General characteristics of closed injuries
Closed injuries are not accompanied by the formation of open wounds. The main clinical forms include bruises, crushes, the formation of local hemorrhages, and hematomas. The clinical picture of these conditions is generally universal and similar to the manifestations of soft tissue injuries of any other anatomical localization. The leading symptoms are local pain syndrome, tissue edema, and impaired function of the injured limb segment.
Ligament sprain (Distorsio)
A ligament sprain, or Distorsio, occurs during movements that exceed the physiological limits of the joint.
Localization and symptoms:
- The ankle joint is most frequently injured (usually as a result of a sudden twisting of the foot).
- Ligaments of the knee joint are less commonly injured.
- The clinical picture largely resembles a conventional bruise: the patient complains of local pain, which intensifies when attempting movements in the affected joint. Visual and palpatory examination reveals swelling and pronounced edema of the surrounding tissues.
Principles of treatment:
- Ensuring complete rest for the injured limb.
- Applying a tight compression bandage to stabilize the joint and limit edema.
- Pain relief: immediately after the injury, freezing with ethyl chloride (trichloroethylene) is highly effective. The spray from the ampoule is directed straight onto the painful area. This allows for rapid relief of pain, as well as a significant reduction in edema and the volume of hemorrhage.
- Temperature regimen: the use of cold is strictly indicated on the first day. In subsequent days, thermal physiotherapy procedures are prescribed to stimulate the resorption of the formed hemorrhage.
Muscle rupture: causes and clinical presentation
Unlike ligaments, muscle tissue is more often damaged not by external impact, but as a result of an internal factor — excessive muscle tension.
Typical locations for ruptures are large muscles experiencing significant loads: the biceps brachii, rectus femoris, and gastrocnemius muscles.
Clinical manifestations at the time of injury:
- Severe, sudden pain, which patients often describe as a sensation of a sharp "electric shock".
- Instantaneous and complete loss of motor function in the injured muscle.
- During objective examination and palpation, the physician identifies a characteristic depression — a defect in the muscle tissue at the site of the rupture, as well as an evolving hematoma.
Management tactics for muscle ruptures
The choice of treatment method directly depends on the degree of damage to the muscle fibers (complete or incomplete rupture).
Conservative treatment (for incomplete rupture): The main rule is immobilization of the limb with a plaster splint in a position of complete relaxation of the injured muscle. The duration of immobilization is 2–3 weeks. To achieve maximum relaxation, the limb is fixed in specific positions:
- For the biceps brachii: flexion of the arm at the elbow joint at a right angle.
- For the rectus femoris: fixation of the lower limb in a fully extended position.
- For the gastrocnemius muscle: flexion of the leg at the knee joint.
After the immobilization period is completed and the plaster is removed, the rehabilitation phase begins, including therapeutic exercise (physical therapy) and a course of massage.
Surgical treatment (for complete rupture): In the case of a complete transection of the muscle belly, conservative methods are ineffective. Exclusively surgical intervention is indicated — surgical suturing of the ends of the ruptured muscle. After surgery, rigid immobilization of the limb is also required for a period of 2 to 3 weeks to ensure suture integrity.
Briefly: answers to topical questions
What complications can develop in cases of extensive untreated soft tissue hematomas?
In cases of extensive and deep soft tissue hematomas, suppuration or organization is possible. To prevent these complications, puncture of the hematoma with blood evacuation followed by the application of a compression bandage is indicated.
What specific clinical tests are used to diagnose a complete ankle ligament rupture?
To diagnose injury to the lateral collateral ligaments of the ankle joint, the following are used:
- anterior drawer test;
- varus stress test.
The criteria for injury are tenderness inferior and anterior to the lateral malleolus, indicating damage to the anterior talofibular and/or calcaneofibular ligaments, as well as pathological laxity compared to the intact joint.
What are the absolute indications for surgical treatment in closed soft tissue injuries?
Sources indicate surgical treatment for the following injuries:
- complete muscle rupture — muscle repair followed by immobilization for 2–3 weeks;
- complete injury of the distal biceps tendon — urgent surgery, including refixation of the tendon to the radial tuberosity;
- complete rupture of the fibular collateral ligament — surgical treatment, since scar tissue regeneration does not occur.
To memorize tactics for incomplete muscle ruptures: "Flex what flexes, and extend what extends" (biceps — flex the elbow, quadriceps — straighten the knee).
Class and exam questions
What is the difference in the application of cold and heat in sprains?
Cold is applied strictly during the first 24 hours after injury to cause vasoconstriction, reduce edema, and stop hemorrhage. Thermal procedures are prescribed in subsequent days to accelerate the resorption of the already formed hematoma.
How to quickly relieve pain and swelling right at the scene of a sprain injury?
For this purpose, local freezing with trichloroethylene is used. The drug spray from the ampoule is directed onto the painful area immediately after the injury.
What is the main palpation sign of a muscle rupture?
Upon palpation of the injured area, the doctor identifies a characteristic depression (soft tissue defect) corresponding to the site of muscle fiber rupture, against the background of an evolving hematoma.
Can a complete muscle rupture be treated with a plaster cast?
No, in the case of a complete rupture of the muscle belly, exclusively surgical treatment (surgical repair) is indicated, after which immobilization is applied for 2–3 weeks.
What else to study on this topic
- Pathogenesis of traumatic hematomas and methods of their puncture
- Differential diagnosis of ligament sprains and intra-articular fractures
- Techniques for applying compression bandages in ankle injuries
- Stages of surgical suturing of muscle tissue
- Physical therapy programs during the rehabilitation phase after prolonged immobilization
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