Treatment Of Soft Tissue Injuries Research Articles

068 Structural and Biochemical Characterization of Renal Capsule Matrix (RCM) Biomaterial

Cellular interaction with biomaterials determines the fate of the implant. Naturally derived biomaterials such as small intestinal submucosa (SIS) and renal capsule matrix (RCM) may provide optimal structure and composition for cellular repopulation in certain wound healing applications. Porcine renal capsule matrix (RCM) is an acellular, naturally occurring extracellular matrix undergoing characterization and preclinical investigation for the treatment of soft tissue injury. Early studies have demonstrated that RCM constructs induce host tissue infiltration, tissue-specific remodeling, and repair. RCM consists primarily of collagen, although the other proteins have been detected, including the growth factors basic FGF, VEGF, and CTGF. Transmission and scanning electron microscopy were used to envision the cellular environment provided by this biomaterial. Comparison of the images utilizing cryo and traditional preparation techniques show that RCM is a dense, heterogeneous matrix consisting of textured fibers of mixed size. Although the matrix architecture shows signs of collapse following lyophilization, much of the native structure seen in the hydrated isolate is preserved. These differences are maintained following rehydration in normal saline. The effects of these structural changes on cellular reaction and infiltration are unknown, but the naturally complex architecture likely facilitates host interaction at the cellular level. Further compositional characterization is under way. This work was supported by Cook Biotech Incorporated, West Lafayette, IN.

Ventral abdominal approach for screw fixation of sacroiliac luxation in clinically affected cats

To investigate sacroiliac luxation repair with positional screw insertion from the ventral surface of the sacral wing via a ventral abdominal approach in cats. 18 European shorthair cats. All cats underwent clinical examination including orthopedic and neurologic examination and assessment of lameness and pain before and immediately after surgery and 6 and 16 weeks after surgery. All sacroiliac luxations were stabilized with a single positional 2.4-mm cortical titanium self-tapping screw. The pelvic floor was also repaired in selected cats. Screw entry points and angles determined in a prior study of cadavers were used. Radiographs were taken before surgery and during follow-up evaluations to assess postoperative sacroiliac luxation reduction, implant placement, and repair stability. All implants were placed correctly. Iatrogenic sciatic nerve injuries occurred in 2 cats. Median time to ambulation was 1.5 days for cats with sacroiliac luxation as the sole injury. Radiographic outcome of sacroiliac luxation repair was excellent in 15 of 17 repairs, good in 1 of 17 repairs, and poor in 1 of 17 repairs. Clinical outcome was excellent in 11 of 15 cats and good in 4 of 15 cats. Insertion of a positional screw across the sacroiliac joint via a ventral abdominal approached can be an alternative to conventional techniques of sacroiliac luxation repair in cats. This novel technique allowed repair of bilateral sacroiliac luxation, repair of pelvic floor fractures, and treatment of soft tissue injuries of the abdominal cavity or abdominal organs with a single approach.

Naproxen and paracetamol [acetaminophen] are comparable for the treatment of soft tissue injuries to the ankle in young people,

Naproxen and paracetamol [acetaminophen] are comparable for the treatment of soft tissue injuries to the ankle in young people,

A survey of injury knowledge and technical needs of junior Rugby Union coaches in Townsville (North Queensland)

Data of the injury knowledge and technical needs of registered coaches of junior Rugby Union teams in the Townsville district junior Rugby Union (North Queensland) were collected via a questionnaire mailed to coaches to determine the knowledge of the management, risk and protective factors of injury. A total of 35 completed self-administered questionnaires were returned in March 2003 for a response rate of 100%. Half of all coaches (54%, n=18) identified the upper limb of the tackler as the body part most likely to be injured in a tackle and one-quarter (26%, n=9) identified the lower limb of the ball carrier. Half (46%, n=16) of coaches identified rest/ice/compression/elevation as the treatment for soft tissue injury. The total injury knowledge score increased with the total number of seasons coached (Spearman's r(s)=0.401, p=0.017). Coaches with a current first aid qualification were more likely to identify rest/ice/compression/elevation as the treatment for soft tissue injury (Fishers Exact test, p=0.002). The results of this survey demonstrate that coaches of junior Rugby Union teams require education of the mechanisms of injury and procedures for the early management of minor and soft tissue in Rugby Union coaching courses.

