Traumatic Scar Tissue

Scar tissue is composed of dense fibres, mainly collagen. It forms rapidly over and around wounds, either to repair breakages in the skin’s surface or damage to internal tissues, often as a result of surgery or severe injury. Scarring is an essential part of the body’s repair cycle, without it the body would be left exposed and susceptible to infection and other complications.

Wounds heal differently in different parts of the body, in some cases excessive or irregular scars develop on the surface of the skin causing scar pain. The process for internal injuries is similar. Fibrous tissue forms in response to inflammation and to repair damaged tissue – in some cases, scar tissue grows excessively causing scar adhesions.

Adhesions bind internal structures which are not normally together, such as organs, nerves and muscles with extremely tough and inflexible connective tissue, this can result in a range of complications. When adhesions form on highly innervated areas, extremely painful symptoms can develop as a result, in the case of cubital tunnel syndrome for example, where adhesions may form within the tunnel, trapping the ulnar nerve. This can occur as a result of a form of irritation or as a side effect of surgery, performed initially to relieve nerve compression or irritation.

In rarer cases, adhesions can encase internal organs causing more serious complications such as full intestinal obstruction – a medical emergency.

Causes

One of the primary causes of excessive adhesive tissue is surgery, more predominately abdominal surgery.

Surgery Associated With Adhesions

  • Gynaecological procedures
    • Caesarean section
    • Episiotomy
  • Appendectomy
  • Hip Surgery
  • Spinal Surgery
  • Full or partial removal of any internal organ
  • Removal of tumours or other obstructions
  • Gastric Bypass
  • Laparoscopy

Traumatic scar tissue may also develop as a result of infection or an inflammatory condition, endometriosis and a number of gynaecological infections, appendicitis, colitis, pelvic inflammatory disease, hepatitis, perforation, abcess are some examples. Other possible causes include radiation therapy, severe impact from falls, accidents or physical abuse.

Where Can Scar Tissue Form?

Internal scar tissue can occur anywhere in the body following injury or trauma, in many cases it presents no symptoms and does not show up on diagnostic tests. Investigation is only necessary when symptoms cause pain and movement restriction.

Abdominal Adhesions

Adhesions are frequently associated with the abdominal region, especially following surgical procedures such as gynaecological and bowel operations. Abdominal adhesions often occur as a result of injury or change to the peritoneum – a slippery, serous membrane which forms the lining of the abdominal cavity. Trauma to this membrane provokes an inflammatory response from the body and a sticky traumatic scar tissue is produced – this can cause structures to bind together, Ceasarian sections carry a high risk of scar adhesion.

Excessive scar tissue is also linked to infertility in females, when adhesions occur around the uterus and ovaries, the chances of a pregnant woman miscarrying are increased, adhesions inside or around the delicate structure of the fallopian tubes increase the likelihood of ectopic pregnancies and pelvic adhesions may also interfere with fertility.

Symptoms of Traumatic Scar Tissue

Nerve Pain

Perineural scarring can lead to painful neuropathy and dysfunction – it can cause nerve tethering which is usually worsened by movement. Nerve gliding planes can be affected, gliding planes describe the flexibility of individual nerves which enable elongation and adaptation to different positions during movement. Adhesions can also entrap nerves released during surgery, resulting in the return of previous symptoms and the need for further treatment.

Restricted movement

Depending on where the scar tissue formed, movement and flexibility can be strongly affected, due to the tough inelastic nature of the scar tissue, it can also shorten muscle tissue which ultimately leads to impaired movement and weakness.

Other Possible Symptoms

  • Unexplained and persistent pain in the:
    • abdomen
    • hips, pelvis, tailbone or buttocks
    • back, shoulders, neck
    • joints
  • bowel changes and irritation
  • numbness
  • ridges where scar tissue has hardened
  • undiagnosed stiffness
  • gynaecological infections
  • infertility
  • dyspareunia

Diagnosis

Clinical diagnosis is not straightforward, as unfortunately adhesions do not always appear on diagnostic examinations such as MRI scans, and are only visible during surgical procedures.

Treatment

A difficult condition to treat as scar tissue and adhesions persist long after the original trauma has healed, in some cases years later, leading to complex clinical presentations. Surgeons usually take some precautionary measures to reduce the risk of the formation of scar tissue such as the use of certain surgical sutures, adhesion preventative products, creating temporary artificial barriers between structures to prevent them from binding together, and administering medication to reduce the body’s inflammatory response.

Larascopic Procedure – Lysis of Adhesions

Key hole surgery is often used to treat scar tissue, primarily this involves dissection, in some cases cauterisation is used. Although surgical techniques can be highly effective, it can also cause yet more scar tissue to form.

Scar Tissue Release Therapy

This is a hands on, non-surgical approach which involves stretching and releasing the scar tissue to detach the adhesions, the primary goal is to decrease pain and increase movement/flexibility.

Medication

Pain medication and anti-inflammatories can provide pain relief and help reduce inflammation.

Multidisciplinary Approach

Due to the complex nature and behaviour of internal scar tissue a multi-disciplinary approach to treatment, involving collaboration between the surgeon, pain management physician, physiotherapist and psychologist, is often the most effective. It provides not only treatment, but also assistance on the management of symptoms, helping the patient to make any appropriate life style changes (diet, exercise, routine etc.) which may be required as part of the treatment as well as psychological support to help cope with the stress of a chronically painful, condition.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment