Types of bruising
A bruise on the knee (technical term: knee contusion) is usually caused by an external force acting directly on the knee joint. The skin surface is not normally affected by this force. However, the tissue directly under the skin is pressed against the hard tissue (e.g. bone or joint capsule) due to the high pressure.
In rare cases, lateral forces cause such a displacement of the tissue and thus lead to a bruise on the knee. Regardless of the respective mechanism of origin, the enormous pressure on the tissue causes tears in small and medium-sized blood and/or lymph vessels. Due to the fact that even a bruise on the knee does not break through the skin surface, the blood exuding from the vessels cannot escape and seeps into the intercellular spaces.
The seepage of the blood exiting the damaged vessels is therefore the actual cause of the bruise. In most cases, a bruise on the knee occurs during physical activity. For this reason, sportspeople in particular are particularly often affected by a bruise on the knee.
In most cases, the subcutaneous fatty tissue located directly above the knee joint is also affected. Due to the enormous pressure that causes the bruise on the knee, vessels within the joint capsule can also tear under certain circumstances. One of the risks of a knee bruise is the development of joint bleeding.
A bruise on the knee should ideally be treated as soon as possible. Immediately after the first symptoms appear (for example, swelling or pain), the affected knee should be supplied with an elastic bandage and elevated. In addition, careful cooling of the knee region can help to prevent consequential damage and reduce the time lost through sport.
If there is a bruise on the knee, it is important to note that any sporting activity should be stopped immediately. People who continue to exercise despite a bruise on the knee run the risk of extensive vascular injuries due to an acute increase in the blood flow in the joint. The actual treatment of a bruise on the knee depends primarily on the extent of the disease.
Due to the direct proximity of the knee, the thigh may also be affected by the bruise. The injury mechanism in the case of a shoulder bruise is usually based on a blunt external force. A shoulder contusion is a typical sports injury, preferably in contact sports such as handball or rugby.
But also in cycling or skiing, some athletes suffer a contusion by falling on the shoulder. In addition to the pain, those affected complain of bruising, swelling and redness over the shoulder area. The pain also worsens when the shoulder is moved.
Nevertheless, the shoulder must be exercised slowly during the healing process with the help of physiotherapists to ensure that all degrees of movement are maintained. It is important here that the strain is kept as low as possible. Since the shoulder consists of a complex muscle and ligament apparatus in addition to the bony structures, if a contusion is suspected, it must always be ruled out that a more serious injury is present or that other structures are additionally affected.
X-rays are particularly suitable for assessing the bony structures.The muscular apparatus can be assessed by ultrasound or even by MRI of the shoulder, if necessary. As with any other contusion, the first therapeutic measure should be to immediately apply the PECH rule, i.e. pause, cool, compress and elevate. In addition, it makes sense to tap the bruised shoulder.
Painkillers and pain and inflammation relieving ointments can also be helpful. In most cases a bruise on the wrist is caused by very typical injury processes. Most of the patients affected by a bruise on the wrist report having supported themselves with their wrists while falling down.
Even in the case of a bruise on the wrist, no injuries can usually be found in the area of the skin surface. If a bruise on the wrist is suspected, a doctor should be consulted immediately. Bruises are often particularly painful in the area of the wrist.
By promptly initiating targeted treatment, further leakage of blood and/or lymph fluid from the injured blood vessels can be prevented and the healing process positively influenced. Depending on the severity of the bruise on the wrist, different treatment measures must be taken. In most cases, decongestant ointment dressings and anti-inflammatory drugs are particularly suitable for treating a contusion on the wrist.
If the pain does not subside significantly within a period of one to two weeks, a doctor must be consulted again. The greatest risk of a bruise on the wrist is the development of the so-called “muscle compression syndrome” which can often lead to permanent damage. For the patients affected, quick action is required.
The dead tissue around the wrist must be removed immediately. Only early intervention can prevent consequential damage. Even smaller bones, such as the phalanges, can be bruised.
A bruise on the finger is in most cases a sports injury. Ball and contact sports are particularly predisposed. Balls, such as volley, hand or basketballs, which unhappily hit individual fingers and compress or bend them, cause a bruise.
But also in martial arts a bruise of the fingers is not a rare injury. The symptoms of a bruise range from severe pain and swelling to bruising and redness. Often the joint capsule is affected.
As a complication of a severe contusion, nerve tissue can be injured or irritated, so that those affected complain of numbness and sensation in the respective fingers. In this case, it is important to make an accurate diagnosis to rule out serious injuries. Then, as with other bruises, it is essential to start treatment immediately according to the PECH rule.
