sprains, and contusions. Review of published literature on topical nonsteroidal anti-inflammatory drugs (NSAIDs), diclofenac, and DETP in patients with acute soft tissue injuries was included. Relevant literature was identified on MEDLINE using the search terms topical NSAIDs, diclofenac, diclofenac epolamine, acute pain, sports injury, soft tissue injury, strain, sprain, and contusion, and from citations in retrieved articles covering the years 1978–2008. Review of published, randomized clinical trials and meta-analyses shows that topical NSAIDs are significantly more effective than placebo in relieving acute pain; the pooled average relative benefit was 1.7 (95% confidence interval, 1.5–1.9). In a limited number of comparisons, topical and oral NSAIDs provided comparable pain relief, but the use of topical agents produced lower plasma drug concentrations and fewer systemic adverse events (AEs). The physical–chemical properties of diclofenac epolamine make it well suited for topical use. In patients with acute soft tissue injuries treated with DETP, clinical data report an analgesic benefit within hours of the first application, and significant pain relief relative to placebo within 3 days. Moreover, DETP displayed tolerability comparable with placebo; the most common AEs were pruritus and other application site reactions. Review of published literature suggests that DETP is generally safe and well tolerated, clinically efficacious, and a rational treatment option for patients experiencing acute pain associated with strains, sprains, and contusions, and other localized painful conditions.

Loss of Protein, Immunoglobulins, and Electrolytes in Exudates From Negative Pressure Wound Therapy

A relatively new technology in wound care, negative pressure wound therapy (NPWT), has become widely used for the management of open abdomens and soft tissue wounds and provides a means to collect wound exudate to quantify protein loss. A prospective observational study was conducted in surgical, trauma, or burn patients (8 patients with open abdomens and 9 patients with acute soft tissue wounds on NPWT). NPWT exudate was collected and assayed to characterize loss of protein, electrolyte, and immunoglobulins over multiple days of NPWT. Total protein was present in open abdomen NPWT exudate, 2.9 ± 0.9 g/dL. In the soft tissue wound exudate, a similar mean concentration was found, 2.59 ± 0.6 g/dL (P = .34). Exudate concentrations of albumin, urea nitrogen, immunoglobulins, and electrolytes between wound types were also not significantly different. There were significant (P = .03) differences in the median volume of exudate, 1031 mL/d for open abdomens in contrast to 245 mL/d soft tissue wounds. Therefore, 24-hour losses of proteins and electrolytes were greater in patients with open abdomens than soft tissue wounds. Mean total protein loss was 25 ± 17 g/d for open abdomens and 8 ± 5 g/d for soft tissue wounds. There are significant losses of proteins in wound exudate. As there is no significant difference in the concentration of total protein between wound type, the rate of loss may be calculated as 2.9 g/dL times the volume of wound exudate. The rate of protein loss from wounds is similar to the presently assumed insensible loss rate of 12-25 g/d.

Injuries Related to Hiking with a Pack During National Outdoor Leadership School Courses: A Risk Factor Analysis

To determine if packweight, anthropometry, and individual characteristics are related to acute musculoskeletal and soft tissue injuries while wearing backpacks on wilderness expeditions. This was a review of prospectively gathered data on participants and instructors enrolled in National Outdoor Leadership School Rocky Mountain hiking courses between March 2008 and October 2009. Packweight, height, body weight, age, and gender were collected. Individuals that suffered acute musculoskeletal and soft tissue injuries while hiking with a backpack were recorded and compared to individuals that did not suffer injuries. Logistic regression was used to determine which variables were significantly correlated with injuries. Odds ratios with associated confidence intervals and p-values are reported. One thousand two hundred and one individuals were included in the final analysis. Twenty-six individuals of this population suffered reportable musculoskeletal and soft tissue injuries while hiking with a pack. None of the factors examined (packweight, height, body weight, age, gender, or packweight to body weight ratio) were significant in predicting acute injury. Based on our results, an individual's packweight, anthropometry, and individual characteristics neither increase nor decrease their risk of experiencing a musculoskeletal or soft tissue injury while hiking with a backpack. Other factors, including fitness, pretrip training, and footwear, should be examined to determine appropriate strategies to reduce significant musculoskeletal and soft tissue injuries on wilderness expeditions.

