Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for soft tissue injuries
- Describe the diagnostics and laboratory values associated with soft tissue injuries
- Apply nursing concepts and plan associated nursing care for patients with soft tissue injuries
- Evaluate the efficacy of nursing care for patients with soft tissue injuries
- Describe the medical therapies that apply to the care of soft tissue injuries
Soft tissue injuries affect multiple parts of the body, including muscles, tendons, and ligaments. These types of injuries are common because they occur by many different mechanisms, including athletics, trauma, falls, and normal aging. There are several different types of soft tissue injuries, including sprains, strains, contusions, tendinitis, and bursitis (Table 13.6).
| Type of Injury | Description | Areas Commonly Affected |
|---|---|---|
| Sprain | Overstretching or tearing of a ligament |
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| Strain | Overstretching or tearing of a muscle or tendon |
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| Contusions (bruises) | Direct blow(s) to a body part (often with a blunt object), causing damage to underlying muscle and tissue without breaking the skin |
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| Tendinitis | Inflammation or irritation of a tendon from overuse |
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| Bursitis | Inflammation of a bursa, producing small, fluid-filled sacs (often co-occurs with tendinitis) |
|
Pathophysiology
The underlying pathophysiology of soft tissue injuries varies depending on the specific type of injury. Strains and sprains are most often the result of playing sports, as movements such as twisting, turning, and pulling may stretch or tear muscles, ligaments, or tendons. Bruising, or contusion, typically occurs from direct blows to the body, such as those obtained from falling or while playing contact sports. The overuse of a tendon causes tendinitis, inflammation of a tendon, so this injury is commonly seen in athletes who repeatedly use the same muscles and tendons: for example, tennis players swinging a racquet or baseball pitchers throwing a ball. Usually, a co-occurring condition with tendinitis is bursitis. As the overused tendon becomes inflamed, fluid builds up in the neighboring bursa, resulting in bursitis, which is inflammation of the bursa.
Clinical Manifestations
Clinical manifestations of soft tissue injuries vary depending on the area of the body affected and the type of injury that occurred. Some of the most common clinical manifestations associated with soft tissue injuries include
- swelling,
- redness or bruising on the skin,
- pain,
- muscle spasms, and
- muscle weakness.
Assessment and Diagnostics
Most often, physical assessment of the affected part of the body is enough to confirm a diagnosis of a soft tissue injury. For injuries that are less obvious upon visual inspection, imaging studies such as CT or MRI may be indicated. X-rays may be used if bone damage is suspected, but they do not show soft tissue injury as well as other imaging modalities do. There are no specific diagnostic tests that are used to confirm soft tissue injury. In some cases, such as traumas or falls, tests such as hemoglobin and hematocrit may be indicated to monitor for blood loss.
Nursing Care of the Patient with Soft Tissue Injuries
The main goals of nursing care for patients with soft tissue injuries are to manage symptoms and heal the affected part of the body. Patient education is a large component of nursing care for these patients to assist in the healing of the affected muscle, tendon, or ligament.
Recognizing Cues and Analyzing Cues
The nurse must remain attentive for clinical signs indicating the patient is experiencing a soft tissue injury. Most often, the patient will present with pain and swelling of the affected area and report having recently participated in an athletic event or experienced a fall or other trauma. With these cues present, the nurse will hypothesize that the patient has experienced some kind of soft tissue injury; the nurse can then ask more specific questions to determine which kind of injury they have. For example, if a patient experiencing shoulder pain reports they are an avid tennis player, the nurse may hypothesize that they have tendinitis in the shoulder from overuse.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
One of the main nursing interventions for patients with soft tissue injuries is using the “RICE” acronym, which stands for rest, ice, compression, and elevation. The nurse will encourage the patient to take a break from the activity that caused the injury and apply ice packs for 20 minutes at a time several times per day. Additionally, the nurse should apply a compression bandage to limit swelling and elevate the affected injury higher than the level of the patient’s heart to reduce swelling and promote circulation to the joint. For sprains, the patient may require application of a brace to stabilize the joint. The nurse should assist the patient in applying the brace for the first time and make sure the patient is able to do it themselves upon discharge home.
Evaluation of Nursing Care for the Patient with Soft Tissue Injuries
Most types of soft tissue injuries are self-limiting, meaning they will improve over time on their own. To ensure the injury is improving, the nurse should schedule a follow-up appointment after discharge. In some severe cases where improvement is not seen at the follow-up appointment, surgery or other intervention may be required, but typically using RICE is enough to produce significant improvement.
Evaluating Outcomes
When evaluating a patient with a soft tissue injury to determine the effectiveness of their plan of care, the nurse should assess for signs indicating that the treatment interventions are working. These signs include
- decreased swelling,
- less self-reported pain,
- improved bruising, and
- improved range of motion.
Medical Therapies and Related Care
In addition to RICE, treatment for soft issue injuries often involves the administration of NSAIDs, which aim to help reduce swelling and pain. In more severe cases of pain, opioid medications may be prescribed, but this is not common. Most importantly, the patient should be educated on strategies to prevent these kinds of injuries in the future. Prevention strategies include
- using proper equipment (e.g., weights, shoes, other sports equipment),
- warming up before participating in physical activity,
- staying hydrated,
- cooling down after physical activity,
- stretching before and after physical activity, and
- resting during physical activity as needed.