A contusion (medical term: contusion) is an injury to a 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 mild and a severe contusion. While mild contusions usually heal completely on their own, a doctor should be consulted for a severe contusion.
What is a contusion?
The support bandage is used as a first aid measure for bruises. Click to enlarge. An injury caused by blunt force from the outside is called a contusion. The skin mantle usually remains intact and there is no external bleeding. As a result of the trauma, soft tissues, such as muscles or vessels, are pressed against the bones and thus bruised. In the process, blood and lymph vessels may be damaged and fluid may leak into the tissue. This leads to localized swelling and the formation of a hematoma (bruise). Contusions often occur on exposed parts of the body. In the case of a mild contusion, only subcutaneous regions are usually affected, i.e. the tissue located directly under the skin. In a severe contusion, anatomically deeper 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. Although this generally heals without complications, in severe cases it can lead to compartment syndrome, which must be treated surgically.
Causes
A contusion occurs when external force in the form of a bump, blow, or kick is applied to a body part. Bruising of tissue can also occur as a result of entrapment. Contusions of varying degrees occur regularly, especially in contact sports such as soccer, handball, boxing or ice hockey. Car accidents or falls on bicycles are also possible causes. However, contusions can also occur in the context of household accidents or physical violence. Manual labor also often involves bruising, especially in the area of the fingers or hand. Toes or ankles can also be affected when heavy items fall on the feet. Bruises of the spine occur as a result of sprains in this area.
Symptoms, complaints and signs
The symptoms of a contusion depend on the part of the body affected and the severity of the injury. Classic symptoms that occur in most cases are hematoma and swelling, as well as moderate to severe pain and tenderness. External bleeding does not occur. Bruising of the musculoskeletal system may result in limited mobility. This is most common when the lesion is in the muscle or joint area. If vessels are injured directly at the joint capsule, a so-called joint effusion occurs due to local bleeding. The consequences are often circulatory disturbances and numbness in the affected area. If the ribs are involved, painful respiratory problems may be the result. Bruising of the eye is manifested by bruising (“black eye”), bleeding of the conjunctiva or swelling of the eyelids. Visual disturbances may also occur. Bone contusions are characteristically very painful at the beginning, but the pain quickly subsides in most cases. However, there may be a longer-term sensitivity of the skin.
Complications
Although contusions are often considered “everyday” injuries, there are contusions that lead to serious consequences. Severe contusions can result in what is called compartment syndrome (muscle compression syndrome, lodge syndrome). In this case, certain muscle groups are affected (compartments), which are surrounded by stabilizing connective tissue (fascia). Since fasciae are only slightly stretchable, a strong local tissue pressure builds up as a result of the muscle contusion. The resulting swelling impedes blood circulation within the affected muscle compartment, which leads to a reduced supply of oxygen and nutrients to the muscles. In the worst case, acute compartment syndrome can lead to neuromuscular dysfunction or tissue necrosis, which is the death of tissue. Without immediate emergency treatment, the bruised tissue can therefore be irreversibly damaged.If a severe compartment syndrome remains untreated for a long time, it may even lead to the need for amputation. A distinction is made between chronic compartment syndrome, which only leads to symptoms in physically stressful situations and does not usually have serious consequences. Another complication of severe contusions is life-threatening organ damage in the abdominal or thoracic cavity. Contusions of the brain, as a result of severe traumatic brain injury, can also have life-threatening consequences. If hematomas develop and are localized deep in muscle tissue, there may be decreased breakdown of the hemorrhage. The hematoma encapsulates (calcifies) and may result in pain or impaired function of the muscle. In all cases, the risk for complications decreases if prompt initial treatment is provided.
When should you see a doctor?
A doctor should always be consulted after falls or accidents involving severe force to rule out internal injuries. This is equally true if no major lesions are visible at first glance. Even if pain does not decrease or increases after immobilization and cooling of the injured body part, a medical clarification of the diagnosis should not be delayed. Other indications for a visit to the doctor are general malaise, dizziness, breathing difficulties, neurological restrictions (visual disturbances, paralysis), extensive hematomas or very strong pressure sensitivity of the bruised tissue. The same applies to severe movement restrictions or difficulty in putting weight on the extremities, as these can also be an indication of bone fractures. In the case of joint contusions, severe swelling of the injured region can cause critical circulatory problems. These are manifested by tingling or numbness in the area of the adjacent extremities. Since neurological structures can also be affected by tissue pressure, a physician should be consulted directly if these symptoms occur. Bruises 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, it is imperative that the affected person be medically monitored to prevent severe bleeding into the tissue. If infants or young children are affected, a doctor must be consulted in any case. In the case of minor complications, a visit to the family doctor is sufficient. In case of doubt, the physician can refer the patient to a specialist. In the case of sports injuries, an orthopedist or sports physician can be consulted directly. In the case of severe complications and severe injuries to the head, an emergency physician is the best option.