Oral Cyclo-Oxygenase 2 Inhibitors versus Other Oral Analgesics for Acute Soft Tissue Injury

Acute soft tissue injuries are common and carry significant societal costs. Cyclo-oxygenase 2 (COX-2) inhibitors (coxibs), non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics are used to treat acute soft tissue injuries, with ongoing debate about their analgesic efficacy, effects on tissue healing and adverse effects (AEs). To systematically review the evidence comparing oral coxibs with other oral analgesics for acute soft tissue injuries, using the outcomes: pain, swelling, function and AEs. The following databases were searched: MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, AMED, PEDro and SPORTDiscus. Further studies were sought through clinical trials registries, dissertations, correspondence with pharmaceutical companies and manual searches of relevant journals. There was no language restriction. 'Coxibs' were defined as drugs that inhibit COX-2 >5-fold more than COX-1; 'acute' was defined as injury occurring within 48 hours of enrollment; 'soft tissue injury' was defined as closed injuries to upper or lower limb soft tissues (ligaments, muscles or tendons). Randomized controlled trials in humans comparing a coxib to a different class of oral analgesic agent for the treatment of acute soft tissue injuries for <30 days, and in which >or=80% of participants met the definition of acute soft tissue injury, were included. Studies were excluded if >20% of participants enrolled had back pain, cervical spine injury, repetitive strain injuries, delayed-onset muscle soreness, fractures, cartilage injury, penetrating wounds or primary inflammatory conditions (tendonitis, bursitis and arthritis). Nine out of 23 (39.1%) potentially relevant studies met the selection criteria. A standard form was used to extract data. Included studies were screened by the authors for risk of bias using the Cochrane risk of bias tool and evidence was graded for quality using the GRADE tool. Clinical heterogeneity was minimized by application of strict selection criteria. Statistical heterogeneity was assessed using the I2 statistic and meta-analysis was undertaken if appropriate. Weighted mean difference (WMD) was used to assess pain, relative risk (RR) to assess AEs, and Peto odds ratio (OR) to assess return to function. The nine RCTs evaluated in the meta-analysis included 3060 patients. Coxibs were found to be equal to NSAIDs (day 7+, n = 1884, 100 mm visual analogue scale [VAS]), WMD = 0.18 mm (95% CI -1.76, 2.13), p = 0.85 and tramadol (day 7+, n = 706, 100 mm VAS), WMD = -6.6 mm (95% CI -9.63, -3.47) [single study, difference clinically insignificant] for treating pain after soft tissue injuries. Coxibs had fewer gastrointestinal AEs than NSAIDs, even with short-term use (RR 0.59 [95% CI 0.41, 0.85], p = 0.004) [low quality evidence]. Swelling was measured in two studies with no difference being found between groups, but the presentation of the data was not sufficient to allow further analysis. Coxibs were found to be unlikely to be different to NSAIDs in helping patients return to function (OR 1.0 [95% CI 0.77, 1.3], p = 0.99); however, a single study suggested they may improve time to return to function (moderate quality evidence) and may have fewer AEs than tramadol (very low quality evidence). The risk of serious AEs with both coxibs and NSAIDs in this setting was low (but incompletely defined). More studies comparing coxibs with NSAIDs and other analgesics in the setting of acute soft tissue injuries are necessary. A different review methodology would be required to answer the question of cardiovascular risk associated with short-term use of coxibs and NSAIDs.

Time to significant pain reduction following DETP application vs placebo for acute soft tissue injuries

Objective:Nonsteroidal anti-inflammatory drugs (NSAIDs) provide fast and effective acute pain relief, but systemic administration has increased risk for some adverse reactions. The diclofenac epolamine 1.3% topical patch (DETP) is a topical NSAID with demonstrated safety and efficacy in treatment of acute pain from minor soft tissue injuries. Significant pain reduction has been observed in clinical trials within several hours following DETP application, suggesting rapid pain relief; however, this has not been extensively studied for topical NSAIDs in general. This retrospective post-hoc analysis examined time to onset of significant pain reduction after DETP application compared to a placebo patch for patients with mild-to-moderate acute ankle sprain, evaluating the primary efficacy endpoint from two nearly identical studies.Research design and methods:Data from two double-blind, randomized, parallel-group, placebo-controlled studies (N = 274) of safety and efficacy of the DETP applied once daily for 7 days for acute ankle sprain were evaluated post-hoc using statistical modeling to estimate time to onset of significant pain reduction following DETP application.Main outcome measures:Pain on active movement on a 100 mm Visual Analog Scale (VAS) recorded in patient diaries; physician- and patient-assessed tolerability; and adverse events.Results:DETP treatment resulted in significant pain reduction within approximately 3 hours compared to placebo. Within-treatment post-hoc analysis based on a statistical model suggested significant pain reduction occurred as early as 1.27 hours for the DETP group. The study may have been limited by the retrospective nature of the analyses. In both studies, the DETP was well tolerated with few adverse events, limited primarily to application site skin reactions.Conclusion:The DETP is an effective treatment for acute minor soft tissue injury, providing pain relief as rapidly as 1.27 hours post-treatment. Statistical modeling may be useful in estimating time to onset of pain relief for comparison of topical and oral NSAIDs.

