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Soft tissue

Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ligaments, fat, fibrous tissue, lymph and blood vessels, fasciae, and synovial membranes.

The characteristic substances inside the extracellular matrix of soft tissue are the collagen, elastin and ground substance. Normally the soft tissue is very hydrated because of the ground substance. The fibroblasts are the most common cell responsible for the production of soft tissues' fibers and ground substance. Variations of fibroblasts, like chondroblasts, may also produce these substances.

At small strains, elastin confers stiffness to the tissue and stores most of the strain energy. The collagen fibers are comparatively inextensible and are usually loose (wavy, crimped). With increasing tissue deformation the collagen is gradually stretched in the direction of deformation. When taut, these fibers produce a strong growth in tissue stiffness. The composite behavior is analogous to a nylon stocking, whose rubber band does the role of elastin as the nylon does the role of collagen. In soft tissues, the collagen limits the deformation and protects the tissues from injury.

Human soft tissue is highly deformable, and its mechanical properties vary significantly from one person to another. Impact testing results showed that the stiffness and the damping resistance of a test subject’s tissue are correlated with the mass, velocity, and size of the striking object. Such properties may be useful for forensics investigation when contusions were induced. When a solid object impacts a human soft tissue, the energy of the impact will be absorbed by the tissues to reduce the effect of the impact or the pain level; subjects with more soft tissue thickness tended to absorb the impacts with less aversion.

Graph of lagrangian stress (T) versus stretch ratio (λ) of a preconditioned soft tissue.

Soft tissues have the potential to undergo large deformations and still return to the initial configuration when unloaded, i.e. they are hyperelastic materials, and their stress-strain curve is nonlinear. The soft tissues are also viscoelastic, incompressible and usually anisotropic. Some viscoelastic properties observable in soft tissues are: relaxation, creep and hysteresis. In order to describe the mechanical response of soft tissues, several methods have been used. These methods include: hyperelastic macroscopic models based on strain energy, mathematical fits where nonlinear constitutive equations are used, and structurally based models where the response of a linear elastic material is modified by its geometric characteristics.

Pseudoelasticity

Even though soft tissues have viscoelastic properties, i.e. stress as function of strain rate, it can be approximated by a hyperelastic model after precondition to a load pattern. After some cycles of loading and unloading the material, the mechanical response becomes independent of strain rate.

S = S ( E , E ˙ ) S = S ( E ) {\displaystyle \mathbf {S} =\mathbf {S} (\mathbf {E} ,{\dot {\mathbf {E} }})\quad \rightarrow \quad \mathbf {S} =\mathbf {S} (\mathbf {E} )}

Despite the independence of strain rate, preconditioned soft tissues still present hysteresis, so the mechanical response can be modeled as hyperelastic with different material constants at loading and unloading. By this method the elasticity theory is used to model an inelastic material. Fung has called this model as pseudoelastic to point out that the material is not truly elastic.

Residual stress

In physiological state soft tissues usually present residual stress that may be released when the tissue is excised. Physiologists and histologists must be aware of this fact to avoid mistakes when analyzing excised tissues. This retraction usually causes a visual artifact.

Fung-elastic material

Fung developed a constitutive equation for preconditioned soft tissues which is

W = 1 2 [ q + c ( e Q 1 ) ] {\displaystyle W={\frac {1}{2}}\left[q+c\left(e^{Q}-1\right)\right]}

with

q = a i j k l E i j E k l Q = b i j k l E i j E k l {\displaystyle q=a_{ijkl}E_{ij}E_{kl}\qquad Q=b_{ijkl}E_{ij}E_{kl}}

quadratic forms of Green-Lagrange strains E i j {\displaystyle E_{ij}} and a i j k l {\displaystyle a_{ijkl}} , b i j k l {\displaystyle b_{ijkl}} and c {\displaystyle c} material constants. W {\displaystyle W} is the strain energy function per volume unit, which is the mechanical strain energy for a given temperature.

