Contusion

Contusion is the medical term for a bruise, one of the most common injuries that can affect anyone, from active children to athletes and older adults, occurring when blood vessels break beneath the skin due to a direct blow or impact.

Bruise, Ecchymosis, Hematoma

Table of contents

• What Is a Contusion?
• Types of Contusions
• What Causes Contusions?
• Signs and Symptoms
• How Contusions Are Diagnosed
• Treatment and Home Care
• How Long Do Contusions Last?
• When to See a Doctor
• Possible Complications
• Prevention

What Is a Contusion?

A contusion is the medical term for a bruise. It occurs when a part of the body receives a direct blow or impact, such as from a fall, collision, or being struck by an object. When this happens, small blood vessels called capillaries (tiny blood vessels that connect arteries and veins) break beneath the skin surface^[1].

The blood from these broken vessels leaks out into the surrounding tissue under the skin. Because the skin remains unbroken, the blood becomes trapped, creating the characteristic colored mark we recognize as a bruise^[2]. Contusions are a type of hematoma, which means any collection of blood outside a blood vessel^[1].

Anyone can get a contusion, regardless of age. They are particularly common among children who are active and athletes who play contact sports. Contusions are one of the most common types of injuries in active children and rank as the second most common sports injury after strains^[3].

Types of Contusions

Contusions can affect different parts of your body in different ways. There are several main types based on which tissue is damaged.

Skin and Soft Tissue Contusions

The most familiar type of contusion affects the skin and the tissue just beneath it. This is what most people picture when they think of a bruise. These subcutaneous contusions (bruises just beneath the skin) show up as discolored marks on the skin that can be red, purple, blue, black, green, yellow, or brown depending on how old the bruise is^[1]. Areas that people tend to land on during falls, such as hands and knees, are especially prone to this type of injury^[23].

Muscle Contusions

Muscle contusions occur when direct force crushes underlying muscle fibers and connective tissue without breaking the skin^[3]. These injuries are deeper than skin bruises and are usually more painful. Athletes in contact sports frequently experience muscle contusions, particularly to the thigh muscles^[11].

While you may not always see discoloration on the skin surface with a muscle contusion, the injured muscle typically feels weak, stiff, and painful. Sometimes a pool of blood collects within the damaged muscle tissue, forming a lump called a hematoma^[3].

Bone Contusions

Bones can also get bruised, though this is less commonly known. A bone contusion or bone bruise is similar to a bruise on your skin but occurs within the bone itself^[4]. Your bones are living tissue made up of blood vessels, and when hit with sufficient force, these vessels can bleed without the bone breaking.

Bone bruises are usually impossible to see, even on regular X-rays. They require more advanced imaging like an MRI scan to be detected^[1]. A bone contusion feels like a dull, throbbing ache coming from deeper inside your body than a typical surface bruise^[4].

Bone contusions can be classified into three types based on where the damage occurs:

• Periosteal contusion: Affects the periosteum, which is a membrane of blood vessels and nerves that wraps around most bones
• Subchondral lesions: Bruising in a joint, located under the cartilage
• Intraosseous contusion: Bruising inside the bone itself^[4]

What Causes Contusions?

Contusions happen when a direct blow or impact strikes part of the body with enough force to damage blood vessels but not enough to break the skin. The injury crushes underlying tissue and blood vessels, causing them to leak blood into the surrounding area^[2].

Common causes include:

• Bumping into objects or furniture
• Falls
• Sports injuries, especially in contact sports like football, soccer, basketball, and rugby
• Being struck by objects such as balls, sticks, or other equipment
• Car accidents
• Jamming the body against a hard surface
• Players colliding during sports activities^[3]

Injuries that twist your joints or body are more likely to cause bone contusions. For example, ankle and knee sprains can put enough pressure on bones to bruise them^[4].

Risk Factors

While anyone can develop a contusion, certain factors increase the risk:

• Playing contact or extreme sports
• Having physically demanding jobs or hobbies
• Being over 65 years of age, as blood vessels become more fragile with aging
• Having blood disorders or bleeding conditions
• Having arthritis
• Poor nutrition, which can cause weakness and dizziness that increase fall risk
• Smoking, which constricts blood flow and slows healing^[4][11]

Signs and Symptoms

The symptoms of a contusion vary depending on which type of tissue is injured and how severe the injury is.

