Contusion is defined as an injury of a body part where the skin remains intact.
Dark red to purple to black skin discoloration is the presentation. Many factors modify the clinical presentation of contusions. These include the type of tissue affected, severity of trauma, age, sex, skin color and systemic diseases (like bleeding disorders). Systemic diseases usually give rise to small bruises (petechiae) whereas trauma or mechanical compression causes single large contusions involving vast expanse of skin.
Clinical presentation of contusion also depends on the affected organ. Based on the involved structure, contusions are of following types.
Subcutaneous contusions present as:
Intramuscular contusions seldom show on the skin surface. Pain is the main symptom of such contusions. Limitation of the range of motion is also common in such cases. Periosteal contusions are the most painful ones and may present as visible swelling. Pulmonary contusion is accompanied by respiratory symptoms like difficulty in breathing or wheezing. Cerebral contusions present with headache, impaired orientation, vomiting, seizures, syncope and coma.
Workup in contusions consists of the following elements.
The treatment of contusions consists of:
There are many different causes of contusion. Most commonly, it occurs due to blunt trauma (as a result of fall, blunt ended weapon injury, sports injury etc.). Mechanical compression of the tissues as seen in road traffic accidents may also cause contusions. Fractures and ligament tears (such as anterior or posterior cruciate ligaments tears) are also associated with the development of bruising and contusion. Muscle strains may also lead to the formation of contusions. Bites received from animals may also cause the formation of contusions.
Internal organs may also develop contusions as a result of trauma. Intraabdominal contusions are very frequent after blunt abdominal injuries. Injuries to the head may cause the development of intracerebral hemorrhage, subdural hematoma and subarachnoid hemorrhage.
A number of diseases and conditions predispose the patient to the development of contusions. Notable among them are bleeding disorders such as hemophilia B (Christmas disease). Deficiency of the factors involved in the clotting cascade (such as deficiency of factors II, V, VII and X) also increase the risk for the formation of contusions. Contusions are also frequently seen in the patients with reduced platelet count and those with von willebrand disease. Henoch Schloein purpura is also associated with deep bruising. Leukemias may also predispose the patient to the development of contusions.
The exact prevalence of contusions is difficult to establish as majority of the cases go unreported. Contusions are more common in young children and teenagers. Individuals with bleeding and coagulation disorders are also at higher risk.
One-third of the sports injuries result in muscle contusions. Rotator cuff and gastrocnemius injuries are the commonly reported ones.
When external trauma occurs to the tissues, the localized blood vessels rupture. The blood oozes out and accumulates in the tissue spaces, causing formation of a hematoma. Injury to the capillary endothelium triggers the release of endothelin that causes the vasoconstriction, preventing further leakage of blood out of the vessels.
The injury also causes the release of Von-Willebrand factor that triggers the coagulation cascade, resulting in localized clot formation to stem the blood leakage. Involvement of nerve endings can give rise to pain sensations.
The blood is clotted and plugged locally. Tissue plasminogen activator begins the clot resolution, during which the hematoma or the bruise undergoes various color changes due to accumulation of hemoglobin breakdown products as a result of phagocytosis of cellular debris. The clot ultimately dissolves completely.
The age of the bruise can be estimated by external skin discoloration.
Commonly referred to as a deep bruise, a contusion develops as a result of rupture of small blood vessels and the accumulation of blood in the tissue spaces. Purple or bluish discoloration is the common presentation of a contusion. The underlying pathology and the clinical presentation of contusions vary greatly. Conservative treatment modalities can help in healing of contusions.
A contusion or bruise is accumulation of blood as a result of bursting of small blood vessels as a result of blunt force trauma or a multitude of other causes. Bleeding disorders like hemophilia can also precipitate bruising. Result is deep purple or bluish discolorations, swelling and pain. A bruise usually resolves itself in about 2-3 weeks.
Observing road safety measures can prevent contusions due to major trauma like accidents. Other preventive measures include wearing head gear and protective padding during sports activities. If bruising occurs repeatedly and even after minor injuries, a physician should be immediately consulted as it may indicate presence of other threatening conditions.