Isotropic simplification

The Fung-model, simplified with isotropic hypothesis (same mechanical properties in all directions). This written in respect of the principal stretches ( λ i {\displaystyle \lambda _{i}} ):

W = 1 2 [ a ( λ 1 2 + λ 2 2 + λ 3 2 3 ) + b ( e c ( λ 1 2 + λ 2 2 + λ 3 2 3 ) 1 ) ] {\displaystyle W={\frac {1}{2}}\left[a(\lambda _{1}^{2}+\lambda _{2}^{2}+\lambda _{3}^{2}-3)+b\left(e^{c(\lambda _{1}^{2}+\lambda _{2}^{2}+\lambda _{3}^{2}-3)}-1\right)\right]} ,

where a, b and c are constants.

Simplification for small and big stretches

For small strains, the exponential term is very small, thus negligible.

W = 1 2 a i j k l E i j E k l {\displaystyle W={\frac {1}{2}}a_{ijkl}E_{ij}E_{kl}}

On the other hand, the linear term is negligible when the analysis rely only on big strains.

W = 1 2 c ( e b i j k l E i j E k l 1 ) {\displaystyle W={\frac {1}{2}}c\left(e^{b_{ijkl}E_{ij}E_{kl}}-1\right)}

Gent-elastic material

Further information: Gent (hyperelastic model)
W = μ J m 2 ln ( 1 ( λ 1 2 + λ 2 2 + λ 3 2 3 J m ) ) {\displaystyle W=-{\frac {\mu J_{m}}{2}}\ln \left(1-\left({\frac {\lambda _{1}^{2}+\lambda _{2}^{2}+\lambda _{3}^{2}-3}{J_{m}}}\right)\right)}

where μ > 0 {\displaystyle \mu >0} is the shear modulus for infinitesimal strains and J m > 0 {\displaystyle J_{m}>0} is a stiffening parameter, associated with limiting chain extensibility. This constitutive model cannot be stretched in uni-axial tension beyond a maximal stretch J m {\displaystyle J_{m}} , which is the positive root of

λ m 2 + 2 λ m J m 3 = 0 {\displaystyle \lambda _{m}^{2}+2\lambda _{m}-J_{m}-3=0}

Soft tissues have the potential to grow and remodel reacting to chemical and mechanical long term changes. The rate the fibroblasts produce tropocollagen is proportional to these stimuli. Diseases, injuries and changes in the level of mechanical load may induce remodeling. An example of this phenomenon is the thickening of farmer's hands. The remodeling of connective tissues is well known in bones by the Wolff's law (bone remodeling). Mechanobiology is the science that study the relation between stress and growth at cellular level.

Growth and remodeling have a major role in the cause of some common soft tissue diseases, like arterial stenosis and aneurisms and any soft tissue fibrosis. Other instance of tissue remodeling is the thickening of the cardiac muscle in response to the growth of blood pressure detected by the arterial wall.

There are certain issues that have to be kept in mind when choosing an imaging technique for visualizing soft tissue extracellular matrix (ECM) components. The accuracy of the image analysis relies on the properties and the quality of the raw data and, therefore, the choice of the imaging technique must be based upon issues such as:

  1. Having an optimal resolution for the components of interest;
  2. Achieving high contrast of those components;
  3. Keeping the artifact count low;
  4. Having the option of volume data acquisition;
  5. Keeping the data volume low;
  6. Establishing an easy and reproducible setup for tissue analysis.

The collagen fibers are approximately 1-2 μm thick. Thus, the resolution of the imaging technique needs to be approximately 0.5 μm. Some techniques allow the direct acquisition of volume data while other need the slicing of the specimen. In both cases, the volume that is extracted must be able to follow the fiber bundles across the volume. High contrast makes segmentation easier, especially when color information is available. In addition, the need for fixation must also be addressed. It has been shown that soft tissue fixation in formalin causes shrinkage, altering the structure of the original tissue. Some typical values of contraction for different fixation are: formalin (5% - 10%), alcohol (10%), bouin (<5%).

Imaging methods used in ECM visualization and their properties.

Transmission Light

Confocal

Multi-Photon Excitation Fluorescence

Second Harmonic Generation

Optical coherence tomography

Resolution

0.25 μm

Axial: 0.25-0.5 μm

Lateral: 1 μm

Axial: 0.5 μm

Lateral: 1 μm

Axial: 0.5 μm

Lateral: 1 μm

Axial: 3-15 μm

Lateral: 1-15 μm

Contrast

Very High

Low

High

High

Moderate

Penetration

N/A

10 μm-300 μm

100-1000 μm

100-1000 μm

Up to 2–3 mm

Image stack cost

High

Low

Low

Low

Low

Fixation

Required

Required

Not required

Not required

Not required

Embedding

Required

Required

Not required

Not required

Not required

Staining

Required

Not required

Not required

Not required

Not required

Cost

Low

Moderate to high

High

High

Moderate

Soft tissue disorders are medical conditions affecting soft tissue.

