SPRAIN

SOFT TISSUE INJURY

SOFT TISSUE INJURY
Soft tissue injuries (STI) are when trauma or overuse occurs to muscles,
tendons or ligaments. Most soft tissue injuries are the result of a sudden
unexpected or uncontrolled movement like stepping awkwardly off a
curb and rolling over your ankle. 
The most common soft tissues injured are muscles, tendons, and ligaments. These
injuries often occur during sports and exercise activities, but sometimes simple
everyday activities can cause an injury.
 CAUSE
•Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the
body. Examples include sprains, strains, and contusions.
•Overuse injuries occur gradually over time when an athletic or other activity is
repeated so often that areas of the body do not have enough time to heal between
occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
 STRAIN
OVERU
SPRAIN
SE

CONTU DISLOC
SION ATION

BURSIT LESIO SUBLU

IS NS XATION

MUCLE
GANGL
RUPTU
ION
RE

TENDIN
HEMAR
OPATH
THOSIS
SYNOV Y
TIS
 DYSFUNCTI
ON

MUSCL
E JOIT
DYSFUNCTI
WEKNE ON
SS

CLINICL
CONDITON FROM
INTRINS TRAUMA/PATHOLO
IC GY
CONTRACTU
MUSCL RE
E
SPASM

REFLEX
MUSCLE ADHESI
GUARDIN ON
G
Strain
Tendons are fibrous bands that attach
muscles to bone. Trauma to muscles or
tendons due to overstretching is referred to
as a ‘strain’.
A muscle strain occurs when muscle fibers
cannot cope with the demands placed on
them by exercise overload and leads to
tearing of the fibers.
 It is a contraction-induced injury in which
muscle fibers tear due to extensive
mechanical stress.
This mostly occurs as a result of a powerful
eccentric contraction or over-stretching of
the muscle.
Sprain
A sprain is an injury to the band of collagen
tissue i.e. a ligament, which connects two or
more bones to a joint.
The primary function of a ligament is to
provide passive stabilisation of a joint and it
plays an important role in proprioceptive
function
A sprain is usually caused by the joint being
forced suddenly outside its usual range of
movement and the inelastic fibres are
stretched through too great a range.
GRADES OF INJURY
Strain:
Grade I (mild) strains affect only a limited number
of fibers in the muscle. There is no decrease in
strength and there is a fully active and passive range
of motion. Pain and tenderness are often delayed to
the next day.
Grade II (moderate) strains have nearly half of
muscle fibers torn. Acute and significant pain is
accompanied by swelling and a minor decrease in
muscle strength.
Grade III (severe) strains represent the complete
rupture of the muscle. This means either the tendon
is separated from the muscle belly or the muscle
belly is actually torn in 2 parts. Severe swelling and
pain and a complete loss of function are
characteristic of this type of strain.
Sprain:
Grade I - structural damage only on
microscopic level, with slight local
tenderness and without joint instability.
Grade II - partial tear (rupture) of the
ligament, visible swelling and noticeable
tenderness, but without joint instability
(or with mild instability).
Grade III - a severe sprain: complete
rupture of the ligament with significant
swelling and with instability of the joint
SOFT TISSUE INJURIES CAN RESULT
FROM BOTH ACUTE AND CHRONIC
CAUSES
Acute injuries are due to
sudden trauma, such as
falling, slipping, twisting, or
sustaining a blow. Bruises,
sprains, and strains are
considered acute soft tissue
injuries.
Chronic injuries are the
result of repeatedly using a
joint or muscle without
adequate rest in between
periods of use. Bursitis and
tendinitis are chronic soft
tissue injuries. These types
of injuries can be
debilitating over a long
period of time.
 LIGAMENT INJURIES
Knee Ligament Injuries
ACL Injury
PCL Injury
MCL Sprain
LCL Sprain
Posterolateral Corner Injury
Patella Dislocation
Superior Tibiofibular Joint Sprain
MCL
The medial collateral ligament (MCL) is one of the four ligaments that are critical to
maintainning the mechanical stability of the knee joint.
 a combined movement of flexion/valgus/external rotation will lead to tears in the
fibres.
The athlete might feel immediate pain, and feel or hear a popping or tearing sound.
Mostly the deep part of the ligament gets damaged first, and this may lead to medial
meniscal damage or anterior cruciate ligament damage
GRADES SYMPTOMS SIGNS TEST

1 • mild medial pain • medial edema positive abduction stress

• possibility of swelling • tenderness test
and limping
• medial edema
• tenderness

2 • moderate medial pain • medial edema • positive McMurray's

• swelling and limping • tenderness test (if meniscus is
• instability involved)
• abduction stress test

3 • severe medial pain • marked medial edema Lachmann test for ACL
• swelling • tenderness stability should be
• knee gives way into accomplished when a
valgus grade III MCL instability
is present.
LCL
•MECHANISM OF INJURY:
 A direct blow to the anteromedial knee and posterolateral corner
 Non-contact hyperextension
 Non-contact varus stress

FUNCTION:
 Stabilizes lateral side of the knee in varus stress
 Posterolateral rotation of tibia
 Stretches when knee extension

Tests:
Adduction stress test( varus)
PATELLA DISLOCATION
Mechanism of Injury
 Non-contract: Twisting of the leg, with internal rotation of the femur on a fixed foot and tibia
 Often associated with valgus stress (strong lateral force then dislocates the patella)
 Traumatic: A direct blow to the knee (lateral or medial)
ANKLE LIGAMENT INJURIES
SPRAINED ANKLE
 DELTOID LIGAMENT COMPEX (pronation and rotation movements of the hindfoot)
 POSTERIOR TIBIOTALAR LIG
 TIBIOCALCANEAL LIG
 TIBIONAVICULAR LIG
 ANTERIOR TIBIOTALAR LIG
 Passive inversion or plantar flexion with inversion should replicate symptoms for a lateral ligament
sprain. Passive eversion should replicate symptoms for a medial ligament sprain.
 Special Tests: +ve Anterior Draw, Talar Tilt or Squeeze Test (depending on the structures involved)
ASPECT MECHANISM OF INJURY Ligaments

ANTERIOR INVERSION &PF anterior talofibular ligament

calcaneo-fibular ligament
posterior talofibular ligament

MEDIAL EVERSION posterior tibiotalar ligament

tibiocalcaneal ligament
tibionavicular ligament
anterior tibiotalar ligament

LATERAL ER &DF anterior-inferior tibiofibular

ligament
posterior-inferior tibiofibular
ligamen
transverse tibiofibular ligament
interosseous membrane
interosseous ligament
inferior transverse ligament
SHOULDER LIGAMENTS INJURY
Acromioclavicular Ligament (controls horizontal stability in the anterior­posterior plane)
Coracoclavicular ligament (control vertical stability)
Grade Description Observation/Testing

I Sprain of AC ligaments. The AC and CC No instability of clavicle detected on

ligaments are intact stress tests

II AC ligaments are ruptured, CC Clavicle is unstable to direct stress tests

ligaments are intact. Often described as a
subluxation.

III Complete disruption of both the AC and Deformity present with clavicle
CC ligaments without significant appearing elevated (acromion
disruption of the delto-trapezial fascia. depressed), clavicle unstable in both
This is often described as a dislocation. vertical and horizontal plane

IV Distal clavicle is posteriorly displaced Posterior deformity present.

into trapezius muscle

V More severe form of grade III. Complete Pseudo lateral clavicle elevation,
disruption of both the AC and CC downward displacement of the scapular.
WRIST AND HAND
LIGAMENTS
A wrist sprain is an
injury to the ligaments
of the wrist region,
including the ligaments • Extensor
connecting the carpal
bones and the compartment
ligaments connecting
the proximal row of
carpal bones with the
• Skier’s thumb
radius and the ulna. By
injury we mean that the • Game keeper’s thumb
ligaments are partially
or completely torn
Skier's thumb is an acute partial
or complete rupture of the ulnar
collateral ligament (UCL) of the
thumb’s metacarpophalangeal
joint (MCPJ) due to a
hyperabduction trauma of the
thumb.
Gamekeeper’s thumb specifically
refers to the cause being
associated with a chronic injury to
the UCL in which it became
attenuated through repetitive
stress.
SPINAL LIGAMENT INJURY

Neck
Sprain

Whiplash Text Neck

 The most common presentation of Text Neck is
neck pain, stiffness and soreness. The main

TEXT NECK
symptoms include:

Stiff neck: soreness and difficulty in moving the

neck is usually present when trying to move the
neck after long usages
Pain: can be localized to one spot or may be
diffused over an area, usually lower part of the
neck. Can be described as dull aching or can also
be sharp or stabbing in extreme cases
Radiating pain: there can often be radiation of pain
into the shoulders and arms.
Muscular weakness: shoulders muscles namely,
trapezius, rhomboids and shoulder external
rotators are often weak
Headache: sub-occipital muscle tightness can lead
to tension type headaches.
 WHIPLASH INJURY
Due to sudden acceleration and deceleration movement
Grade 1 the patient complains of neck pain, stiffness, or tenderness with no positive
findings on physical exam.
Grade 2 the patient exhibits musculoskeletal signs including decreased range of motion and
point tenderness.
Grade 3 the patient also shows neurologic signs that may include sensory deficits, decreased
deep tendon reflexes, muscle weakness.
Grade 4 the patient shows a fracture
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