Deep Tissue Injury or DTI

By Courtney Laymon PTA

What is a Deep Tissue Injury?

Deep tissue injuries (DTIs) are damage to underlying layers of skin, fat, and muscle tissues. This damage can result from prolonged pressure and shear forces. Additionally, It is important to identify these injuries early and begin remediation to prevent further tissue breakdown and necrosis.

They will present as a dark purple or maroon discolored area of intact skin that may be painful, mushy, boggy, firm, and warm to touch. Bruising is an indication of a deep tissue injury and should have continuous monitoring for further development and healing.

Diagram showing what layer that a deep tissue injury can affect on the human body. JOI Rehab

Image of a Deep Tissue Injury Anatomy

What causes a DTI?

Prolonged pressure over bony prominences is the primary cause of deep tissue injuries and pressure wounds. Sustained pressure on the skin causes halted blood flow, or ischemia, to the tissue resulting in blanching and subsequent tissue decay and death. In most circumstances, DTIs primarily develop over these bony prominences such as the sacrum, heels, buttocks, and shoulder blades in patients who are bed ridden.

They can also form with improper fitting or wear of orthotics, braces, and medical equipment. As a consequence, DTIs are most commonly seen in hospital, skilled nursing, and long term care facilities where many patients are bed ridden from various illnesses or injuries limiting mobility. Injuries seen in orthopedic settings are less common. However, they can occur from decreased mobility after injury/surgery and improper application of medical equipment, like braces.

Common Risk Factors

Risk factors for developing a deep tissue injury include poor mobility, impaired sensation, and decreased blood flow. In inpatient settings, a risk assessment for DTI is typically performed by a licensed healthcare practitioner, including the physician, nurse, or physical therapist, within 8 hours of the patient being admitted. The Braden Scale is a tool that assesses six subscales contributing to pressure injury risk. These six subscales are:

  1. Sensory perception
  2. Moisture
  3. Activity
  4. Mobility
  5. Nutrition
  6. Friction or shear

The scale has a maximum score of 23, with scores under 18 considered as increased risk for pressure injury development.

How to avoid DTI’s

Educating patients in proper application, wear, and management of orthotic devices can prevent deep tissue injuries in the orthopedic and neurological patient populations. Devices that are applied too tight, applied with improper pressure over bony prominences, and are not properly cushioned with soft material like foam can cause DTI. Daily skin inspections are also important to teach patients and their caregivers to monitor for pressure injuries by looking for changes in skin tone, temperature, and consistency compared to adjacent areas.

Bruising is a key indicator of a deep tissue injury. JOI Rehab

Image of a Deep Tissue Injury

How to Treat a Deep Tissue Injury

Treatment of acute deep tissue injuries such as bruises, ligament sprains, and muscle strains are most beneficial if applied in the first 48 hours after injury. The “R.I.C.E.” Protocol is an acronym for Resting, Icing, Compressing, and Elevating. Rest can prevent further injury to the area during the early stages of inflammation and healing as the tissue is more susceptible. Ice packs can aid in reducing pain, swelling, and prompt the healing process. Compression wraps and elevating the limb above the heart level is beneficial to control swelling and pain.

Written By : Courtney Laymon PTA

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