Often soft tissue injuries are some of the most chronically painful and difficult to treat because it is very difficult to see what is going on under the skin with the soft connective tissues, fascia, joints, muscles and tendons.

Musculoskeletal specialists, manual therapists and neuromuscular physiologists and neurologists specialize in treating injuries and ailments in the soft tissue areas of the body. These specialized clinicians often develop innovative ways to manipulate the soft tissue to speed natural healing and relieve the mysterious pain that often accompanies soft tissue injuries. This area of expertise has become known as soft tissue therapy and is rapidly expanding as the technology continues to improve the ability of these specialists to identify problem areas more quickly.

A promising new method of treating wounds and soft tissue injuries is via platelet growth factor (PGF).

There is a close overlap between the term "soft tissue disorder" and rheumatism. Sometimes the term "soft tissue rheumatic disorders" is used to describe these conditions.

  1. "Soft tissue". Retrieved13 July 2020.
  2. Definition at National Cancer Institute
  3. Skinner, Harry B. (2006). Current diagnosis & treatment in orthopedics. Stamford, Conn: Lange Medical Books/McGraw Hill. p. 346. ISBN 0-07-143833-5.
  4. Junqueira, L.C.U.; Carneiro, J.; Gratzl, M. (2005). Histologie. Heidelberg: Springer Medizin Verlag. p. 479. ISBN 3-540-21965-X.
  5. Mohamed, Amar; Alkhaledi, K.; Cochran, D. (2014). "Estimation of mechanical properties of soft tissue subjected to dynamic impact". Journal of Engineering Research. 2 (4): 87–101. doi:10.7603/s40632-014-0026-8.
  6. Alkhaledi, K., Cochran, D., Riley, M., Bashford, G., and Meyer, G. (2011). The psychophysical effects of physical impact to human soft tissue. ECCE '11 Proceedings of the 29th Annual European Conference on Cognitive Ergonomics Pages 269-270
  7. Humphrey, Jay D. (2003). The Royal Society (ed.). "Continuum biomechanics of soft biological tissues". Proceedings of the Royal Society of London A. 459 (2029): 3–46. Bibcode:2003RSPSA.459....3H. doi:10.1098/rspa.2002.1060.
  8. Fung, Y.-C. (1993). Biomechanics: Mechanical Properties of Living Tissues. New York: Springer-Verlag. p. 568. ISBN 0-387-97947-6.
  9. Sherman, Vincent R. (2015). "The materials science of collagen". Journal of the Mechanical Behavior of Biomedical Materials. 52: 22–50. doi:10.1016/j.jmbbm.2015.05.023. PMID 26144973.
  10. Gent, A. N. (1996). "A new constitutive relation for rubber". Rubber Chem. Technol. 69: 59–61. doi:10.5254/1.3538357.
  11. Humphrey, Jay D. (2008). Springer-Verlag (ed.). "Vascular adaptation and mechanical homeostasis at tissue, cellular, and sub-cellular levels". Cell Biochemistry and Biophysics. 50 (2): 53–78. doi:10.1007/s12013-007-9002-3. PMID 18209957.
  12. Holzapfel, G.A.; Ogden, R.W. (2010). The Royal Society (ed.). "Constitutive modelling of arteries". Proceedings of the Royal Society of London A. 466 (2118): 1551–1597. Bibcode:2010RSPSA.466.1551H. doi:10.1098/rspa.2010.0058.
  13. Elbischger, P. J; Bischof, H; Holzapfel, G. A; Regitnig, P (2005). "Computer vision analysis of collagen fiber bundles in the adventitia of human blood vessels". Studies in Health Technology and Informatics. 113: 97–129. PMID 15923739.
  14. Georgakoudi, I; Rice, W. L; Hronik-Tupaj, M; Kaplan, D. L (2008). "Optical Spectroscopy and Imaging for the Noninvasive Evaluation of Engineered Tissues". Tissue Engineering Part B: Reviews. 14 (4): 321–340. doi:10.1089/ten.teb.2008.0248. PMC2817652. PMID 18844604.
  15. Rozman, P; Bolta, M (December 2007). "Use of platelet growth factors in treating wounds and soft-tissue injuries". Acta Dermatovenerol Alp Panonica Adriat. 16 (4): 156–65. PMID 18204746.
  16. "Overview of soft tissue rheumatic disorders".