Subatmospheric Pressure Dressings in the Temporary Treatment of Soft Tissue Injuries Associated With Type III Open Tibial Shaft Fractures in Children

This study was designed to evaluate the use of subatmospheric pressure dressings on high-energy open tibial shaft fractures in children. We hypothesized that the use of a negative-pressure dressing in these fractures would result in a decreased incidence of infection and decreased need for pedicled muscle flaps and free tissue transfer. A retrospective case series of 15 consecutive pediatric patients with 16 type III open tibial shaft fractures (8 type IIIA, 7 type IIIB, and 1 type IIIC). The patients' age ranged from 2 to 17 years. All patients underwent a standard protocol of serial irrigation and debridement of the open wound with bony stabilization. Temporary coverage of the open wound was obtained with the use of a subatmospheric pressure dressing until definitive wound coverage or closure. Infection occurred in 5 of 16 fractures, 2 requiring antibiotics alone (1 type IIIA and 1 type IIIB) and 3 requiring surgical intervention (2 type IIIB and 1 type IIIC). Seven of 16 (3 type IIIA, 3 type IIIB, and 1 type IIIC) fractures required repeat surgical intervention to facilitate bony healing. Only 3 patients required free tissue transfers or rotational muscle flaps for coverage, a 50% decrease compared with the initial classification. Compared with other described methods, the use of subatmospheric pressure dressings in the temporary treatment of soft tissue wounds associated with high-energy open tibial shaft may reduce the need for major soft tissue coverage procedures. Its effect on infection and fracture healing rates requires further study. A reduction in the need for major soft tissue coverage procedures with the use of negative-pressure dressings in this setting should result in decreased morbidity for these patients and in decreased social and financial costs.

Simulation of Soft Tissue Failure Using the Material Point Method

Understanding the factors that control the extent of tissue damage as a result of material failure in soft tissues may provide means to improve diagnosis and treatment of soft tissue injuries. The objective of this research was to develop and test a computational framework for the study of the failure of anisotropic soft tissues subjected to finite deformation. An anisotropic constitutive model incorporating strain-based failure criteria was implemented in an existing computational solid mechanics software based on the material point method (MPM), a quasi-meshless particle method for simulations in computational mechanics. The constitutive model and the strain-based failure formulations were tested using simulations of simple shear and tensile mechanical tests. The model was then applied to investigate a scenario of a penetrating injury: a low-speed projectile was released through a myocardial material slab. Sensitivity studies were performed to establish the necessary grid resolution and time-step size. Results of the simple shear and tensile test simulations demonstrated the correct implementation of the constitutive model and the influence of both fiber family and matrix failure on predictions of overall tissue failure. The slab penetration simulations produced physically realistic wound tracts, exhibiting diameter increase from entrance to exit. Simulations examining the effect of bullet initial velocity showed that the anisotropy influenced the shape and size of the exit wound more at lower velocities. Furthermore, the size and taper of the wound cavity was smaller for the higher bullet velocity. It was concluded that these effects were due to the amount of momentum transfer. The results demonstrate the feasibility of using MPM and the associated failure model for large-scale numerical simulations of soft tissue failure.

Observation on therapeutic effect in acupuncture treatment of soft tissue injuries by differentiation of deficient and excessive patterns

Objective: To compare the therapeutic effects between the needling method by identification of deficient and excessive patterns and the needling method by routine meridian differentiation in the treatment of soft tissue injuries.Methods: 380 cases of the patients with soft tissue injuries were randomly divided into pattern identification group (200 cases, with the needling method by identification of deficient and excessive patterns) and meridian identification group (180 cases, with the needling method by routine meridian differentiation), to observe and compare the therapeutic effects in the two groups.Results: The curative effect was 86% in the pattern identification group and 31.11% in the meridian identification group, with a significant difference (P<0.01). In comparison with the total average treatment times in the cured and improved cases, the pattern identification group was 8.8 days and the meridian identification group was 15.6 days, with a remarkable significant difference (P<0.01). The pattern identification group was better than the meridian identification group.Conclusion: In the treatment of soft tissue injuries, the needling method by identification of deficient and excessive patterns was better than the needling method by routine meridian differentiation.

