A bruise (medical: contusion) is an injury to tissue or organs caused by blunt trauma, such as a bump, kick, or impact. Depending on the severity of the tissue damage, a distinction is made between a light or a severe bruise. While minor bruises usually heal completely on their own, a doctor should be consulted for a severe contusion.
What is a bruise?
An injury caused by external blunt force trauma is called a contusion. The skin coat usually remains intact and there is no external bleeding. As a result of the trauma, soft tissues such as muscles or blood vessels are pressed against the bones and thereby crushed. See healthknowing for What is the Definition of Hoffa-Kastert Syndrome.
Blood and lymphatic vessels can be damaged and fluid can leak into the tissue. This leads to localized swelling and the formation of a hematoma (bruising). Bruises often appear on exposed parts of the body. A minor bruise usually only affects the subcutaneous regions, i.e. the tissue that is just under the skin.
In the case of a severe bruise, anatomically lower-lying structures such as muscles, joints or internal organs are also affected. A well-known form of bruise is the so-called “horse kiss”, which usually occurs on the thigh. Even if this generally heals without complications, severe cases can lead to compartment syndrome, which must be treated surgically.
A bruise occurs when an external force in the form of a bump, punch, or kick is applied to a part of the body. Tissue bruises can also result from pinching. Contusions of varying degrees regularly occur, particularly in contact sports such as football, handball, boxing or ice hockey.
Car accidents or falls from a bicycle are also possible causes. However, bruises can also occur as part of household accidents or physical violence. Manual work also often causes bruises, especially in the area of the fingers or hands. Toes or ankles may also be affected if heavy objects fall on feet. Spinal contusions occur as a result of sprains in this area.
Symptoms, Ailments and Signs
The symptoms of a bruise depend on the part of the body that is affected and the severity of the injury. Classic symptoms that occur in most cases are bruising and swelling, as well as moderate to severe pain and tenderness.
External bleeding does not occur. Bruises of the musculoskeletal system can lead to restricted mobility. This is particularly noticeable when the lesion is in the muscles or joints. If vessels are injured directly on the joint capsule, local bleeding causes a so-called joint effusion. The consequences are often circulatory disorders and numbness in the affected area.
Pain-related breathing difficulties can result if the ribs are involved. Bruises on the eye show up as bruises (“violets”), bleeding of the conjunctiva or swelling of the eyelids.
Visual disturbances can also occur. Bone bruises are typically very painful at first, but the pain subsides quickly in most cases. However, long-term skin sensitivity can occur.
Although bruises are often considered “everyday” injuries, there are contusions that lead to serious consequences. Severe bruises can result in what is known as compartment syndrome (muscle compression syndrome, box syndrome).
Certain muscle groups are affected (compartments), which are surrounded by stabilizing connective tissue (fascia). Since fasciae can only be stretched slightly, the muscle bruise causes strong tissue pressure to build up locally. The resulting swelling impedes blood circulation within the affected muscle compartment, resulting in a reduced supply of oxygen and nutrients to the muscles.
In the worst case, acute compartment syndrome can lead to neuromuscular disorders or tissue necrosis, i.e. tissue death. Therefore, without immediate emergency treatment, the bruised tissue can be irreversibly damaged. If a severe compartment syndrome is left untreated for a long time, it can even lead to the need for an amputation.
A distinction is made between chronic compartment syndrome, which only leads to symptoms in situations of physical stress and usually has no serious consequences. Another complication of severe contusions is life-threatening organ damage in the abdomen or chest. Contusion of the brain, as a result of severe craniocerebral trauma, can have life-threatening consequences.
If hematomas form deep in the muscle tissue, bleeding may be reduced. The hematoma encapsulates (calcifies) and can cause pain or dysfunction of the muscle. The risk of complications decreases in all cases if there is quick first aid.
When should you go to the doctor?
After falls or accidents involving severe violence, a doctor should always be consulted to rule out internal injuries. This also applies if no larger lesions are visible at first glance. Even if the pain does not decrease or increases after immobilization and cooling of the injured part of the body, a medical clarification of the diagnosis should not be delayed.
Other indications for a doctor’s visit are general malaise, dizziness, breathing difficulties, neurological limitations (visual disturbances, paralysis), extensive hematomas or very strong pressure sensitivity of the bruised tissue. The same applies to severe movement restrictions or load difficulties in the extremities, as these can also be an indication of broken bones.
In the case of joint bruises, severe swelling of the injured region can cause critical circulatory disorders. These are expressed by tingling or numbness in the area of the adjacent extremities. Since neurological structures can also be affected by tissue pressure, a doctor should be consulted immediately if these symptoms occur.
Contusions of the spine must also be examined by a doctor in any case. If there is a known blood clotting disorder or if blood thinners are being taken at the time of the bruise, the person concerned should be medically monitored to prevent severe bleeding into the tissue.
If babies or small children are affected, a doctor must be consulted in any case. In the case of minor complications, going to the family doctor is sufficient. In case of doubt, he can initiate a referral to a specialist. In the case of sports injuries, an orthopaedist or sports physician can be consulted directly. In the case of serious complications and severe injuries to the head, an emergency doctor is the best option.
