Diagnosis
A bruise is usually diagnosed by a gaze diagnosis and a physical examination. A swelling or the presence of a bruise in connection with the trauma described makes the examiner think of a contusion. Joints and bones are palpated (palpation) and thus the areas that are particularly painful are identified.
The most important differential diagnosis of a contusion is a fracture (bone fracture). Patients who complain of pain, swelling or impaired movement and report trauma must first be examined and a fracture of the corresponding joint or bone must be ruled out. X-ray imaging is particularly suitable for this purpose.
If there are contusions of the ribs, rib fractures in particular must be excluded. In this case, it is particularly important to prove that none of the ribs have come loose and injured parts of the lung. Here, too, an X-ray is usually sufficient (so-called hemithorax = one-sided image of the chest and ribs).
Furthermore, a so-called pneumothorax must be ruled out in the case of indicated respiratory rib pain. This is a detachment of the lung from the thorax and a constriction. A pneumothorax is ruled out by an x-ray of the entire thorax (X-ray thorax). If no trauma is reported, a heart attack must always be ruled out for the specified pain in the ribs (writing an ECG, determining the cardiac enzymes).
Therapy
Most bruises can be treated conservatively.This conservative therapy consists mainly of an adequate pain therapy, which consists of a drug-based pain therapy and a physical pain therapy. The physical measures are mostly cold treatments but also a heat treatment can be perceived as pleasant by the patient. Since horse ointment has both a warming and cooling effect, it can be used to alleviate symptoms by applying it externally to the affected area.
Furthermore, the areas affected by a bruise should be immobilized and not subjected to stress. A plaster cast for immobilization is not necessary. Raising the extremities can also provide relief from pain.
If the ribs are involved, respiratory therapy should also be carried out in any case, as patients complain of pain with every breath and automatically go into a gentle respiration. Respiratory therapy prevents pneumonia and respiratory insufficiency that may be triggered by this gentle breathing. Especially bruises of the joints can often be accompanied by injuries of the joint, the ligaments and the capsule.
In this case, surgical treatment should be discussed. Initially and immediately after the injury, a contusion must be treated with ice. Cold therapy is part of the acute measures according to the PECH rule for sports injuries such as contusions, strains or sprains: P= break, E= ice, C= compression and H= elevation.
Ice sprays or cooling pads are best suited. In order to achieve simultaneous compression, a cold, tight-fitting compress can also be applied around the bruised area if necessary. Cooling can also be achieved by applying the pain and inflammation-relieving drug Voltaren Emulgel® or quark compresses.
A few days after the contusion, it is possible to switch from cold to heat therapy. In the further healing process it is necessary to supply the bruised tissue with sufficient oxygen and nutrients and at the same time to remove the inflammatory infiltrate. This can be realized by an increased blood flow due to a vessel dilatation based on the heat therapy.
In contrast, in the acute situation, the vessels have contracted due to the cold, so that the blood flow was reduced and less inflammatory infiltrate and blood could enter the tissue. Thus swelling and severe pain could be counteracted. As soon as the healing process is advanced, however, heat therapy becomes more important.
Heat pads, heat plasters or a sauna visit are suitable for this. Wobenzym® is a drug which belongs to the group of anti-inflammatory drugs. It consists of a combination of the two enzymes bromelain and trypsin as well as rutoside, a flavonoid.
It is usually used in the form of tablets. However, Wobenzym® is not only used in the case of a contusion but also, for example, in the case of a pulled muscle or joint pain due to rheumatism or arthrosis. Wobenzym® has the property of improving the inflammatory symptoms by increasing blood circulation.
Due to the increased blood flow, the inflammation infiltrate is removed more quickly and the bruised area is supplied with more oxygen and nutrients, so that regeneration is faster. Wobenzym® stimulates the body’s own healing processes, so to speak. The advantage of Wobenzym® is that its use both relieves pain and reduces swelling.
Wobenzym® is therefore superior to pure painkillers. The therapy of a contusion with the help of Wobenzym® ultimately aims to eliminate the cause of the pain, i.e. the inflammatory process. Wobenzym® is used especially when only a short regeneration period is desired after a contusion.
