Treatment Of Soft Tissue Injuries Research Articles

Topical Non-steroidal Anti-inflammatory Products as Ultrasound Couplants: Their Potential in Phonophoresis

<h2>Summary</h2> The transmission of ultrasound through commercially available topical products containing non-steroidal anti-inflammatory drugs was investigated. A Bio-tek wattmeter was ued to measure percentage transmission of ultrasound relative to de-ionised degassed water at a range of ultrasound frequencies (ie 0.75, 1.5 and 3.0 MHz with total power output of 1.5 and 5 watts). Gel-based formulations were shown to transmit ultrasound efficiently at 1.5 and 3.0 MHz, but less efficiently at 0.75 MHz. The study provides information which may be useful when considering the use of topical NSAID preparations as couplants during ultrasound treatment of soft tissue injuries and musculoskeletal conditions.

Role of platelet‐derived growth factor in osteoblast function and bone synthesis

In vitro studies have shown that platelet-derived growth factor binds to specific receptors on osteoblasts and induces proliferation. Some reports also indicate that platelet-derived growth factor may inhibit differentiation of bone cells. Such findings are difficult to interpret, however, because many of these studies used impure platelet-derived growth factor extracted from platelets (rather than pure, recombinant platelet-derived growth factor), used mixed cell populations, and added serum to the culture media (likely introducing additional growth factors). In vivo studies also have yielded conflicting results regarding the effects of platelet-derived growth factor on bone formation. Platelet-derived growth factor may act in concert with insulin-like growth factor I to induce bone formation in a canine periodontal system. Other investigators, however, have shown that platelet-derived growth factor inhibits the effects of osteoinductive proteins such as osteogenin. No evidence of bone formation has been detected in patients receiving platelet-derived growth factor treatment of soft tissue wounds overlying bony prominences in clinical trials. Thus, despite the observations that osteoblasts can specifically bind and proliferate in response to platelet-derived growth factor in tissue culture, platelet-derived growth factor alone has not yet been proved to be osteoinductive in vivo. These observations suggest that in the presence of the many cytokines and multiple cell types found in wounds and fractures, the direct effects of platelet-derived growth factor on osteoblasts are eclipsed.

Clinical trials of ultrasound treatment in soft tissue injury: A review and critique

Although the use of ultrasound in the treatment of soft tissue injuries has been widely adopted by physiotherapists, relatively few investigations into its effectiveness have been undertaken. Of 18 studies identified, almost all were found to be methodologically flawed. These flaws included a lack of control groups, poor matching of groups, failure to adopt a double-blind design and a lack of statistical analysis. Variation in the parameters of ultrasound treatment and assessment measures are also explored. Only one study incorporating a placebo group found response to ultrasound to be superior to response to placebo and this review concludes that the case for ultrasonic treatment of soft tissue injuries is not well founded at present. The need to conduct well-controlled, discriminative studies employing standardised criteria is discussed. The standardisation of diagnostic, treatment and assessment criteria permits meaningful comparisons between studies and, where appropriate, pooling of data. This in tur...

Comparison of the efficacy and tolerability of diclofenac gel (Voltarol Emulgel) and felbinac gel (Traxam) in the treatment of soft tissue injuries

SummaryIn an observer‐blind, randomised study, the efficacy and tolerability of two topical NSAID preparations were assessed in 384 patients with acute soft tissue injuries. The patients were allocated to receive treatment with either diclofenac gel (Voltarol Emulgel) 4 g tds or felbinac gel (Traxam) 4 g tds for three or seven days, depending on the rate of recovery.In every parameter studied (pain at rest, pain on movement, pain on local pressure, swelling, range of movement, bruising, degree of recovery, requirement for rescue analgesics, daily pain levels), diclofenac was found to be more effective at day 3 and day 7, with the single exception of bruising at day 7. Treatment differences were statistically significant in favour of diclofenac for pain at rest (p = 0.03) and bruising on day 3 (p = 0.03), and pain on pressure at day 7 (p = 0.009). The difference in favour of diclofenac in reduction of daily pain level (as recorded on diary cards) did not quite reach significance (p = 0.06). Both preparations were well tolerated, with no significant treatment‐related side‐effects reported.

More topical NSAIDs: worth the rub?