Clavicle and acromioclavicular joint injuries: a review of imaging, treatment, and complications

Fractures of the clavicle account for 2.6-5% of all fractures. Clavicular fractures have traditionally been treated conservatively, however, there has recently been increased interest in surgical repair of displaced clavicular fractures, with resultant lower rates of nonunion and malunion. Treatment of acromioclavicular (AC) separation has traditionally been conservative, with surgery reserved for patients with chronic pain or significant dislocation and acute soft tissue injury. It is important for the radiologist to become familiar with the surgical techniques used to fixate these fractures as well as the post-operative appearance and potential complications.

Role of MRI in the diagnosis of clinically suspected scaphoid fracture: analysis of 611 consecutive cases and literature review

BackgroundA clinically suspected scaphoid fracture with normal initial plain x-rays is a difficult but common problem. The role of MRI as a diagnostic modality in this situation was analysed based...

Efficacy and Safety of Celecoxib in the Treatment of Acute Pain due to Ankle Sprain in a Latin American and Middle Eastern Population

Ankle sprains are common acute soft-tissue injuries. This 7-day open-label, multicentre, randomized study compared the efficacy and safety of celecoxib with non-selective non-steroidal anti-inflammatory drugs (NSAIDs) in treating acute ankle sprain with moderate-to-severe ankle pain in 278 patients. Patients received either celecoxib (400 mg loading dose followed by 200 mg twice daily) or standard doses of non-selective NSAIDs. The primary endpoint was a change in the patient's assessment of ankle pain on a 0 mm (no pain) - 100 mm (worst possible pain) visual analogue scale (VAS) at day 3 compared with baseline. From a baseline of 73 mm, mean VAS pain scores decreased to 29 and 32 mm in the celecoxib and non-selective NSAID groups, respectively. The lower limit of the 95% confidence interval for the treatment difference with regard to change from baseline was greater than the pre-established non-inferiority margin of -10 mm. Using an initial loading dose, celecoxib was at least as efficacious as non-selective NSAIDs in treating acute pain due to ankle sprain.

Clinical and cost effectiveness of different emergency department healthcare professionals in the management of musculoskeletal soft tissue injuries

This study compared the minor injuries care provided by extended scope physiotherapists (ESPs) and emergency nurse practitioners (ENPs) with routine treatment by doctors (of all grades) in emergency departments. It...

Use of prehospital dressings in soft tissue trauma: is there any conformity or plan?

Background:Acute soft tissue wounds are commonly seen in the prehospital setting. It was hypothesised that there is a lack of consistency in early management of trauma wounds, particularly in the...

Career guidance: how do we inspire students and young doctors to careers in paediatrics and child health?

<h3>Aims:</h3> The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practised. This review was conducted to examine the medical literature...

Cold Therapy in Maxillofacial Surgery

Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities used in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established (BMC Musculoskelet Disord 2007;8:125). From January 2008 to July 2008, 10 patients (4 men and 6 women) affected by dental-skeletal classes II and III were treated. Considering the biologic effects and the low temperature achieved, in this study, a cooling and compression system, at fixed temperature and adjustable for maxillofacial cutaneous tissues, called Hilotherapy system (Hilotherm GmbH, Ludwigsburg, Germany) was used. With the use of Hilotherapy system, the swelling and pain decrease in intensity and time, allowing a quicker path to recovery of mandibular dynamics, a better comfort for patients, and an easy management of patients by medical attendants. The Hilotherapy system has been proven to have a safe and effective use as a cold therapy to control postsurgery course.