Traumeel® is a homeopathic remedy which is mainly used for bruises, but also for strains, sprains or severe bruising. Traumeel® is available as tablets, creams, ampoules or drops. It contains a total of 14 different active ingredients which, when used in combination, have an optimal effect.These include comfrey (= Symphytum officinale), mountain cabbage (= Arnica montana), wolfsbane (= Aconitum napellus), yarrow (= Achillea millefolium), daisies (= Bellis perennis), St. John’s wort (= Hypericum perforatum), chamomile (= Matricaria recutita), lime sulphur liver (= Hepar sulfuris), Purpuer coneflower (= Echinacea purpurea), calendula (= Calendula officinalis), narrow-leaved coneflower (= Echinaea angustifolia), belladonna (= Atropa bella-donna), magic shrub (= Hamamelis virginiana) and a mixture with the main ingredient mercuroamidonitrate (= Mercurius solubilis Hahnemanni).
Traumeel® is very well suited to relieve the pain of a contusion and to promote the healing process. Traumeel® can be taken in the form of tablets or drops, but can also be applied directly to the bruised area as an ointment or gel. Voltaren® is an analgesic and anti-inflammatory drug with a wide range of applications.
It is very often used for bruises, as it can combat the main complaints such as pain and swelling. The active ingredient of Voltaren Emulgel® is diclofenac, an arylacetic acid derivative that belongs to the group of so-called non-steroidal anti-inflammatory drugs. In addition to relieving pain and inflammation, diclofenac also inhibits fever and thus has an antipyretic effect.
It works by inhibiting a special enzyme so that certain substances for the inflammatory process can no longer be produced. Voltaren should be applied locally to the area and massaged in gently. It is important that the skin is intact, which by definition is actually the case with a pure contusion.
In addition, Voltaren Emulgel® should be applied as soon as possible after the injury, so that it can achieve an optimal effect. A positive side effect is also the cooling property of Voltaren Emulgel® due to its aqueous and alcohol-based base. In the treatment of a contusion, it is possible to take advantage of a number of home remedies that usefully supplement conventional therapeutic measures or even be used as effective alternatives.
With the help of various home remedies, it is possible to alleviate the symptoms of a contusion: pain, swelling and bruising can thus be easily combated. In the context of a cold therapy to reduce pain and swelling, quark wraps are particularly effective. Depending on the location of the bruise, the curd can either be wrapped under a bandage or pressed onto the bruised area in a small bag.
Alternatively, the use of peppermint oil promises a cooling effect. There are also various essential oils, herbs or other substances that can be used to relieve the pain in the event of a bruise. These include tea tree oil, marjoram leaves and a combination of chopped parsley and stiffly beaten egg white.
The healing process of a contusion can also be accelerated or supported by fighting the inflammation, which is accompanied by a reduction of swelling and pain. A blood circulation-promoting agent with exactly this effect is the rubbing alcohol. It contains substances such as mountain pine oil, juniper berry oil, spruce needle oil and menthol.
Creams or ointments containing substances such as arnica, comfrey, menthol, rosemary, marigold and horse chestnut have a particularly good decongestant effect. In addition, the use of Schüssler Salt No. 3, the so-called “Ferrum phosphoricum“, can be applied in the treatment of a bruise.
Most of the ingredients of the household remedies mentioned so far can either be found in the own herb garden or can be bought in the pharmacy, so that one can make the corresponding remedies oneself if needed and interested. In general, if the symptoms persist, household remedies should not be used alone. It is advisable to consult a doctor to exclude the possibility of serious illnesses.
The duration of the healing period can vary greatly from one person to another in the presence of a contusion. In this context, the extent of the injury and the timing of the start of treatment play a decisive role. In most cases, the pain felt by the affected patient can be effectively relieved by simple measures.
In addition, the healing time of the contusion can be significantly shortened by quickly initiating a suitable therapy. Light painkillers (analgesics) such as ibuprofen or paracetamol can be taken during the entire healing phase. In addition, analgesics containing the active ingredient diclofenac are particularly suitable for alleviating bruise-related pain.To further accelerate the healing process and thus shorten the time to full recovery, special ointments, creams and cooling gels can also be applied.
Nevertheless, the exact duration of the healing process in the presence of a contusion cannot be determined even with extensive protection and the application of supportive medication. In general, however, it can be assumed that the pain typical of a contusion will subside within a few days. After the pain has subsided, the affected area no longer needs to be cooled.
From this point on, the duration of healing can be further shortened by using red light, heat pads or medicinal baths. Persons with a contusion should refrain from any kind of sports activities. Excessive strain on the bruised area can lead to serious complications and significantly prolong the healing time. Overall, it can be assumed that the average time to complete healing of a contusion is approximately six weeks. After this period, the affected area can slowly be brought back to a state of stress.