Partial-thickness burn to the leg following application of a cold pack: Case report and results of a questionnaire survey of Scottish physiotherapists in private practice

0 d A 29-year-old, healthy female sustained a moderate soft issue injury to the left gastrocnemius muscle during a run up nd down Ben Lomond. She treated this with a shop-bought old pack taken from the ‘quick freeze’ compartment of her ome freezer. The pack was applied to the area that evening ith a dishcloth separating it from and the skin. The leg as rested on a chair, producing an additional compression ffect. Despite aiming to have the pack in situ for only 5 minutes, she lost track of time and it remained in place or approximately 30 minutes. No pain was reported during pplication. Following removal of the cold pack, a large, hard and usky purple area was noted, surrounded by blanching of the kin. Over the next hour, this area became extremely painful ith surrounding erythema. The following morning, signifiant swelling of the lower extremity was noted with a large lister over the posterior calf, amounting to around 3% total ody surface area. The patient attended the burns clinic at Glasgow Royal The use of ice in the treatment of soft tissue injury is widespread and mainly occurs in conjunction with other modalities: protection, rest, compression and elevation (PRICE). Despite this, there is little substantive evidence, other than a few experimental trials, that treatment with ice is of benefit [1], and certainly no general consensus regarding how it should be used [2]. The rationale behind the use of ice is the reduction in pain, swelling and muscle spasm with an associated decrease in metabolic rate of the underlying tissue. This is thought to protect surrounding uninjured tissue from ischaemia and damage from enzymes released from the injured area as a result of the inflammatory cascade [3]. This principle of therapeutic hypothermia has been utilised in other areas of medicine with varied success, including after cardiac arrest and after head injury [4,5]. A literature search of Medline, CINAHL, AMED, SPORTDiscus and Cochrane reviews resulted in only four previous reports of injury attributed to the use of ice [6–9]. We postulated that the incidence of this injury may be far greater than nfirmary where the blister was deroofed and the burn depth as assessed as a combination of superficial and deep partial hickness. She required 14 days off work with continuous levation of the leg, and was assessed every 48 hours by the linic. No skin grafting was required but full skin coverage that anecdotally reported in the literature, and may be a significant factor to consider prior to prescribing this treatment. As far as we are aware, there are no published data other than the cited case reports looking at this specific complication. However, the time required to decrease intramuscular t R s a o r

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 ( J Manipulative Physiol Ther. 2005;28:010-040).

010 Structural Characterization of Small Intestinal Submucosa (SIS) using Cryo and Traditional Scanning Electron Microscopy (SEM)

Composition and structure determine the fate of biomaterials in the body, encouraging or discouraging acceptance, cellular infiltration, and degradation or incorporation into host tissue. Most biomaterials research has been focused on composition, while structure remains a relatively uninvestigated factor in biomaterial success. Naturally derived biomaterials may provide optimal structure for cellular repopulation in certain applications. Porcine small intestinal submucosa (SIS) is an acellular, naturally occurring extracellular matrix used in the clinical treatment of soft tissue injury, including pressure, venous, and diabetic ulcers. Numerous studies have demonstrated that SIS induces host tissue infiltration, tissue‐specific remodeling, and repair. SIS consists primarily of collagen, although the presence of other proteins, growth factors, glycosaminoglycans, and proteoglycans has been reported. SEM was used to characterize the cellular environment provided by this biomaterial. Cryo‐SEM was used to image mechanically isolated, oxidatively disinfected, lyophilized, sterilized, and rehydrated SIS. The fractured cross‐sectional faces of intact intestine, oxidatively disinfected SIS, and lyophilized SIS were imaged with traditional SEM. Comparison of the images utilizing cryo and traditional preparation techniques show that SIS is a heterogeneous matrix consisting of textured fibers of mixed size. There are differences in the structure of the mucosal and serosal surfaces. Although the matrix architecture shows signs of collapse and delamination following lyophilization, much of the native structure is preserved. These changes are preserved following rehydration. The effects of these structural changes on cellular reaction and infiltration are unknown, but the naturally complex architecture‐clearly facilitates host interaction on thecellular and subcellular levels. This work was supported by Cook Biotech Incorporated.

