Soft tissue pain and physical therapy

This article outlines physical treatments for soft tissue pain in acute and chronic settings. Active treatments such as exercise and education are essential in the management of all soft tissue pains, but passive treatments, such as heat/cold treatment, ultrasound treatment, and massage are effective only in the management of acute pain. In chronic pain a multidisciplinary approach is often necessary. Self-management, goal-setting, and functional restoration are emphasized in treating chronic soft tissue pain.     

Omental free flap for surgical treatment of chronic osteomyelitis of lower limb: A technical note

Soft tissue reconstruction of chronic lower extremity wounds with bone infection entails an important challenge in reconstructive surgery. We report our experience using the omentum free flap to provide coverage in two patients suffering chronic osteomyelitis of the lower limbs. After extensive soft tissue and bone debridement, an omentum free flap was performed in both cases, providing dead space obliteration and soft tissue coverage in behalf of its large size and pliability. As a result, the chronic illness was eradicated in both patients, with satisfactory outcomes and infection resolution.     

慢性软组织损害性疼痛外周不同组织中TNF-α表达的研究

目的 研究慢性软组织损害性疼痛患者不同外周组织中TNF-α的表达,探讨其致痛机制。方法 选择行手术治疗的软组织损害性疼痛患者18例作为实验组,腰椎间盘突出症患者16例为对照组,分别取腰部深筋膜、肌肉、骨表面软组织标本,检测各部位组织中TNF-α的表达并进行比较。结果 实验组中肌肉组织TNF-α的表达最高,与深筋膜和骨表面组织相比有显著差异（P〈0.05）,与对照组相比有显著差异（P〈0.05）,对照组各组织中TNF-α表达相比无差异。结论TNF-α在慢性软组织损害性疼痛中可能起重要作用,肌肉组织是疼痛的主要病灶部位。     

Chronic calcaneal osteomyelitis associated with soft‐tissue defect could be successfully treated with platelet‐rich plasma: a case report

Chronic osteomyelitis associated with soft‐tissue defect following surgical management is a severe complication for orthopaedic surgeons. Traditionally, the treatment protocol for the notorious complication involved thorough debridement, bone grafting, long‐term antibiotic use and flap surgery. Alternatively, platelet‐rich plasma (PRP), a high concentration of platelets collected via centrifugation, has been successfully used as an adjuvant treatment for bone and soft‐tissue infection in medical practices. PRP has numerous significant advantages, including stypsis, inflammation remission and reducing the amount of infected fluid. It increases bone and soft‐tissue healing and allows fewer opportunities for transplant rejection. Through many years of studies showing the advantages of PRP, it has become preferred organic product for the clinical treatment of infections, especially for chronic osteomyelitis associated with soft‐tissue defect. To promote the clinical use of this simple and efficacious technique in trauma, we report the case of a patient with chronic calcaneal osteomyelitis associated with soft‐tissue defect that healed uneventfully with PRP.     

Management of chronic calcaneal osteomyelitis with pull-through abductor hallucis muscle flap -a report of three cases

Three patients who had chronic osteomyelitis of the calcaneus were treated with radical debridement of all involved soft tissue and bone and obliteration of dead space with a pull-through abductor hallucis brevis muscle flap. Two patients had calcaneal osteomyelitis without soft tissue loss resulting from previous comminuted calcaneal fractures while a third patient had a large soft tissue defect and calcaneal osteomyelitis resulting from a destructive infection. All of the patients had undergone several surgical procedures for treatment of the osteomyelitis with histories ranging 18 months to 30 months. Following treatment with the pull-through muscle flap there has been no recurrence over the longterm (>two years). We believe that radical removal of all contaminated tissue and immediately coverage with a muscle flap provides an effective single stage treatment of chronic calcaneal osteomyelitis.     

TENS and acupuncture therapy for soft tissue pain

Acupuncture and transcutaneous electrical nerve stimulation (TENS) are two commonly used physical therapies in the management of soft tissue pain. Stimulation is used to provide analgesia in the treatment of both acute and chronic soft tissue pain.     

封闭式负压引流治疗软组织感染

目的探讨封闭式负压引流治疗软组织感染的疗效。方法应用封闭式负压引流治疗开放性骨折发生软组织感染18例。结果18例均获随访,时间6个月-1年6个月。软组织感染均愈合,骨折正常愈合12例,延迟愈合6例,无慢性骨感染发生。结论封闭式负压引流治疗软组织感染,可短期控制感染,为进一步治疗创造条件,尤其适用于深部软组织感染患者。手术简单,疗效可靠,适合基层医院应用。     

Chronic lead poisoning by lead shots and augmentation of facial soft tissue defect with Alloderm dermal graft

Lead is a soft-heavy metal with silver-bluish white color, and it has no physiological features in the body. However, it can cause acute or chronic lead poisoning depending on the body lead level. Lead intake may occur in different ways such as inhalation or ingestion. In the presented case chronic lead poisoning developed due to a relatively rare cause and mechanism; lead shots, located in the facial soft tissue as a result of shotgun injury to the face 8 years ago, caused chronic lead poisoning. The patient was treated with EDTA for poisoning and augmentation with Alloderm dermal graft for the facial soft tissue defect.     