Self Management of Acute Soft Tissue Injuries: A Survey of Female Gaelic Football Players

Background: Within Gaelic football, high rates of inju ry have been reported. The Ladies Gaeli c Football Association has 100,000 members; however no injury management research currently exists within this population . The aim of this study was to survey th e knowledge of sen ior level ladies Gaelic football club fclayer.s of acute soft tissue inju ry management. Secondary' aims were to investigate the treatments employed ollow ln g injury and player awareness of potentially harmful post injury pra cti ces. Meth~ds: A questionnaire exploring demographic, treatm ent, and PRICE (Protection, Rest, Ice, Compression, Elevation) details was constructed. Results: All six sen ior County C lare ladies Gaelic football club teams were sampled, and a response rate of 95% was achieved. 43 .9 % of respondents knew four or more of the PRICE letters. Treatments employed by respondents included ice (61 .8%), physiotherapy (59.2%) and rest (36.8%). 27.6% of participants would aVOid three or more of the following immediately post injury; heat, alcohol, vigorous exercise and vigorous massage. If respondents were to use ice as a form of treatment in the initial stages folloWing injury, 85.7% of them would commence th e intervention immediately aher injury, and it would be applied by players everyone (54.4%) or two (22.2%) hours. ~onclusion: The PRICE reg im e was moderately well known by thi~ pc:pulation. Poor knowledge of potentially armful post injury practices and recommended cry'otherapy appll~atlo~ was reporte~. As th e evidence concerning the PRICE gU id elin es is not conclUS ive, further researc h In thi S area IS required.

Recovery From a National Collegiate Athletic Association Division I Football Game: Muscle Damage and Hormonal Status

The purpose of this study was to examine markers of skeletal muscle tissue damage and circulating anabolic and catabolic hormones to gain insight into the recovery process from Friday until Monday, when a new practice week begins. Twenty-eight National Collegiate Athletic Association Division I football players gave consent to participate in the investigation in the ninth game of the season. Sixteen players started the game and played the entire game (PL), and 12 others did not play and were on the bench during the game (DNP). Each player had fasted blood samples obtained at the same time of day between 1000 and 1200 hours the day before the game (Friday; T1), 18-20 hours after the game (Sunday; T2), and then 42-44 hours after the game (Monday; T3). Blood samples were analyzed for concentrations of creatine kinase (CK), lactate dehydrogenase (LDH), myoglobin, testosterone, and cortisol. The PL players showed significantly (p <or= 0.05) increased concentrations of CK (T2 > T1 and T3), myoglobin (T2 > T1 and T3), and LDH (T2 > T1). In contrast, DNP players showed significant differences in cortisol (T3 < T1 and T2) and testosterone:cortisol (T3 > T1). Few changes were observed in testosterone and cortisol changes, indicating stability of the anabolic/catabolic hormones. In conclusion, these data indicate that participation in a college football game late in the season results in some degree of tissue damage but with minimal hormonal responses, which seem to have stabilized at resting concentrations without predominance of cortisol's catabolic presence. As previously noted in the literature, some type of "contact adaptation" to the season may have occurred with regard to tissue damage responses. However, by the ninth game of a season, players do carry soft tissue damage levels above resting ranges into subsequent games, indicating that recovery should be monitored, with coaches being careful with scheduling scrimmage and full-contact drills. How such data implicate overuse injuries remains unclear, considering that hormonal status in this study was highly stable, with catabolic influences minimized by the high level of athlete conditioning. These data again support that high-level conditioning can stabilize anabolic and catabolic hormonal signals and limit acute soft tissue injury, making cerebral concussion (acute and chronic) and traumatic injury the biggest threats to a student-athlete's health and well-being during an American football game.

Occupational injuries reported in a Canadian university setting: A five year retrospective study

Research examining occupational injuries of university employees is limited, with previous work in the education sector focusing primarily on students and athletic teams. The current study examined occupational injuries over a five year period to determine the magnitude and nature of occupational injuries in a Canadian university with a view to developing prevention and intervention strategies. Findings suggested that women in full-time positions reported more injuries than men, and that as employees' level of experience increased the incidence of injury decreased. Analysis of injury characteristics revealed that the fingers, back and hand were the most frequently injured sites typically as a result of being struck or caught by an object, a slip/trip, or overexertion. These injuries resulted predominantly in an acute soft tissue injury requiring medical attention. Over the five year study period, food services, housekeeping and clerical staff filed the greatest number of accident/incident reports. Future investigations should employ a prospective approach which would allow researchers to determine variables of interest, ensure adequate data collection, and aim to improve the generalizability of research findings in this area.

Ice/cryotherapy and management of soft tissue injuries

I read with interest the review article by Collins regarding the use of ice in the management of acute soft tissue injuries (STI) and the conclusion that there is insufficient...