TRAUMEEL® PRODUCT MONOGRAPH8

Classification of musculoskeletal injuries Periarticular soft tissue complaints include localized disorders of tendons, ligaments, muscles, fascia, and joint capsules.[Speed 2001]

Musculoskeletal injuries can be classified according to the duration of symptoms. Up to 2 weeks, symptoms may be described as acute, 2 4 weeks may be described as subacute, and if symptoms have been present for over 6 weeks, the condition may be described as chronic.[Speed 2001]

Traumatic soft tissue injuries may also be classified as macrotraumatic or microtraumatic. A macrotraumatic injury involves a single episode of acute tissue destruction, while a microtraumatic injury involves either chronic overload or an acute-on-chronic episode.[Speed 2006]

Acute exacerbations of chronic disorders occur when a chronic disorder flares to produce acute symptoms. These should be managed as an acute injury with additional regard to the underlying condition and its long-term management in order to prevent further flares.

Tissue response to acute injury After acute injury, inflammation is the body s method of limiting the amount of tissue damage and protecting against further insult.[Heng 2011, Reinke 2012, Demidova-Rice 2012, Sorg 2017] The inflammatory response has defined phases involving different sets of mediators and cell types. First, injury of soft tissue results in a non-specific physiologic response that activates a series of pro-inflammatory events.

Physiologic response to soft tissue injury.[Heng 2011, Reinke 2012, Demidova-Rice 2012, Sorg 2017]

Immediate vasoconstriction limiting local hemorrhage followed by subsequent vasodilatation and an increase in vascular permeability near the site of injury.

Platelets adhere to one another at the site of capillary damage to provide a mechanical plug to prevent further bleeding.

Activation of the clotting cascade results in the formation of fibrin and fibronectin, which form cross-links with collagen to reinforce the temporary plug and stop hemorrhage.

Pain-producing chemical mediators including bradykinin, serotonin and histamine are released and aid in the attraction of leukocytes to the site of injury.

Leukocytes (neutrophils, eosinophils, basophils, macrophages and lymphocytes) balance clotting and anticoagulation, stimulate local edema, clear debris and have immunologic functions.

The zone of the primary injury is defined by the extent of the initial hematoma. However, more cell damage can occur from the edema and tissue hypoxia resulting from the acute vascular inflammatory response. This is referred to as the secondary zone of injury .