The management of chronic distal radioulnar instability

The stabilizing constraints of the distal radioulnar joint (DRUJ) include its bony geometry and the surrounding soft tissue support. Given the shallow nature of the sigmoid notch, reconstruction of the palmar and dorsal ligamentous sleeve provides the best solution for restoring stability in cases of chronic DRUJ instability. The pertinent anatomy, indications, contraindications, soft tissue stabilizing procedures, and rehabilitation for the management of chronic DRUJ instability are highlighted in this review.     

Application of VSD technique in adults with chronic osteomyelitis of the extremities combined with soft tissue defects

To investigate the clinical application of vacuum sealing drainage (VSD) in chronic osteomyelitis of the extremities combined with soft tissue defects in adults. This study retrospectively included 32 adult patients with clearly diagnosed chronic osteomyelitis of the extremities combined with local soft tissue defects, and the trauma was covered by VSD after debridement, osteotomy, and vancomycin-laden bone cement filling of the occupancy, and the trauma was covered by selecting a suitable flap transfer repair according to the site and extent of the soft tissue defect after the trauma condition was suitable, and the secondary trauma was taken from the abdominal full-thickness skin free skin slice graft, according to whether the skin graft area was performed. The skin flap hematoma and infection rate, as well as the skin flap survival rate and implant fixation time were compared and analysed between the two groups. The primary outcome is the implant fixation time, and the secondary outcome is the skin fragment survival rate. In 32 patients, VSD was performed on the bone cement surface to cover the trauma, and 33.2 to 39.8 kPa continuous vacuum sealing drainage was set. The average VSD time duration before soft tissue coverage was 47.87 ± 23.14 days, and the average number of VSD use was 7.18 ± 3.23. The use of VSD before soft tissue coverage did not cause complications such as negative pressure could not be maintained, vacuum sealing drainage was not smooth, skin blistering, trauma. Among the 32 patients, 12 cases of soft tissue coverage were followed by trauma free skin grafting with packing + VSD, and 20 cases were fixed with packing alone, and the duration of continuous packing and fixation of free skin pieces in the VSD group was significantly less than that in the control group (P = .006). The survival rate was significantly higher than that of the control group (P = .019). VSD in adult patients with chronic osteomyelitis of the extremities combined with soft tissue defects can effectively improve the trauma condition, provide the possibility of second-stage soft tissue coverage, and significantly shorten the preparation time for soft tissue coverage. In addition, when soft tissue coverage trauma is performed, VSD combined with skin graft packing technique can significantly improve the survival rate of skin pieces, shorten the time of skin graft fixation.     

MRI of soft tissue disorders of the ankle

In summary, MRI has become the dominant imaging modality for assessing soft tissue disorders of the ankle. It is useful in evaluating patients with acute or chronic ankle pain or instability, and for diagnosis and staging of soft tissue mass lesions. MRI often provides information that is essential to treatment planning of a variety of traumatic, degenerative, and neoplastic lesions.     

Soft tissue calcifications induced by local corticosteroid injection

The authors discuss soft tissue calcifications as a possible effect of local corticosteroid therapy. The literature will be reviewed and a case report will be presented, which illustrates soft tissue calcifications in the heel of a patient who received multiple injections of triamcinolone hexacetonide, for heel spur syndrome. The accumulation of insoluable steroid acts as a foreign body and induced a chronic granulomatous inflammatory process, with subsequent dystrophic calcification.     

111-In leukocyte scintigraphy in inflammatory diseases of the support and motor systems--initial results

Acute osteomyelitis and arthritis, soft tissue infections as well as reactivated chronic osteomyelitis and septic total hip endoprostheses show positive scans in 111-In-Acetylaceton-Leucocyte-Scintigraphy. Negative results are found in chronic osteomyelitis and nonbacterial inflammations as rheumatic and degenerative diseases of the skeleton. Accuracy for all studies was 86%, specificity 100% and sensitivity 66%. False negative scans findings occurred especially in soft tissue infections and acute spondylitis. There have been no false positive scans. Typical case reports are illustrated.     

Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta‐analysis

This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English‐language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration''s “risk of bias” tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow‐up duration were extracted. The fixed or random‐effects model was used to calculate the pooled effect sizes according to studies’ heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta‐analysis. The meta‐analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73‐fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30‐6.04, P < .001) and improved wound‐healing area percentage by 30.45% (Standardized Mean Difference (SMD) = 30.45; 95% CI: 23.79‐37.12; P < .001). ESWT reduced wound‐healing time by 3 days (SMD = −2.86, 95% CI:‐3.78 to −1.95, P < .001) for acute soft tissue wounds and 19 days (SMD = −19.11, 95% CI: −23.74 to −14.47, P < .001) for chronic soft tissue wounds and the risk of wound infection by 53% (OR = 0.47, 95% CI: 0.24‐0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher‐quality and well‐controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds.     