Soft tissue
Soft tissue Language Watch Edit 160 160 Redirected from Soft tissue disorder Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth 1 Soft tissue connects surrounds or supports internal organs and bones and includes muscle tendons ligaments fat fibrous tissue lymph and blood vessels fasciae and synovial membranes 1 2 Micrograph of a tendon H amp E stain It is sometimes defined by what it is not such as nonepithelial extraskeletal mesenchyme exclusive of the reticuloendothelial system and glia 3 Contents 1 Composition 2 Mechanical characteristics 2 1 Pseudoelasticity 2 2 Residual stress 2 3 Fung elastic material 2 3 1 Isotropic simplification 2 3 2 Simplification for small and big stretches 2 4 Gent elastic material 3 Remodeling and growth 4 Imaging techniques 5 Disorders 6 See also 7 References 8 External linksComposition EditThe characteristic substances inside the extracellular matrix of soft tissue are the collagen elastin and ground substance Normally the soft tissue is very hydrated because of the ground substance The fibroblasts are the most common cell responsible for the production of soft tissues fibers and ground substance Variations of fibroblasts like chondroblasts may also produce these substances 4 Mechanical characteristics EditAt small strains elastin confers stiffness to the tissue and stores most of the strain energy The collagen fibers are comparatively inextensible and are usually loose wavy crimped With increasing tissue deformation the collagen is gradually stretched in the direction of deformation When taut these fibers produce a strong growth in tissue stiffness The composite behavior is analogous to a nylon stocking whose rubber band does the role of elastin as the nylon does the role of collagen In soft tissues the collagen limits the deformation and protects the tissues from injury Human soft tissue is highly deformable and its mechanical properties vary significantly from one person to another Impact testing results showed that the stiffness and the damping resistance of a test subject s tissue are correlated with the mass velocity and size of the striking object Such properties may be useful for forensics investigation when contusions were induced 5 When a solid object impacts a human soft tissue the energy of the impact will be absorbed by the tissues to reduce the effect of the impact or the pain level subjects with more soft tissue thickness tended to absorb the impacts with less aversion 6 Graph of lagrangian stress T versus stretch ratio l of a preconditioned soft tissue Soft tissues have the potential to undergo large deformations and still return to the initial configuration when unloaded i e they are hyperelastic materials and their stress strain curve is nonlinear The soft tissues are also viscoelastic incompressible and usually anisotropic Some viscoelastic properties observable in soft tissues are relaxation creep and hysteresis 7 8 In order to describe the mechanical response of soft tissues several methods have been used These methods include hyperelastic macroscopic models based on strain energy mathematical fits where nonlinear constitutive equations are used and structurally based models where the response of a linear elastic material is modified by its geometric characteristics 9 Pseudoelasticity Edit Even though soft tissues have viscoelastic properties i e stress as function of strain rate it can be approximated by a hyperelastic model after precondition to a load pattern After some cycles of loading and unloading the material the mechanical response becomes independent of strain rate S S E E S S E displaystyle mathbf S mathbf S mathbf E dot mathbf E quad rightarrow quad mathbf S mathbf S mathbf E Despite the independence of strain rate preconditioned soft tissues still present hysteresis so the mechanical response can be modeled as hyperelastic with different material constants at loading and unloading By this method the elasticity theory is used to model an inelastic material Fung has called this model as pseudoelastic to point out that the material is not truly elastic 8 Residual stress Edit In physiological state soft tissues usually present residual stress that may be released when the tissue is excised Physiologists and histologists must be aware of this fact to avoid mistakes when analyzing excised tissues This retraction usually causes a visual artifact 8 