Chinese massage therapy for ankle injury

Purpose: To explore the therapeutic methods and effects in the treatment of acute and chronic injuries of the ankle joint by Chinese massage therapy in combination with external application of Chinese herbal drugs and functional exercises.Methods: Totally, 36 cases of the patients with acute soft tissue injury, chronic soft tissue injury and post-fracture sequelae of the ankle joint were treated by Chinese massage therapy, external application or external wash of Chinese herbal drugs, and exercises of dorsal flexion and extension of the ankle joint, to observe the restoration of the ankle functions.Results: In 36 cases of the patients, the results showed remarkable effect in 18 cases, effect in 16 cases, failure in 2 cases and the effective rate in 94.4%.Conclusion: The combined use of Chinese massage therapy, external application of Chinese herbal drugs and functional exercises can produce precise effect in the treatment of soft tissue injury of the ankle joint.

Die komplexe Beckenverletzung im Kindesalter

Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.

Managing soft tissue injuries.

vol 10 no 1 april 2002 emergency nurse 11 This article will discuss whether a chartered physiotherapist is a useful health care professional in the treatment of soft tissue injuries (STI) to which the emergency nurse practitioner (ENP) may refer such patients. It will describe the pathophysiology of STI and its relation to the current recommended treatments in the literature. It will also discuss whether physiotherapists should be based in the emergency department (ED) and if there are any advantages to this arrangement. Although ENPs can be independent in their assessment, diagnosis and treatment of their patients, to maximise the quality of care available they should employ other specialists. Taylor (1999) says ‘adoption of a team approach allows for the provision of high quality care to be achieved successfully.’ Thus to improve patient care, it would appear the ENP needs to work with other health care professionals as a member of a multidisciplinary team and one of the team could be the physiotherapist.

Therapeutic ultrasound in soft tissue lesions.

Therapeutic ultrasound is one of the most common treatments used in the management of soft tissue lesions, which constitute the majority of rheumatic complaints. Although many laboratory-based research studies have demonstrated a number of physiological effects of ultrasound upon living tissue, there is remarkably little evidence for benefit in the treatment of soft tissue injuries. This may be related to several confounding factors, including technical variables, the complexity and variety of underlying pathologies in soft tissue lesions, methodological limitations of clinical studies, or true lack of effect. In this review the scientific basis for the use of therapeutic ultrasound in soft tissue lesions and the existing evidence relating to its clinical effect are detailed.

Benchmarking in rehabilitation: comparing physiotherapy services.

This report presents outcome data from 3,176 consecutive prospective patients referred to physiotherapy for the treatment of soft tissue injuries. The results detailed here are part of a larger study collecting data from different NHS trusts in a benchmarking study. The Therapy Outcome Measure was used to collect data on each patient in four domains: Impairment, Disability/activity, Handicap/participation, and Distress/wellbeing on the entry and the exit from physiotherapy. The study concludes that patients do not have equal opportunity of accessing therapy for their specific condition according to their abilities and needs. Therapy provided in the Trusts did not produce similar changes in the patients' abilities and some dimensions appeared to improve more significantly in some locations. Furthermore this study would suggest that there are no common criteria for discharge of patients with similar conditions from physiotherapy across the Trusts as measured by the Therapy Outcome Measure.

The Effects of Low Power Laser Therapy on Muscle Healing Following Acute Blunt Trauma.

Many forms of treatment are utilized by physiotherapists for the treatment of soft tissue injuries. One of these is the use of low powered laser (LPLT). The purpose of this study was to determine the effects of LPLT (lj/cm2, daily 10) on acute blunt trauma to muscles in controlled animal experiments. A reproducible model of single acute blunt trauma to the lower leg muscles of anaesthetized male rats (n=28) was used. The level of contractile protein content and collagenous protein content were determined 12 days post-trauma in control, injured, laser-control and laser treated animals. Our data demonstrated an overall decrease in the levels of contractile protein content, in the various groups, which were not statistically different (p>0.05), and an overall significant increase in the levels of collagenous protein content (p<0.005). It was concluded that the LPLT protocol used for the recovery of injured muscle was not of significant benefit during the time period employed in this study (day 3 to day 12 post-trauma) following acute blunt trauma. The data confirmed a decrease in the levels of contractile proteins and an increase in the levels of collagenous proteins in muscle following injury.

Enhanced proliferation of fibroblasts and endothelial cells treated with an extract of the leaves of Chromolaena odorata (Eupolin), an herbal remedy for treating wounds.

