Soft tissue injury

Specialties > Emergency medicine and intensive care

Differential Diagnosis Schema 🧠

Muscle Injuries

Muscle strain: Sudden onset during activity, localized pain, possible swelling and bruising.
Muscle contusion: Direct trauma, resulting in localized pain, swelling, and bruising, often without loss of muscle function.
Delayed onset muscle soreness (DOMS): Pain and stiffness developing 24-48 hours post-exercise, common after unaccustomed or intense activity.

Ligamentous Injuries

Sprain: Stretching or tearing of ligaments, common in joints like the ankle and knee; characterized by pain, swelling, and joint instability.
Grade I sprain: Mild stretching of the ligament without joint instability, slight swelling, and pain.
Grade II sprain: Partial tear of the ligament, with moderate pain, swelling, and some joint instability.
Grade III sprain: Complete tear of the ligament, severe pain, swelling, and significant joint instability, often requiring surgical intervention.

Tendon Injuries

Tendonitis: Inflammation of the tendon, often due to overuse, characterized by pain and tenderness along the tendon, commonly affecting the Achilles, patellar, or rotator cuff tendons.
Tendinosis: Degenerative changes in the tendon, often chronic, with pain and reduced tendon strength, without significant inflammation.
Tendon rupture: Sudden onset of severe pain, often with an audible pop, and loss of function in the affected area, such as Achilles tendon rupture.

Bursitis

Acute bursitis: Inflammation of a bursa, often due to repetitive movement or trauma, causing localized pain, swelling, and warmth over the affected bursa.
Chronic bursitis: Recurrent or persistent inflammation, often due to prolonged pressure or overuse, with less intense pain but more frequent episodes.

Key Points in History 🥼

Mechanism of Injury

Direct trauma: Consider contusions, lacerations, or fractures when there is a history of a direct blow or fall.
Twisting or overstretching: Common mechanism in ligamentous injuries like sprains, particularly in joints like the ankle or knee.
Overuse: Gradual onset of symptoms suggests overuse injuries like tendonitis or chronic bursitis.

Symptoms and Functional Impact

Pain: Onset, location, and severity of pain help differentiate between muscle strain, ligament sprain, and tendon injury.
Swelling and bruising: Immediate swelling often suggests a more severe injury like a ligament tear, while delayed swelling may be seen in minor injuries.
Loss of function: The extent of functional impairment, such as difficulty bearing weight or moving the affected area, can indicate the severity of the injury.
Popping or snapping sound: Suggests possible ligament rupture or tendon injury.

Background

Past Medical History: Prior injuries to the same area, chronic conditions like rheumatoid arthritis that may predispose to soft tissue injuries.
Drug History: Use of medications like corticosteroids, which can weaken tendons and increase injury risk.
Family History: Genetic predispositions to conditions affecting connective tissues, such as Ehlers-Danlos syndrome.
Social History: Occupational or recreational activities that may contribute to overuse injuries, such as repetitive motions or heavy lifting.

Possible Investigations 🌡️

Imaging Studies

X-ray: Primarily to rule out fractures in the setting of trauma, particularly when there’s a suspected sprain or contusion.
Ultrasound: Useful for evaluating soft tissue injuries like tendon tears, muscle strains, and bursitis.
MRI: Provides detailed imaging of soft tissues, useful for assessing ligamentous injuries, complex tendon injuries, or when there’s a suspicion of a complete rupture.

Laboratory Tests

Inflammatory markers: ESR and CRP may be elevated in cases of severe or chronic inflammation, such as tendonitis or bursitis.
Rheumatologic tests: Consider in patients with a history suggestive of underlying autoimmune or inflammatory conditions (e.g., rheumatoid factor, ANA).
Electrolyte levels: Imbalances such as low potassium or calcium may contribute to muscle cramps or spasms.

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