Diagnosis
The diagnosis of a contusion is made by a process of exclusion, since the symptoms that occur are not specific. After a detailed clarification of the course of the accident (anamnesis), it must first be ensured that there are no fractures or injuries to the internal organs. In the case of head injuries, a craniocerebral trauma must be ruled out. During 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 examined for injuries to the skin to prevent infection. Imaging techniques such as an X-ray, ultrasound or MRI (magnetic resonance imaging) may subsequently be used to confirm the diagnosis.
Treatment and therapy
Initial treatment in any case follows the so-called PECH rule: rest, ice, compression (“compression”), elevation. All physical activities should be stopped immediately to relieve pressure on the bruised body part. Long-term rest must be maintained until the discomfort subsides. If the bruise is on the arms or legs, they should be elevated to prevent excessive fluid from entering the tissue. A central treatment measure is always cooling of the affected region with ice packs or cold compresses. Ice sprays or cooling ointments are also frequently used. Sustained cooling relieves pain and swelling, as cold constricts the blood vessels and reduces bleeding into the surrounding tissue. Cooling should be interrupted regularly so that wound healing can be activated during the cold-free phases. Swelling can also be reduced by a light pressure bandage.An adapted pain treatment can take place concomitantly. The follow-up therapy depends individually on the severity and type of injury. If a large hematoma has formed as a result of a contusion, this can be punctured to reduce the pressure on the injured tissue. In severe cases, surgical removal of a hematoma may be appropriate to prevent inflammation. For this purpose, a drain is placed to remove excess fluid from the injured tissue. After an appropriate recovery period, light massage or physiotherapy can be used in the final phase of treatment. Alternatively, ultrasound therapy may be used to improve blood flow to the bruised body part and remove potential adhesions within the hematoma. Compartment syndrome always requires surgical treatment. This involves surgically splitting the skin and underlying muscle fascia in the affected muscle compartment in a procedure called a fasciotomy to remove pressure from the bruised muscle tissue (decompression). Dead tissue can also be removed during this surgical procedure. The surgical wound is then covered and closed only after the swelling has subsided.
Outlook and prognosis
Usually, the prognosis is good in the case of a contusion. Most contusions 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 physical impairment, and the age and health constitution of the individual. In general, it can be said that the prognosis improves with a rapid onset of therapeutic measures. The prognosis of any contusion can also be favorably influenced by the prompt application of the PECH rule. If acute contusions are left untreated or improperly treated, healing may be delayed and secondary complications such as calcification of the hematoma may occur. Even with serious complications such as compartment syndrome, the timing of the onset of therapy is critical to the subsequent prognosis. 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 limitations of the injured muscles may result.
Prevention
Preventing a contusion is generally not possible. Especially in contact sports such as field hockey or soccer, bruises occur frequently and can hardly be prevented. To prevent the risk of injury, it is always recommended to wear appropriate protective clothing (shin guards, knee pads, helmet). In everyday life, no prevention is possible either, since bruises usually occur as the result of an accident and the causes cannot be predicted. When working in the trades, work shoes with steel toecaps can protect against toe bruises.
Aftercare
As a rule, a bruise heals on its own, so no specific measures in terms of aftercare are necessary afterwards. This is probably true for mild and fast healing as well as for severe bruises. In rare cases, however, scarring changes can occur in the area of the hemorrhages in severe contusions. These should be observed when they occur and, if necessary, should also be examined by a physician. As soon as the contusion has completely subsided, sports can be resumed. In the case of a mild contusion, this is usually the case after two to three weeks, and sometimes even after days. A severe bruise, however, can last around four weeks or even longer. Therefore, even after successful treatment, some rest should be given. Here, particular attention should be paid to the pain and, when the pain subsides, movement should be started slowly at first. Early exercise stimulates blood circulation, which can cause the swelling to increase again. Therefore, sports should never be started too intensively. It is advisable to wait 1-2 weeks before resuming sports even after the pain has subsided and treatment appears to be completed. In addition, it is not advisable to start again directly at full power, but to begin with light exercise. If resumed lightly and not too early, a contusion generally does not show any long-term consequences or limitations.
You can do it yourself
Most bruises can be treated well by yourself. In this case, the therapy is also initially according to the “PECH” scheme. After the initial treatment, pain can be treated. For lighter bruises, local treatments with diclofenac or ibuprofen are an option. These agents 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 thus intensify bleeding into the injured tissue. After a visible decrease in swelling, cool chamomile tea compresses can be applied to reduce inflammation and soothe the injured tissue. Alternatively, zinc ointment can be applied to the affected skin areas to relieve pain and help the bruise continue to reduce swelling. Ointments containing arnica or comfrey are also good alternatives. Once the swelling has completely subsided, it is recommended that the injured area of the body be warmed with warm cloths or heat pads to re-stimulate circulation and promote natural regeneration of the bruised tissue.