General Symptoms

Most contusions share some common signs:

• Pain at the injury site
• Tenderness when the area is touched
• Swelling
• Discoloration of the skin
• Warmth in the affected area as part of the body’s inflammatory response^[2]

Skin and Soft Tissue Contusion Symptoms

Soft tissue contusions have distinct characteristics that make them easier to identify:

• Discolored skin that looks red, green, purple, blue, or black
• A small bump over the area in some cases
• Pain that’s usually worse when pressure is applied to the area^[1]

Muscle Contusion Symptoms

When a muscle is bruised, you may experience:

• Swelling and pain
• Bluish discoloration from torn blood vessels
• Weakness in the injured muscle
• Stiffness
• Limited range of motion in nearby joints
• Sometimes a lump over the injury if blood has pooled^[3]

Bone Contusion Symptoms

Bone bruises typically cause:

• Bone pain
• Tenderness around the bone
• Swelling
• Skin bruising or discoloration (though the bone bruise itself isn’t visible)
• A dull, throbbing ache coming from deep inside the body
• Pain that may worsen when moving, standing, or sitting in certain positions^[4]

Color Changes Over Time

One characteristic feature of contusions is how their color changes as they heal:

• When first formed: Red as blood appears under the skin
• Within 1-2 days: Bluish-purple or even black as the hemoglobin in the blood changes
• After 5-10 days: Green or yellow
• After 10-14 days: Yellow-brown or light brown
• Finally: The bruise fades away completely^[6]

How Contusions Are Diagnosed

For most minor contusions, a doctor can make a diagnosis through a physical examination. The doctor will examine the injured area to determine the exact location and extent of the injury^[3].

However, if there’s concern about more serious damage, your doctor may order diagnostic tests:

• X-rays: Used to rule out broken bones or fractures. However, X-rays cannot detect bone bruises^[1]
• MRI (Magnetic Resonance Imaging) scans: Provide better images of bone contusions and soft tissue damage^[1]
• CT (Computed Tomography) scans: May be used to visualize inside the injured area^[3]
• Ultrasound: Can help examine soft tissue injuries^[3]

For some injuries, your doctor may also need to check for nerve damage or injury to internal organs if the contusion is on the abdomen or chest^[3].

Treatment and Home Care

Most contusions are minor and heal with simple home treatment. The goal of treatment is to minimize bleeding and swelling, reduce pain, and support the healing process.

RICE Method

The most widely recommended approach for treating contusions is the RICE protocol, which should be used for the first 24 hours for minor contusions and 48 hours for moderate or severe ones^[12]:

• Rest: Protect the injured area from further harm by stopping activity. You may need to use crutches, a sling, or other protective devices^[3]
• Ice: Apply cold packs for 15-20 minutes at a time, several times a day. Always put a thin cloth between the ice pack and your skin. Never apply ice directly to the skin. Ice helps reduce blood flow to the area, which can prevent the bruise from becoming as severe and reduce swelling^[3]
• Compression: Lightly wrap the injured area in a soft bandage or elastic wrap. This helps squeeze tissues and prevent blood vessels from leaking further. Compression can lessen the severity of the bruise and reduce pain and swelling^[3]
• Elevation: Raise the injured area above the level of your heart. This helps relieve pain and drain fluid away from the bruised area. Prop the injured part up on pillows when resting^[3]

Pain Management

Your doctor may recommend pain relief medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help with pain and inflammation^[1]
• Acetaminophen for pain relief if NSAIDs are not suitable^[6]

Additional Treatment Measures

After the first 48 hours, when the injury has stabilized, additional measures may help:

• Apply heat or use a heating pad to boost circulation and increase blood flow, which helps clear away trapped blood. However, avoid heat during the first 24-48 hours as it can increase bleeding^[12]
• For muscle contusions, keep the muscle in a gentle stretch position to prevent scar tissue formation and facilitate drainage^[12]
• Gentle movement and light stretching once initial healing has begun^[3]

What to Avoid

Certain actions can worsen contusions or delay healing:

• Do not massage the injured area, as this can increase damage^[3]
• Avoid heat during the first 24-48 hours to prevent increased bleeding and swelling^[12]
• Do not try to rehabilitate the muscle too quickly, as this can lead to complications^[4]
• Avoid retraumatizing the muscle, which is a significant factor in prolonging disability^[12]

How Long Do Contusions Last?

