How should I manage soft tissue injuries in adults, and when should I consider referral to a specialist?

For the management of soft tissue injuries in adults, several aspects of rehabilitation and monitoring should be considered.

• Swelling and Oedema Management: Discuss with patients the expected swelling after a traumatic injury, how to monitor it daily, and the signs or symptoms that warrant medical advice ². Consider alternative medical causes for unexpected swelling, such as deep vein thrombosis, and investigate as necessary ². Initiate a programme of circulation exercises and elevate the affected limb to prevent and reduce swelling ². Compression bandaging may be considered under specialist supervision, for example, from a hand therapy specialist ².
• Scar Management: Encourage patients to desensitise themselves to their injury by looking at, gently touching, and moving the affected area ². Reassure patients that unpleasant sensations like pain and itchiness in the area of wounds or skin injuries are normal after a traumatic injury and may change during recovery ².
• Splinting and Orthoses: Monitor the pressure effects on the skin caused by orthoses or splints, particularly in individuals with reduced cutaneous sensation or recent skin grafts or flaps ². Avoid positions that could lead to loss of function or future complications when using splints or braces to immobilise and protect joints ². For upper limb injuries affecting hand and finger movement, offer bespoke (thermoplastic) splints as early as clinically possible to maintain range of movement ².

Referral to a specialist should be considered under the following circumstances:

• Complex Hand Injuries: Refer people with complex hand injuries to a hand therapy specialist, as appropriate ².
• Pressure Effects from Orthoses/Splints: If monitoring pressure effects on the skin by orthoses or splints, seek advice from tissue viability services and/or plastic surgery specialists as needed ².
• Problems with Spinal Orthoses: If spinal orthoses are causing issues such as pain, pressure sores, or swallowing or breathing difficulties, or significantly affecting rehabilitation, inform the relevant surgical team ².
• Unexpected Swelling: If alternative medical causes for unexpected swelling, such as deep vein thrombosis, are suspected and require investigation ².
• Fragility Fractures: For adults with a fragility fracture, assess bone health and refer as necessary, for example, to a specialist bone health clinic or outpatient service ².
• Falls Risk: If a traumatic injury was caused by a fall, ask about previous falls and consider a falls risk assessment and a referral to a community falls service ². All adults over 65 who have a traumatic injury should be assessed for their risk of falls ².
• Spinal Cord Injury: For people in a trauma unit or major trauma centre who have a spinal cord injury, the trauma team leader should immediately contact the specialist neurosurgical or spinal surgeon on call ³.
• Unimalleolar Ankle Fractures: Arrange for orthopaedic follow-up within 2 weeks if there is uncertainty about stability ¹. Advise all patients to return for review if symptoms are not improving 6 weeks after injury ¹.