The prospect that topical application might deliver at least some of the benefit of NSAIDs, without the risks of systemic treatment, is seductive, as promotional literature often shows. When we reviewed benzydamine (Difflam), the first topical NSAID other than salicylate, to be licensed in Britain we concluded that it was of uncertain value in the treatment of soft tissue injuries.1 Three more preparations are now available and others are likely to follow. Felbinac gel (Traxam – Lederle) is intended for short-term use in soft tissue injuries. Piroxicam gel (Feldene – Pfizer) and ibuprofen cream (Proflex – Zyma) have additional indications embracing a variety of less short-lived musculo-skeletal disorders.

A comparative study of naproxen gel and flufenamic acid gel in the treatment of soft tissue injuries

One hundred patients were enrolled in a single-blind, randomized, parallel group study to compare naproxen gel (10%) with flufenamic acid gel (3%) for the treatment of soft tissue injuries. Demographic variables, the distribution of diagnoses (tendinitis, bursitis/synovitis, synovitis, periarthritis, epicondylitis) and initial severity of the complaint were similar between the two groups. The gels were applied 2 to 6 times per day, as required, and conventional clinical indices were evaluated at Day 1 (on entry to the study), Day 3 and Day 7. Global assessments of efficacy were made by both physicians and patients at the end of the study. By Day 7 both treatments had produced a highly significant improvement in symptoms (p less than 0.001). The patients using naproxen gel, however, improved more rapidly. At Day 3 the number of patients rating 'swelling', 'tenderness to firm palpation' or 'limitation of use' as 'severe' or 'moderate' was significantly less (p less than 0.05) than for patients using flufenamic acid gel. At the end of the study the physician's global efficacy rating showed no significant differences between the two gels; patients, in contrast, showed a significant preference for naproxen gel (p less than 0.05). Both gels were well tolerated. The more rapid onset of effect and patient preference for naproxen gel may be important factors in the choice of medication.

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.

The use of cold and superficial heat in the treatment of soft tissue injuries.

The use of cold and superficial heat in the treatment of soft tissue injuries.

Acute Soft-Tissue Injuries in the Young Athlete

Although the incidence of soft-tissue injury is high in the young athlete, one must be constantly aware of the tendency toward epiphyseal and apophyseal injuries in individuals with open growth plates. After the diagnosis of a soft-tissue injury (sprain, strain, or contusion) has been made, treatment must include an initial 24- to 48-hour period of RICE. Appropriate splinting may be required. Rehabilitation then proceeds aggressively, with early restoration of strength, flexibility, and joint range of motion. Prior to return to full athletic activity, the athlete should meet the criteria outlined in this article. Protective taping or bracing may be necessary upon return to full activity. The treatment of soft-tissue injuries should start with prophylaxis. All predisposing factors to the development of injury should be sought on preparticipation physical examinations and corrected prior to allowing the young athlete to compete. Using the program described as a guide to treating the injured athlete should result in early return to function with low recurrence rates of injury.

The Combination of Ice and Intermittent Compression System in the Treatment of Soft Tissue Injuries

Summary The author describes the treatment of pain and oedema in soft tissue injuries obtained while playing rugby, using an intermittent compression system and ice.

Nabumetone in the treatment of skin and soft tissue injury

Nabumetone, a new nonsteroidal anti-inflammatory agent, has been evaluated for the treatment of skin and soft tissue injury, including sports injury, in clinical trials involving nearly 1,000 patients. Its efficacy, safety, and tolerance in these patients is reviewed. The efficacy of nabumetone in the treatment of soft tissue injury has been demonstrated to be similar to that of soluble aspirin, ibuprofen, and naproxen. It was not possible in these studies to demonstrate a definite advantage over placebo, and the reasons for this are discussed along with some suggestions for future studies. There were no serious adverse experiences reported, and nabumetone was well tolerated and compared favorably with the other agents used, including placebo. It caused significantly fewer gastrointestinal side effects than soluble aspirin. Nabumetone is an appropriate choice of non-steroidal anti-inflammatory drug for the treatment of sports injury.