A bruise is diagnosed using a process of exclusion, since the symptoms that occur are not specific. After the detailed clarification of the course of the accident (anamnesis), it must first be ensured that there are no broken bones or injuries to the internal organs.
In the case of head injuries, a craniocerebral trauma must be ruled out. As part of the further examination, the injured region is carefully palpated, the intensity of the pressure pain is analyzed and possible movement restrictions are recorded. The affected area should also be checked for broken skin to prevent infection. Imaging procedures such as an X-ray examination, an ultrasound or an MRI (magnetic resonance imaging) can then be used to confirm the diagnosis.
Treatment & Therapy
In any case, first aid is provided according to the so-called PECH rule: break, ice, compression (“compression”), elevation. All physical activity should be stopped immediately to relieve the bruised body part.
Rest must be maintained over the long term until the symptoms subside. If the bruise is on the arms or legs, they should be elevated to prevent excessive fluid penetration into the tissue. A central treatment measure is always the cooling of the affected region with ice packs or cold wraps.
Ice sprays or cooling ointments are also often used. Prolonged cooling reduces pain and swelling because the cold constricts blood vessels and reduces bleeding into surrounding tissues. The cooling should be interrupted regularly so that the wound healing can be activated in the cold-free phases. Swelling can also be reduced with a light pressure bandage. An adapted pain treatment can take place concomitantly.
Follow-up therapy depends on the severity and type of injury. If a large hematoma has formed as a result of a bruise, it can be punctured to reduce the pressure on the injured tissue. In severe cases, surgical removal of a hematoma can be useful to prevent inflammation. A drain is placed to drain excess fluid from the injured tissue.
After an appropriate regeneration time, light massage or physiotherapy can be used in the final phase of the treatment. Alternatively, ultrasound therapy can be used to improve blood flow to the bruised body part and eliminate potential adhesions within the hematoma.
Compartment syndrome must always be treated surgically. The skin and the underlying muscle fascia in the affected muscle compartment are surgically split as part of a so-called fasciotomy in order to take the pressure off the squeezed muscle tissue (decompression). Dead tissue can also be removed during this surgical procedure. The surgical wound is then covered and only closed again after the swelling has subsided.
Outlook & Forecast
As a rule, the prognosis in the case of a bruise is good. Most bruises heal completely within a few days to weeks without further complications. However, the individual prognosis is influenced by the degree of injury, the extent of the physical impairment, as well as the age and health constitution of the individual.
In general, it can be said that the prognosis improves with the rapid onset of therapeutic measures. The prognosis of every bruise can also be favorably influenced by the immediate application of the PECH rule. In the case of untreated or incorrectly treated acute bruises, healing can be delayed and subsequent symptoms such as calcification of the hematoma can occur.
Even in the case of serious complications such as compartment syndrome, the point in time at which therapy begins is crucial for the further prognosis. An early fasciotomy is usually successful and free of complications. The tissue can regenerate completely. However, if treatment is delayed, irreversible damage to the affected tissue and permanent functional impairment of the injured muscles can occur.
Preventing a bruise is generally not possible. Especially in contact sports such as hockey or football, bruises occur frequently and can hardly be prevented. To prevent the risk of injury, it is always advisable to wear suitable protective clothing (shin guards, knee pads, helmet). Prevention is also not possible in everyday life, since bruises usually occur as a result of accidents and the causes are unpredictable. When working in trades, work shoes with steel toe caps can protect your toes from bruising.
As a rule, a bruise heals on its own, so no specific aftercare measures are necessary afterwards. This applies both to light and fast-healing bruises and to severe bruises. In rare cases, however, scarring changes can occur in the area of bleeding from severe bruises (contusions).
These should be observed when they occur and, if necessary, examined by a doctor. Once the bruise has completely healed, you can start exercising again. In the case of a slight bruise, this is usually the case after two to three weeks, sometimes even after a few days. However, a severe bruise can last around four weeks or even longer.
Therefore, even after successful treatment, a little rest should be given. Particular attention should be paid to the pain and when the pain subsides, the movement should be started slowly at first. Early exercise stimulates blood circulation, which can increase the swelling again.
Sport should therefore never be started too intensively. It is advisable to wait another 1-2 weeks before resuming sport even after the pain has subsided and the treatment seems to have been completed. In addition, you should not jump back in with full force, but start with light movement at first. If re-entry easily and not too early, a contusion generally does not show any long-term consequences or limitations.
You can do that yourself
Most bruises can be treated easily on your own. The therapy is also initially based on the “PECH” scheme. After initial care, pain can be treated. For minor bruises, local treatments with diclofenac or ibuprofen are recommended. These active ingredients relieve pain and help prevent inflammation in the injured area.
For more severe symptoms, painkillers can also be taken. However, acetylsalicylic acid (Aspirin®, ASS) should never be used for bruises, as this active ingredient inhibits blood clotting and can therefore intensify bleeding into the injured tissue. After a visible reduction in swelling, cool chamomile tea compresses can be used to reduce inflammation and soothe the injured tissue.
Alternatively, zinc ointment can be applied to the affected areas of skin to relieve pain and help further swelling of the bruise. Arnica or comfrey ointments are also good alternatives. Once the swelling has gone down completely, it is advisable to warm up the injured area of the body with a warm cloth or heat pack to stimulate blood circulation and promote the natural regeneration of the bruised tissue.