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Contusion

A contusion, commonly known as a bruise, is a type of hematoma of tissue in which capillaries and sometimes venules are damaged by trauma, allowing blood to seep, hemorrhage, or extravasate into the surrounding interstitial tissues. The term "contusion" is often used interchangeably with "bruise," although the latter is more commonly used in layman's terms.

Pathophysiology

A contusion occurs when a direct blow or impact causes damage to the small blood vessels beneath the skin. The force of the impact causes the blood vessels to rupture, leading to bleeding into the surrounding tissues. This results in the characteristic discoloration of the skin, which can range from red to purple, blue, green, yellow, and brown as the bruise heals.

Stages of Bruising

1. Red/Purple Stage: Immediately after the injury, the bruise appears red due to the presence of oxygen-rich blood under the skin. 2. Blue/Purple Stage: Within a day or two, the bruise turns blue or purple as the oxygen is depleted from the blood. 3. Green Stage: After a few days, the bruise may turn green as the hemoglobin in the blood breaks down into biliverdin. 4. Yellow/Brown Stage: Finally, the bruise turns yellow or brown as the biliverdin breaks down into bilirubin and is reabsorbed by the body.

Clinical Presentation

Contusions are characterized by:

• Discoloration: The skin overlying the contusion changes color as described in the stages above.
• Swelling: There may be localized swelling due to the accumulation of blood and fluid in the tissues.
• Pain: The area may be tender to touch, and pain can vary depending on the severity of the contusion.
• Loss of Function: In severe cases, especially when muscles or joints are involved, there may be a temporary loss of function.

Diagnosis

Diagnosis of a contusion is primarily clinical, based on the history of trauma and the characteristic appearance of the bruise. In some cases, imaging studies such as ultrasound or MRI may be used to assess the extent of the injury, especially if there is concern about deeper tissue damage.

Management

The management of contusions involves symptomatic treatment and supportive care:

• Rest: Avoiding activities that may aggravate the injury.
• Ice: Applying ice packs to the affected area to reduce swelling and pain.
• Compression: Using an elastic bandage to compress the area and limit swelling.
• Elevation: Keeping the affected area elevated above the level of the heart to reduce swelling.
• Pain Relief: Over-the-counter pain medications such as acetaminophen or ibuprofen can be used to manage pain.

Complications

While most contusions heal without complications, severe contusions can lead to:

• Compartment Syndrome: Increased pressure within a muscle compartment that can compromise circulation and function.
• Myositis Ossificans: Calcification of the muscle tissue following severe contusion.
• Infection: Rarely, if the skin is broken, there may be a risk of infection.

Prevention

Preventive measures include wearing protective gear during sports and activities, ensuring safe environments to reduce the risk of falls, and maintaining good muscle strength and flexibility.

See Also

• Hematoma
• Ecchymosis
• Soft tissue injury

Classification
External resources