The healing time for contusions varies depending on the type and severity of the injury.

Most skin bruises fade away in about 2 weeks^[6]. Soft tissue contusions with no serious damage often improve within a few days to a few weeks with home treatment^[17].

Bone bruises take much longer to heal. On their own, bone bruises can take anywhere from a few days to several months to heal, depending on how severe the injury is^[1].

Most athletes with muscle contusions recover quickly with simple treatment measures, though severe contusions can cause deep tissue damage and may prevent an athlete from playing sports for months^[3].

When to See a Doctor

While most contusions are minor and can be treated at home, you should seek medical attention in certain situations:

Immediate Medical Attention Needed

Go to the emergency room or call for emergency help if:

• You experience intense pain that feels like it’s coming from a bone
• There is very painful swelling in the bruised area
• You cannot move a joint or think you might have a broken bone
• You have numbness, weakness, or rapidly increasing swelling in the injured area (possible signs of compartment syndrome)
• The area near the contusion is cold or pale
• You are unable to move a leg at all
• You lose bladder or bowel control (if the contusion is on your back)
• You have blood in your urine (if the contusion is on your back)^[8][4]

Schedule a Doctor’s Visit If

Contact your doctor if:

• A bruise isn’t improving after 2 weeks
• You still have pain 3 days after a minor injury
• The bruise is swollen and very painful
• You bruise often or seem to get bruises for no clear reason
• You have frequent, large, or painful bruises
• Bruises begin suddenly or develop for no reason
• You have a personal or family history of easy bruising or bleeding
• A lump forms over the bruise (sign of a hematoma)
• You have unusual bleeding, such as from the nose or gums
• You have new or worse symptoms in your legs or buttocks
• You are not getting better as expected^[13][17]

Possible Complications

While most contusions heal without problems, severe ones can lead to complications.

Compartment Syndrome

This serious complication occurs when pressure rises in and around your muscle. With a muscle contusion, rapid bleeding can cause this increased pressure. Compartment syndrome is very painful and can be dangerous because it limits the flow of blood, oxygen, and nutrients to muscles and nerves. It can cause serious damage and may require urgent surgery. Signs include numbness, weakness, or rapidly increasing swelling in the injured area^[11].

Myositis Ossificans

This complication happens when bone forms inside your muscle after a traumatic injury. It sometimes develops after a severe muscle contusion if you try to rehabilitate the muscle too quickly. It can take 2 to 4 weeks after the injury before myositis ossificans becomes noticeable^[4].

Large Hematomas

Sometimes a large volume of blood collects in the muscle or tissue, forming a painful swelling called a hematoma. Doctors may need to drain a large hematoma to help the area heal more quickly^[3].

Internal Organ Damage

Contusions to the abdomen or chest may damage internal organs, such as the heart, lungs, liver, kidney, pancreas, and spleen. These require immediate medical attention^[3].

Associated Injuries

If tissue damage is extensive, you may also have additional injuries including:

• Broken bones
• Dislocated joints
• Sprains (stretching or tearing of ligaments)
• Torn muscles
• Nerve damage^[3]

Untreated Bone Contusions

Untreated bone contusions can weaken your bone enough to cause a bone fracture. If you continue using a bruised bone or putting stress on it, the damage can worsen to the point that your bone cracks or breaks^[4].

Prevention

While it’s not always possible to prevent contusions, especially during sports, you can take steps to reduce your risk:

Sports and Activity Safety

• Wear appropriate protective equipment during contact sports and activities
• Purchase shoes designed for your particular sport, as wearing shoes designed for another activity will not provide adequate support
• Check playing fields for divots or hazards that could cause falls
• Replace athletic shoes after about 500 miles of wear, usually once or twice a year for active people^[16]

Home Safety

• Keep walkways clear of clutter
• Use adequate lighting, especially on stairs
• Be careful around furniture with sharp corners
• Use non-slip mats in bathrooms

General Health

• Maintain good nutrition to prevent weakness and dizziness that can lead to falls
• If you smoke, quit, as smoking affects blood flow and healing
• Manage any underlying health conditions that affect bleeding or bone health^[15]