Upper limb soft tissue injury

Specialties > General practice

Background knowledge 🧠

Definition

Injuries to the soft tissues of the upper limb, including muscles, tendons, ligaments, nerves, and blood vessels.
Commonly result from trauma, overuse, or repetitive strain.
May involve acute or chronic conditions.
Examples include rotator cuff tears, tendonitis, bursitis, and nerve entrapment syndromes.

Epidemiology

Common in athletes and manual workers due to high physical demands.
High incidence in older adults due to degenerative changes.
Occupational injuries account for a significant proportion.
Upper limb soft tissue injuries are a leading cause of musculoskeletal pain and disability.

Aetiology and Pathophysiology

Traumatic causes include falls, direct blows, and accidents.
Repetitive strain injuries due to overuse, common in sports like tennis or occupations like painting.
Degenerative changes, particularly in older adults, leading to conditions like rotator cuff tears.
Inflammatory processes such as tendonitis or bursitis.
Nerve entrapment syndromes, e.g., carpal tunnel syndrome, due to anatomical or positional factors.

Types

Muscle injuries: strains, tears.
Tendon injuries: tendonitis, tears, ruptures.
Ligament injuries: sprains, ruptures.
Nerve injuries: compressions, entrapments (e.g., carpal tunnel syndrome).
Bursitis: inflammation of bursae, commonly at the shoulder or elbow.
Vascular injuries: rare but may include damage to major arteries or veins.

Clinical Features 🌡️

Symptoms

Pain: acute or chronic, localized to the affected area.
Swelling: due to inflammation or injury.
Weakness: particularly in cases of muscle or tendon injury.
Numbness or tingling: suggestive of nerve involvement.
Decreased range of motion: often due to pain, swelling, or mechanical blockage.

Signs

Tenderness on palpation of the affected area.
Visible deformity or muscle wasting in chronic cases.
Reduced strength on muscle testing.
Positive special tests (e.g., Hawkins-Kennedy test for shoulder impingement).
Abnormal posture or compensatory movements.

Investigations 🧪

Tests

X-rays: useful for ruling out fractures or dislocations.
MRI: gold standard for assessing soft tissue structures like muscles, tendons, and ligaments.
Ultrasound: useful for dynamic assessment of tendons and muscles, as well as guided injections.
Nerve conduction studies: indicated for suspected nerve injuries or entrapment syndromes.
Blood tests: rarely required, but may be indicated if infection or systemic disease is suspected.

Management 🥼

Management

Rest and activity modification to allow healing.
Physiotherapy: exercises to restore range of motion and strength.
Pharmacological: NSAIDs for pain and inflammation.
Injections: corticosteroids for severe inflammation, guided by ultrasound if necessary.
Surgical intervention: considered for complete tears, failed conservative treatment, or significant mechanical issues.

Complications

Chronic pain: can persist despite treatment.
Stiffness: particularly if rehabilitation is delayed or incomplete.
Recurrent injury: due to incomplete healing or premature return to activity.
Nerve damage: particularly in cases of severe trauma or delayed treatment.
Functional impairment: loss of strength, range of motion, or dexterity.

Prognosis

Good prognosis with early and appropriate treatment.
Chronic cases may require long-term management strategies.
Rehabilitation is key to preventing recurrence.
Surgical outcomes are generally favorable when indicated.
Some patients may experience residual symptoms or limitations.

Key Points

Upper limb soft tissue injuries encompass a wide range of conditions with varying severity.
Early diagnosis and management are crucial for optimal outcomes.
Multidisciplinary approach often required, including physiotherapy and, in some cases, surgical intervention.
Prevention strategies include proper technique in sports and ergonomics in the workplace.
Patient education on activity modification and adherence to rehabilitation is essential.

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