Burns are a major problem in many developing countries. Eupolin ointment is a topical agent used in the treatment of soft-tissue wounds and burns in Vietnam and is made from an aqueous extract of the leaves of Chromolaena odorata (formerly Eupatorium odoratum). Clinical studies using this extract have shown antimicrobial and anticoagulation effects as well as the promotion of tissue remodeling in the wound healing process. However, the mechanism by which this agent affects cells involved in the wound healing process is unknown. In our research, fibroblasts and endothelial cells, two cell types that play a crucial role in wound healing, were used to investigate some of the effects of Eupolin extract in vitro. Cell growth was estimated by a colorimetric assay at different time intervals. Enhanced growth of fibroblasts and endothelial cells was found at concentrations of 10 microg/ml and 100 microg/ml of Eupolin extract. This was particularly evident in medium supplemented with only 0.5% fetal calf serum where the cells were quiescent. Toxicity of the extract to fibroblasts was observed at 250 microg/ml in Dulbecco's modified Eagle's medium/0.5% fetal calf serum, but there was no significant damage at this dose to the endothelial cells. The results of the study demonstrated that Eupolin extract increased fibroblast and endothelial cell growth, and this could explain in part the beneficial clinical effects that have been observed.

The complex injury of the elbow.

The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma , or a prolonged ischemia caused by vascular injury or compartment syndrom. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatement show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrom. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatement of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.

An aqueous extract of the leaves of Chromolaena odorata (formerly Eupatorium odoratum) (Eupolin) inhibits hydrated collagen lattice contraction by normal human dermal fibroblasts.

Chromolaena odorata (formerly Eupatorium odoratum) is used as a traditional medicine in Vietnam (Nghiem, 1992), where its Vietnamese common name is "co hoi." While it has been widely considered a weed by agriculturalists (Holm et al., 1991), the aqueous extract and the decoction from the leaves of this plant have been used throughout Vietnam for the treatment of soft tissue wounds, burn wounds, and skin infections. A number of clinical studies done by Vietnamese as well as foreign medical workers has demonstrated the efficacy of this extract on the wound-healing process. In this article, the effect of the Eupolin extract on hydrated collagen lattice contraction by human dermal fibroblasts, an in vitro model of wound contraction, is described. The significant inhibition of collagen gel contraction by Eupolin extract at 50 to 200 micrograms/ml is demonstrated in various concentrations of collagen. When the extract at 50 to 150 micrograms/ml was washed out of the lattices and replaced by fresh medium without Eupolin, the contraction of collagen by cells was resumed. The visualization of cells in the lattices by incubation in a tetrazolium salt for 2 h showed live cells at 50 to 150 micrograms/ml of extract. In contrast, all cells were killed in the higher extract doses of 300 or 400 micrograms/ml. These preliminary results showing the inhibitory effect of Eupolin extract on collagen contraction suggest that a clinical evaluation of its effect on wound contraction and scar quality should be made. This work illustrates that traditional remedies that are used by folk practitioners to improve healing can be examined in a scientific manner using in vitro wound-healing models. It could be that the synergistic properties of components of the natural extract contribute to the positive effects demonstrated on various wound-healing mechanisms.

An in vitro investigation into the effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts.

Soft tissue injuries due to repetitive motion are common sports injuries and are often treated with antiinflammatory therapies. We investigated the in vitro effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. In addition, we studied the effects related to the presence of inflammatory cells. Repetitive motion was associated with an increased release of prostaglandin E2 and increased deoxyribonucleic acid (DNA) and protein synthesis. The presence of nonsteroidal antiinflammatory medication decreased prostaglandin E2 release and DNA synthesis but increased protein synthesis. Contact with macrophages caused a marked additional increase in prostaglandin E2 and a concomitant increase in DNA synthesis. Release of interleukin-6 by the macrophages also suggested that this cytokine plays a role in the response to repetitive motion. Our results can aid in the search for a more scientific approach to the treatment of soft tissue injuries associated with repetitive motion. They suggest that nonsteroidal antiinflammatory medication may have potentially negative effects during the proliferative phase of a healing since it was associated with decreased DNA synthesis. However, it may be beneficial in the maturation and remodeling phase since it stimulated protein synthesis.