In the case of a bruised finger, a splint is often applied afterwards. In this case not only one but at least two fingers are fixed and stabilized, as this can lead to an optimal healing process. Particularly in the case of bruised fingers, patients should be patient and allow themselves sufficient rest and protection, as the fingers tend to be stressed again much too early in everyday life.
A bruise of the thigh is usually caused by sports. A classic example of an injury is when an opponent in a duel in soccer rams his knee into the side of his thigh. This characteristic bruise on the thigh caused by an external force is also called “horse kiss“.
It is a bruise of the musculature, which is accompanied by pain and a dominant bruise. Since the tendon plate of the iliotibial tract on the outer edge of the thigh yields little, some patients experience extreme tension or pressure pain. As a complication, in severe cases a compartment syndrome can occur after a contusion on the thigh.
This is a phenomenon in which the blood flow is interrupted because the pressure caused by the swelling compresses the vessels and surgical intervention is necessary. In harmless cases, the same treatment recommendations apply to a bruise on the thigh as to other bruises. Therefore, immediate pausing, cooling, compressing and elevating the patient is recommended.
As soon as the complaints have subsided, the sporting activity can be resumed. Most bruises occur in the area of the foot. Especially amateur athletes are often affected by a bruise on the foot.Usually the bruise on the foot is noticeable as severe pain.
In addition, affected patients develop severe swelling and bruising (haematomas) along the ankle. A bruise on the foot does not only limit the athletic activity of the affected person. In most cases, the localization of the bruise also greatly impairs everyday life.
Since the foot continues to be subjected to enormous strain during walking and running, a foot bruise often requires a significantly longer healing time. However, the affected patients can positively influence the healing process by following certain rules of conduct. In this context, appropriate treatment should be initiated immediately after the underlying event.
In the case of a foot bruise, careful cooling within the first 15 to 20 minutes after the onset of pain can help to accelerate the healing process. During cooling, however, care must be taken to ensure that the coolant is never placed directly on the skin surface. To prevent damage from cold, a thin towel should ideally be placed between the coolant and the skin surface.
In addition, the application of an elastic bandage can help to relieve the pain caused by the bruise on the foot. By elevating the affected foot, a further subsidence of blood and/or lymphatic fluid in the intercellular spaces can be avoided, thus alleviating the pain. After a bruise on the foot, a targeted drug treatment can also actively support the healing process.
Especially herbal medicines (e.g. arnica) have so far proven to be effective in the treatment of bruises on the foot. Arnica can be taken in tablet form or applied locally as an ointment. A contusion of the ribs is very painful.
The reason for this is that there is little skin and fatty tissue above the ribs, so the pain is felt comparatively more strongly than with bruises in other places. The reason for a rib contusion is in most cases a fall on the chest area during a sports activity or simply in everyday life when climbing or descending stairs. The pain caused by a rib contusion is often respiratory, which is perceived by those affected as incredibly unpleasant.
Therefore, they often breathe shallower and less deeply. In this context, the risk of insufficient ventilation and pneumonia increases. In most cases, patients can pinpoint the exact location of the pain, but the painful area often extends over several ribs.
Coughing, sneezing or laughing usually increases the pain by tensing the chest muscles that are connected to the ribs. Since the ribs, like a bony cage, have a protective function for some internal organs such as the lungs or heart, it is essential to clarify the integrity of the ribs in the event of a severe rib contusion. In addition, an X-ray can be taken to ensure that it is only a contusion and not a rib fracture.
Therapeutically useful immobilization is somewhat difficult in the case of a rib contusion, since the ribs are moved with every breath. In general, the PECH rule should be followed. Since rib contusion is one of the most painful contusions, a good and sufficiently strong pain therapy is also indispensable.
A contusion of the back is usually caused by a fall or a hard impact. Patients who suffer from a bruise on the back feel a lot of pain. In addition, extensive bruising (haematomas) occurs shortly after the accident.
Due to fluid retention within the damaged tissue, severe swelling can occur immediately after the accident. Since the bruising is classically caused by strong forces acting on the back, a specialist must be consulted promptly. A simple contusion on the back cannot usually be distinguished from serious injuries by the clinic alone.
For this reason, the presence of a bone fracture (technical term: fracture) in the area of the spine must be excluded. This is typically done by a specific examination of the back and spine. If the findings are unclear, additional imaging procedures can be initiated (e.g. the preparation of an X-ray).
