Contusion (Bruise, Bruising)
Summary
A contusion, also called a bruise, is a painful discoloration of the skin. Contusions occur when trauma, such as a blow, damages the blood vessels below the skin leading to the release of blood into the surrounding soft-tissues. These injuries are very common in athletes, especially those who participate in contact sports. Contusions will cause pain and swelling that commonly improves within days to weeks. A contusion will lead to discoloration of the skin which can range from blue, purple, or even black -and will change to yellow in the days or weeks after the injury. Physical examination will determine the severity of the injury. Treatment is dependent on severity, although most contusions can be treated with rest, ice, compression, and elevation (RICE protocol). As the bruising settles it may be helpful to massage the soft-tissues to minimize the risk of painful chronic scarring in this area. Occasionally if a large collection of blood forms under the skin (hematoma) surgical drainage may be required.
Clinical Presentation
Patients with a contusion will have a recent history of a blow, bump, or other trauma to the area. Bruising may also occur from injuries to muscles, ligaments, or blood vessels that causes bleeding under the skin -not just from direct trauma. Patients will present with skin discoloration. Patients will also present with pain and swelling that is worse at the time of the injury and improves over the course of a few days or weeks. As the injury heals, the contusion may change color from red to purple to green and finally to yellow or light brown. The location of the bruising may also change as the blood under the skin moves based on gravity. As an example, an ankle sprain that causes bruising on the outside of the ankle may result in bruising around the heel area after a few days.
Types of Contusions
Contusions can be described by where the trauma occurs and how deep the damaged blood vessels are relative to the skin. Some common types of contusions include:
- Subcutaneous contusion: a bruise that occurs when a blow damages blood vessels just below the skin.
- Muscle contusion: damage to the blood vessels that supply the muscles, or damage to the muscles themselves leading to local bleeding
- Bone contusion: damage to bones, such as the ribs or thigh bone (femur) near the knee.
- Organ contusion
- Eye contusion
A subcutaneous contusion occurs when there is damage to the blood vessels just below the skin. These, along with muscle contusions, tend to be less severe. Contusions involving the bones, organs, and eye may be associated with more complications. Injury to the bone can lead to small breaks and cracks. Organ injury can impact the functioning of the organ (ex. lungs, heart, kidneys, spleen). Eye contusions, such as a black eye, commonly heal over time. However, damage to the outer, transparent layer of the eye (called the cornea) can have more serious implications for the patient’s vision.
Physical Examination
Physical exam results will be variable depending on how long it has been since the initial incident (i.e. trauma, blow) and the location of the injury. Patients may have difficulty with motion that involves the bruised area. For example, the pain associated with a muscle contusion from a recent blow in the leg may affect a patient’s ability to walk. Physical examination can localize the injury and determine the extent of the injury. Features such as the color of the bruise and pain to touch are key in making these determinations. In the case of an organ bruise involving the lungs or heart, patients may also have difficulty breathing during the physical examination.
Treatment
Most contusions respond well to rest, ice, compression, and elevation (RICE protocol). Pain relievers such as anti-inflammatory medication or acetaminophen can help relieve some of the discomfort. Once the contusion starts to improve it may be beneficial to massage and mobilize the surrounding tissue so as to minimize the likelihood of painful scarring. If swelling in a muscle contusion persists, this could be indicative of a buildup of blood, called a hematoma. A large hematoma will often need to be drained by a healthcare provider. A large undrained hematoma will often ossify (turn into a bone-like mass) that will lead to pain and dysfunction of the involved muscle or tissue.
Edited July 12th, 2020