The Principles of the Treatment of Tibial Shaft Fractures: A Review of 10,146 Cases From the Literature

The tibial shaft is a common site of long bone fracture, and both nonoperative and operative treatment methods have been developed in an effort to speed union while minimizing complications. To compare the recent results of present treatment alternatives and to identify those factors of prognostic significance, a review of the 1976-1981 English literature was performed, representing a review of 10, 146 fractures. Comminution, displacement, bone loss, distraction, soft tissue injury, infection, polytrauma, and patient personality were found to be factors that place the patient with a tibial shaft fracture at risk for local and systemic complications. Fracture location, fracture configuration, and concomitant fibula fracture were found to be of no prognostic significance. The advantages and disadvantages of casts, traction, plates, intramedullary rods, and external fixation are discussed. The principles of treatment of soft tissue injury, transverse and short oblique fractures, spiral fractures, single butterfly comminution, segmental fractures, comminuted fractures, bone loss, "floating knee" injuries, bilateral tibial fractures, and brain injured patients are detailed.

Maxillofacial Trauma

No other region of the body demands the precision and attention to detail that the face does when injured. For treatment of complex injuries, the team approach is advantageous. Emergency treatment and treatment of soft tissue injuries, facial fractures, and gunshot wounds are discussed in detail.

Taktisches Vorgehen bei der Therapie polytraumatisierter Kinder

In the management of multiply injured children, especially those with lesions of abdominal organs and of the great vessels, effective stoppage of bleeding takes precedence over operative correction of gastric- or intestinal-rupture, and the treatment of soft-tissue wounds or fractures. Where the spleen is ruptured, an accompanying injury of the pancreas should be sought. Procedure in dealing with liver trauma (direct suture, resection) depends on the findings in situ. Tearing of the great vessels, occasionally seen when the patient has been run over, requires reconstructive measures, giving preference to autologous transplants (veins). Intracranial haemorrhage should be attacked only after stoppage of potentially lethal bleeding from parenchymatous organs (in the abdomen) and from blood vessels. The maximal length of operation (4-5 hrs) should not, if possible, be superceded. For this reason, any osteosyntheses necessary are performed at an interval of 5-7 days.

The management of soft tissue ankle injuries.

The anatomy of the ankle, and the types of sporting injuries that occur in this joint, are described. Traditional treatment of soft tissue injuries involves immobilisation, and the value of this is questioned. An alternative treatment strategy is described, and involves immobilisation and compression for twenty-four hours, followed by rapid mobilisation using a balance board. This alternative strategy can bring about full functional mobility in 94% of patients within 14 days.

Ketoprofen in the Treatment of Soft Tissue Injury

Ketoprofen in the Treatment of Soft Tissue Injury

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.

Section 1 Ibuprofen (‘Brufen’) in soft-tissue injuries

SummaryA double-blind trial was carried out in 22 professional footballers to compare the effectiveness of 1200 mg. ibuprofen and 3.0 g. aspirin daily in the treatment of soft-tissue injuries. A total of 60 injuries were treated. The duration and severity of pain were significantly reduced on ibuprofen compared to aspirin, as was the time needed before players returned to training or were fit again for match play.

Facial Injuries

An undeniable increase in violent injury is reflected in the incidence of facial injuries by causative agents. Over half of fractures of the maxillofacial area are caused by automobile accidents. The etiology and treatment of soft tissue injury and facial fractures are presented in some detail.

Symposium on maxillo-facial trauma. IV. Pitfalls in the treatment of mid-facial trauma.

AbstractThe overall treatment of severe mid‐facial trauma calls for specialized knowledge and experience in an anatomical area shared by a number of surgical specialties. Increasing specialty board requirements and changing respect for anatomical boundaries among the various specialties make the mid‐facial area a bone of contention in medical centers with a limited volume of facial trauma cases. The need to share this educational resource is recognized; however, its distribution may be considered an educational pitfall among those more clinical in nature.The following clinical examples in the treatment of mid‐facial trauma have been briefly discussed and illustrated:1. Serious hematoma formation unrecognized or underestimated.2. Magnitude of facial bone injury unappreciated by initial observation of the patient and review of preliminary X‐rays.3. Poor selection of airway for delivery of general anesthesia.4. Unnecessary use of wire suspension for facial fracture immobilization.5. Failure to establish centric occlusion.6. Unrecognized inter‐canthal trauma.7. Impacted nasal fracture unreduced by closed reduction efforts and left untreated.8. Treatment of soft tissue injuries without regard for facial skeletal injuries.9. Vital structures discarded at time of initial treatment.10. Failure to replace missing dental elements early to avoid contracture.The trend towards introduction of lesser trained personnal in the intial treatment phase of facial traumam, coupled with the trend towards prepaid health group care suggests that the errors of treatment are likely to persist and in all probability to increase.