4 - Late Soft Tissue Complications - D3 Updated
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8/12/2019 4 - Late Soft Tissue Complications - D3 Updated
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Done by: mmar Mansour
Late soft tissue
complication
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Outline
Joint stiffness
heterotopic ossification
Muscle contracture
Tendon rapture Nerve entrapment
Complex regional pain syndrome
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joint stiffness
the symptom of pain on moving a joint, andloss of range of motion.
causes: After fracture
Direct injury to the joint
Oedema and fibrosis Adhesion
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All above conditions are made worse by
Prolonged immobilization
Position of joint, why?
Cause if they were held in which ligaments areat their shortest, no exercise will succeed in
stretching these tissue and restoring the lost
movement completely.
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Treatment Elevation. Functional bracing (orthopaedic brace) used
to immobilize a joint or body segment, restrictmovement in a given direction.
Exercise.
Splinted.
In stiff joints, prolonged and patient
physiotherapy can work wonder. Surgery.
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Clinical features.
Pain
Local swellings
X-ray will appear normal at first butBone scan shows increased activity.
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next 2-3 weekspain gradually subside
limited joint movements.
X-ray
fluffy calcification in soft tissue
By 8 weeks
Palpable bony mass that clearly defined in x-ray
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Treatment:
*Gentle and gradual active movements
*Excise the bony mass
*Indomethacin or radiotherapy
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Muscle contracture
the muscle and its tendons shorten, resulting inreduced flexibility.
Following arterial injury or compartment
syndrome, the patient may develop ischaemic
contracture or
(volkman’s ischaemic contracture)
Nerve injury by ischaemia sometimes recover.
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Volkmann’s ischaemic contracture.
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Richard von volkmann
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clinically Deformity Stiffness
Numbness (inconstant)
In severe case (like forearem)
*muscle wasting and clawing of the fingers.
Common sites
Forearm, hand, leg, foot.
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Treatment
Detachment of flexor muscle at their origin, Mayimprove the deformity.
If the sensation and active movement are not
restored, nerve graft and tendon transfers
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Tendon rupture. After fracture. treatment is direct suture.
Tendon transfer of extensor indicis proprius todistal stump of the ruptured thumb tendon.
No treatment usually in late rupture of the longhead of biceps after fractured head of femur.
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Achilles tendon rupture
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Nerve entrapment
Example
carpal tunnel
syndrome,entrapm
ent median nerve
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Nerve entrapment.
nerve becomes trapped or pinched due to somephysiological abnormalities.
Numbness (parasthesia)
Loss of power
Muscle wasting in distribution of the affected
nerve.
Claw hand in ulnar nerve entrapment
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Ulnar nerve and peroneal nerve entrapment
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Common sites are ulnar nerve and median nerve.
Treatment is early decompression of the nerve.
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Complex regional pain syndrome
Sudeck in 1900.
Sudeck’s atrophy.
Reflex sympathetic dystrophy
Or (algodystrophy) Complex regional pain syndrome
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(CRPS) is a chronic progressive disease
characterized by severe pain, swelling and changes
in the skin
International Association for the Study ofPain has divided CRPS into two typesbased on the presence of nerve lesionfollowing the injury.
Type I, also known as reflex sympatheticdystrophy (RSD), Sudeck's atrophy, reflexneurovascular dystrophy (RND) oralgoneurodystrophy, does not have demonstrablenerve lesions.
Type II, also known as causalgia, has evidence ofobvious nerve damage.
The cause of this syndrome is currentlyunknown.
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severe CRPS ofright arm
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Patient complains.
Continous pain(burining in nature)
Local swelling.
Redness
Warmth. Tenderness.
Moderate stiffness of the joint(near the site of
injury).
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After weeks.
Pale, atrophic skin.
Increased restricted movement.
May develop fixed deformity.
X-ray
Patchy rarefaction of the bone.
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Osteprosis in CRPS
.
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treatment
Elevation.
Active exercise.
Physiotherapy.
early stage treatment:anti-inflammatory drugs and amutriptyline
(helpful)
sympathatic block or sympatholytic
drugs.(unpredictable)
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hank you