Fung elastic material Edit Fung developed a constitutive equation for preconditioned soft tissues which is W 1 2 q c e Q 1 displaystyle W frac 1 2 left q c left e Q 1 right right with q a i j k l E i j E k l Q b i j k l E i j E k l displaystyle q a ijkl E ij E kl qquad Q b ijkl E ij E kl quadratic forms of Green Lagrange strains E i j displaystyle E ij and a i j k l displaystyle a ijkl b i j k l displaystyle b ijkl and c displaystyle c material constants 8 W displaystyle W is the strain energy function per volume unit which is the mechanical strain energy for a given temperature Isotropic simplification Edit The Fung model simplified with isotropic hypothesis same mechanical properties in all directions This written in respect of the principal stretches l i displaystyle lambda i W 1 2 a l 1 2 l 2 2 l 3 2 3 b e c l 1 2 l 2 2 l 3 2 3 1 displaystyle W frac 1 2 left a lambda 1 2 lambda 2 2 lambda 3 2 3 b left e c lambda 1 2 lambda 2 2 lambda 3 2 3 1 right right where a b and c are constants Simplification for small and big stretches Edit For small strains the exponential term is very small thus negligible W 1 2 a i j k l E i j E k l displaystyle W frac 1 2 a ijkl E ij E kl On the other hand the linear term is negligible when the analysis rely only on big strains W 1 2 c e b i j k l E i j E k l 1 displaystyle W frac 1 2 c left e b ijkl E ij E kl 1 right Gent elastic material Edit Further information Gent hyperelastic model W m J m 2 ln 1 l 1 2 l 2 2 l 3 2 3 J m displaystyle W frac mu J m 2 ln left 1 left frac lambda 1 2 lambda 2 2 lambda 3 2 3 J m right right where m gt 0 displaystyle mu gt 0 is the shear modulus for infinitesimal strains and J m gt 0 displaystyle J m gt 0 is a stiffening parameter associated with limiting chain extensibility 10 This constitutive model cannot be stretched in uni axial tension beyond a maximal stretch J m displaystyle J m which is the positive root of l m 2 2 l m J m 3 0 displaystyle lambda m 2 2 lambda m J m 3 0 Remodeling and growth EditSoft tissues have the potential to grow and remodel reacting to chemical and mechanical long term changes The rate the fibroblasts produce tropocollagen is proportional to these stimuli Diseases injuries and changes in the level of mechanical load may induce remodeling An example of this phenomenon is the thickening of farmer s hands The remodeling of connective tissues is well known in bones by the Wolff s law bone remodeling Mechanobiology is the science that study the relation between stress and growth at cellular level 7 Growth and remodeling have a major role in the cause of some common soft tissue diseases like arterial stenosis and aneurisms 11 12 and any soft tissue fibrosis Other instance of tissue remodeling is the thickening of the cardiac muscle in response to the growth of blood pressure detected by the arterial wall Imaging techniques EditThere are certain issues that have to be kept in mind when choosing an imaging technique for visualizing soft tissue extracellular matrix ECM components The accuracy of the image analysis relies on the properties and the quality of the raw data and therefore the choice of the imaging technique must be based upon issues such as Having an optimal resolution for the components of interest Achieving high contrast of those components Keeping the artifact count low Having the option of volume data acquisition Keeping the data volume low Establishing an easy and reproducible setup for tissue analysis The collagen fibers are approximately 1 2 mm thick Thus the resolution of the imaging technique needs to be approximately 0 5 mm Some techniques allow the direct acquisition of volume data while other need the slicing of the specimen In both cases the volume that is extracted must be able to follow the fiber bundles across the volume High contrast makes segmentation easier especially when color information is available In addition the need for fixation must also be addressed It has been shown that soft tissue fixation in formalin causes shrinkage altering the structure of the original tissue Some typical values of contraction for different fixation are formalin 5 10 alcohol 10 bouin lt 5 13 Imaging methods used in ECM visualization and their properties 13 14 Transmission Light Confocal Multi Photon Excitation Fluorescence Second Harmonic Generation Optical coherence tomographyResolution 0 25 mm Axial 0 25 0 5 mm Lateral 1 mm