Contusions and Bruises

A contusion (the medical term for bruise) results from bleeding inside the tissues as a result of trauma from a solid blunt object. For example, when we bump into an opening door or a tabletop, or are accidentally hit by a blunt object. The trauma is blunt enough not to damage the overlying skin, but forceful enough to rupture the underlying small vessels, causing blood leakage into the surrounding tissues. This hemorrhage renders a purplish blue hue to the overlying skin, which we commonly refer to as a bruise.

A bruise or contusion is an important medical sign as it may indicate an as yet undiagnosed bleeding disorder or a serious infection.

Contusions may vary in size and depth. Depending upon the force of impact, the bruise may only be skin deep or may involve the underlying muscles or even the bones.

Sometimes, the bruise does not form at the site of injury but near to it. This is called “ectopic bruising” and occurs when the leaking blood escapes to a nearby site under the force of gravity or other factors. A good example is a black eye, which results from trauma to the anterior part of the scalp or forehead; the blood accumulates in the loose tissue surrounding the eye.

Who is more at risk of acquiring contusions?

Age:

The elderly are more prone to developing bruises compared to young people. The vascular lining weakens with age and becomes more susceptible to damage from trauma.

Sex:

Females bruise more easily due to the presence of a relatively greater amount of fatty tissue under the skin.

Medications:

Blood thinners such as aspirin, warfarin, etc., decrease the coagulating capability of the blood; leading to easy bruising. On the other hand, steroids affect the microvasculature of the skin, which ruptures readily.

Bleeding disorders:

These may be inherited, such as hemophilia, or may result from certain diseases that damage the organs involved in the manufacture of clotting factors, for example hepatitis leading to liver cirrhosis. A deficient clotting system makes one susceptible to bruising, which may be quite extensive and life threatening in severe cases.

Factors affecting the size of a bruise:

The size of resulting contusion or bruise is directly dependent upon:

• Force of impact
• Vascularity of the area
• Presence of loose tissue; the more loose tissue, more area there is available for blood pooling

A lighter skin complexion makes the bruise appear more prominent.

Associated symptoms:

Bruising is associated with pain and swelling of the injured tissue. Pain results from compression of local nerve endings by the leaking blood. Swelling is partly from blood leakage and partly due to inflammation. The color changes from reddish to purplish and finally to a brownish color. These changes occur due to degradation of iron compounds in the blood.

Treatment:

First, one needs to detect the actual extent of the injury and whether or not it is associated with a disease.

Immediate treatment:

In the first couple of days, you need to follow the RICE regime. This includes:

• Giving rest to the injured site, especially if the contusion is deep and involves muscles, in which case movement may be limited or painful.
• Apply ice packs to the traumatized area. Never apply ice directly, cover it with a towel or a wrap. Frequent applications for short duration help reduce bleeding and swelling.
• Compress the area using an elastic wrap; this resists blood pooling and protects the damaged tissue. Be careful not to compromise the blood supply to the more peripheral areas.
• Elevation decreases blood leakage and fluid accumulation in the area.

Use of non-steroidal anti-inflammatory drugs for pain relief is debatable. These drugs suppress the inflammatory response, impairing healing capacity, as well as increasing the risk of bleeding. Acetaminophen (Tylenol) does not have anti-inflammatory effects, but relieves pain.

Delayed management:

After two to three days, the area should be mobilized to an extent that does not cause pain. Heat application and ultrasound therapy improves blood circulation to the area. An improved vascularity is imperative to supply oxygen and nutrients to aid in speedy recovery and to remove the wastes resulting from cellular decomposition.