The use of early flap coverage in severe open physeal fractures: a report of two cases

Open physeal fractures associated with severe overlying soft tissue loss present significant challenges to the pediatric orthopaedic surgeon. In addition to providing adequate soft tissue coverage, preventing chronic infection, and achieving bony healing, surgical care should attempt to preserve the physis to maintain growth for the best long-term outcomes. Here we present two cases of open physeal disruptions with severe soft tissue loss. In each case, early use of vascularized flap coverage assisted in fracture healing and contributed to preservation of the physis and subsequent bony growth.     

Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy

Objective

To describe the subjective pain and functional improvements of a patient with chronic Achilles tendinopathy following a treatment plan incorporating active and passive tissue warm-up, followed respectively by soft tissue mobilization utilizing both Graston Technique^® and Active Release Techniques^®, eccentric exercise, and static stretching in combination with cryotherapy.

Background

The primary characterization of chronic Achilles tendinopathy is gradual onset of pain and dysfunction focused in one or both Achilles tendons arising secondary to a history of repetitive use or excessive overload.

Intervention and Outcome

Conservative treatment is commonly the initial strategy for patient management. Tissue heating, soft tissue mobilization, eccentric training, and static stretching with cryotherapy were implemented to reduce pain and improve function.

Summary

A specific protocol of heat, soft tissue mobilization, eccentric exercise, stretching, and cryotherapy appeared to facilitate a rapid and complete recovery from chronic Achilles tendinopathy.     

Treatment of chronic post-traumatic infections of the bone and soft tissue with gentamycin PMMA beads (PMMA = polymethylmethacrylate) (author's transl)

Temporary implantation of Gentamycin PMMA beads and chains provides a most effective local antibiotic therapy as supplementary and consecutive treatment after surgical procedures executed in bone and soft tissue infections. Gentamycin beads and chains are used as an alternative to irrigation-suction drainage. From 1977 to 1979 70 patients were treated for chronic post-traumatic osteomyelitis and infection of the soft tissue. The chronic bone infections subsided completely in 90% of the patients, but 8.3% re-infections were observed within 3 to 24 months after termination of treatment. In 18 patients with gunshot wounds 66.6% of the patients got primary healing and 33.4% secondary healing.     

腓肠肌皮瓣联合负压封闭引流治疗胫骨慢性骨髓炎及软组织缺损

目的探讨腓肠肌皮瓣联合负压封闭引流,治疗胫骨慢性骨髓炎及软组织缺损的临床疗效。方法回顾分析2010年1月至2013年12月,20例胫骨慢性骨髓炎及软组织缺损患者,8例采用传统治疗方法 (对照组),12例采用腓肠肌皮瓣联合负压封闭引流治疗(实验组)。比较两组各项指标,包括治疗72 h后血清C反应蛋白变化率、治愈率、治愈所需时间、复发率等。结果实验组各指标均显著优于对照组(P<0.05):治疗72 h后血清C反应蛋白变化率、一次性治愈率明显高于对照组,治愈所需时间明显低于对照组,实验组复发率0%。结论腓肠肌皮瓣联合负压封闭引流治疗胫骨慢性骨髓炎及软组织缺损,疗效稳定、恢复快、复发率低,值得临床推广应用。     

Tumoral calcinosis of the foot: a radiologic case study

Tumoral calcinosis is a disorder characterized by deposits of calcium phosphate in the subcutaneous tissues near large joints. While often resembling a neoplasm, the soft tissue deposits of tumoral calcinosis are benign in nature. The deposits can, however, cause significant morbidity to patients due to tissue pressure or impingement. The focus of this case report will include the presentation, radiographic examinations, clinical course, and treatment of a 90-year-old female patient presenting for evaluation of a painful plantar right foot soft tissue mass associated with chronic renal failure and secondary hyperparathyroidism.     

Complete reduction of retro-odontoid soft tissue mass in os odontoideum following the posterior C1-C2 tranarticular screw fixation.

STUDY DESIGN: A case report of os odontoideum with retro-odontoid soft tissue hypertrophy treated by the transarticular screw fixation. OBJECTIVES: To present a case of os odontoideum that showed complete reduction of retro-odontoid soft tissue mass caused by atlantoaxial subluxation after the C1-C2 transarticular screw fixation. SUMMARY OF BACKGROUND DATA: Hypertrophy of the periodontoid soft tissue has been reported to be associated with chronic atlantoaxial subluxation and progressive myelopathy. While the rheumatoid pannus has been reported to become reduced of disappear after fixation of the unstable segment, the reduction of the hypertrophied soft tissue mass has never been reported in atlantoaxial subluxation of nonrheumatoid origin, especially in the case of os odontoideum. METHODS: Posterior C1-C2 transarticular screw fixation was performed in a patient with os odontoideum, who showed signs of progressive myelopathy by the compression of retro-odontoid soft tissue mass and atlantoaxial subluxation. RESULTS: The fixation of atlantoaxial subluxation achieved not only the complete reduction of the retro-odontoid soft tissue mass, but also clinical improvement of the myelopathy. CONCLUSIONS: Posterior atlantoaxial fixation is worth trying in slow progressing myelopathy by the compression of hypertrophy of the soft tissue even in nonrheumatoid atlantoaxial subluxation, thereby obviating the need for direct removal of the mass via the transoral route.