Axial 0 5 mm Lateral 1 mm Axial 0 5 mm Lateral 1 mm Axial 3 15 mm Lateral 1 15 mmContrast Very High Low High High ModeratePenetration N A 10 mm 300 mm 100 1000 mm 100 1000 mm Up to 2 3 mmImage stack cost High Low Low Low LowFixation Required Required Not required Not required Not requiredEmbedding Required Required Not required Not required Not requiredStaining Required Not required Not required Not required Not requiredCost Low Moderate to high High High ModerateDisorders EditSoft tissue disorders are medical conditions affecting soft tissue Often soft tissue injuries are some of the most chronically painful and difficult to treat because it is very difficult to see what is going on under the skin with the soft connective tissues fascia joints muscles and tendons Musculoskeletal specialists manual therapists and neuromuscular physiologists and neurologists specialize in treating injuries and ailments in the soft tissue areas of the body These specialized clinicians often develop innovative ways to manipulate the soft tissue to speed natural healing and relieve the mysterious pain that often accompanies soft tissue injuries This area of expertise has become known as soft tissue therapy and is rapidly expanding as the technology continues to improve the ability of these specialists to identify problem areas more quickly A promising new method of treating wounds and soft tissue injuries is via platelet growth factor PGF 15 There is a close overlap between the term soft tissue disorder and rheumatism Sometimes the term soft tissue rheumatic disorders is used to describe these conditions 16 See also EditBiomaterial Biomechanics Davis s law Rheology Soft tissue sarcomaReferences Edit a b Soft tissue Retrieved 13 July 2020 Definition at National Cancer Institute Skinner Harry B 2006 Current diagnosis amp treatment in orthopedics Stamford Conn Lange Medical Books McGraw Hill p 346 ISBN 0 07 143833 5 Junqueira L C U Carneiro J Gratzl M 2005 Histologie Heidelberg Springer Medizin Verlag p 479 ISBN 3 540 21965 X Mohamed Amar Alkhaledi K Cochran D 2014 Estimation of mechanical properties of soft tissue subjected to dynamic impact Journal of Engineering Research 2 4 87 101 doi 10 7603 s40632 014 0026 8 Alkhaledi K Cochran D Riley M Bashford G and Meyer G 2011 The psychophysical effects of physical impact to human soft tissue ECCE 11 Proceedings of the 29th Annual European Conference on Cognitive Ergonomics Pages 269 270 a b Humphrey Jay D 2003 The Royal Society ed Continuum biomechanics of soft biological tissues Proceedings of the Royal Society of London A 459 2029 3 46 Bibcode 2003RSPSA 459 3H doi 10 1098 rspa 2002 1060 a b c d Fung Y C 1993 Biomechanics Mechanical Properties of Living Tissues New York Springer Verlag p 568 ISBN 0 387 97947 6 Sherman Vincent R 2015 The materials science of collagen Journal of the Mechanical Behavior of Biomedical Materials 52 22 50 doi 10 1016 j jmbbm 2015 05 023 PMID 26144973 Gent A N 1996 A new constitutive relation for rubber Rubber Chem Technol 69 59 61 doi 10 5254 1 3538357 Humphrey Jay D 2008 Springer Verlag ed Vascular adaptation and mechanical homeostasis at tissue cellular and sub cellular levels Cell Biochemistry and Biophysics 50 2 53 78 doi 10 1007 s12013 007 9002 3 PMID 18209957 Holzapfel G A Ogden R W 2010 The Royal Society ed Constitutive modelling of arteries Proceedings of the Royal Society of London A 466 2118 1551 1597 Bibcode 2010RSPSA 466 1551H doi 10 1098 rspa 2010 0058 a b Elbischger P J Bischof H Holzapfel G A Regitnig P 2005 Computer vision analysis of collagen fiber bundles in the adventitia of human blood vessels Studies in Health Technology and Informatics 113 97 129 PMID 15923739 Georgakoudi I Rice W L Hronik Tupaj M Kaplan D L 2008 Optical Spectroscopy and Imaging for the Noninvasive Evaluation of Engineered Tissues Tissue Engineering Part B Reviews 14 4 321 340 doi 10 1089 ten teb 2008 0248 PMC 2817652 PMID 18844604 Rozman P Bolta M December 2007 Use of platelet growth factors in treating wounds and soft tissue injuries Acta Dermatovenerol Alp Panonica Adriat 16 4 156 65 PMID 18204746 Overview of soft tissue rheumatic disorders External links Edit Media related to Soft tissues at Wikimedia Commons Retrieved from https en wikipedia org w index php title Soft tissue amp oldid 1029595268 Disorders, wikipedia, wiki, book,

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