Soft Tissue Injuries, a Lecture by Dr. Peter Schosheim, M.D., F.A.C.S.

The term "soft tissue injury" suffered by a West Palm Beach or Palm Beach County car accident victim and or personal injury victim usually refers to injuries involving the muscles, tendons, and ligaments of the spine (also referred to as cervical strain/sprain, lumbar strain/sprain, connective tissue injury, myofasciitis, fibromyalgia, etc.). However, for this presentation "soft tissue injury" will also include injuries such as: abrasions, lacerations, and contusions.

Even though abrasions and contusions are often casually mentioned in medical records by terms such as, "positive seat belt sign these and other body surface abrasions and contusions can be quite significant. These injuries may also be associated with deeper complications such as nerve or blood vessel injuries. Injury to the lateral femoral cuta­ neous nerve where the lap belt crosses the pelvis can result in a condition known as "meralgia paresthetica." Injury to the brachial plexus from the shoulder belt can result in upper extremity pain and weakness. Injury to the blood vessels to the brain by the shoulder belt can result in formation of blood clots and stroke.

Contusions and bruises sometimes extend much further than skin deep. Hemorrhaging deep in subcutaneous structures and/or muscle can lead to the eventual formation of scar tissue interfering with the normal, pain­ free movement of these structures. The scar tissue can also entrap nerves resulting in weakness or painful conditions.

It is rare, unfortunately, that photographic documentation of abrasions, contusions, and lacerations is taken following a traumatic event. This lack of visuals leaves the attorney with only brief descriptions of the injury or crude drawings. In addition, after closure with staples or sutures, wounds appear far less significant than prior to closure. After healing, a patient with a horrendous gaping wound may have a scar that is barely visible. For these reasons, it is important for plaintiff and defense counsel to ap­preciate how severe these injuries were prior to surgical intervention and healing.

Cervical and lumbar strain (also frequently referred to as connective tissue injury, fibromyalgia, or myofasciitis) is frequently associated with various Figure 17 traumatic events. This condition may also be present in combination with other injuries such as disc bulges and herniations and/or facet arthropathy. The condition often resolves after a period of time. In a few individuals; however, it can become a permanent debilitating condition.

The condition results from excessive movement of the body during trauma. (See Figure 18) As a result, the normal highly organized structure of the muscle and other tissues is significantly disrupted. The tissues are torn and blood pools between the structures that would otherwise move freely over one another. After healing, scar tissue forms between the tissues, resulting in painful movement. The release of chemicals from irritation may also cause painful muscle spasms. In the cervical region, the nerve roots from C1 and C2 travel through the muscles of the cervical spine to provide sensation to the scalp. Muscle spasms or the formation of scar tissue in the cervical spine can therefore result in chronic headaches.

Epidural injections may help alleviate these chronic headaches. In treme cases; however, the dorsal nerve roots (sensory nerve roots) may be surgically cut in an attempt to alleviate the

Large tears of muscles, tendons, and ligaments can also be classified as "soft tissue injuries." These injuries include: rotator cuff tears (tendons), and ligamen­tous injuries such as torn injuries within the ankle and wrist (often simply referred to as "sprains"). Although "sprains" are often thought of as relatively insignificant injuries, most testifying experts will likely agree that a significant ankle sprain takes far longer to heal and causes more long term pain than a typical fracture.

Fractures :

Fractures can be "simple" (consisting of only two fragments) or "comminuted" (consisting of multiple frag­ments). Other terms used in reference to fractures are "displaced" (the fracture fragments are not in their normal relationship to one another) and "intra-articular" (the fracture extends in to a joint surface.)

Simple and minimally displaced fractures do not typically require "reduc­tion." Reduction refers to the realignment of the fracture fragments and is treated solely by immobilization (casting). Significantly displaced frac­tures may be reduced with "closed reduction," which is the manipulation of the fracture fragments, without opening the skin, in order to realign the fracture fragments. This is opposed to "open reduction;" the manipulation of the fragments through an open incision.

After reduction, fractures are then "fixated." Fixation may be performed with a splint or cast or by a variety of other techniques. Fragments may be fixated by placing "percutaneous" (advanced through the skin) pins, wires, or screws. Fractures may also be fixated by "external fixation," the application of screws or pins into the fracture fragments followed by interlocking of the hardware with a hardware apparatus that remains outside of the body.

The most severe of fractures usually require "open reduction and internal fixation." This involves reduction of the fracture fragments through an open inci­sion followed by placement of some type of hardware (plates, screws, rods, etc.) in order to keep the fragments in proper alignment as they heal.