Contusion: causes, symptoms, diagnosis, treatment

Contusion (contusio) is damage to soft tissues due to the short-term action of a traumatic agent, not accompanied by the formation of wounds.

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What causes a bruise?

A bruise occurs mainly from direct violence. Its severity depends on the type, mass and speed of the wounding agent, the area of damage, the elasticity of the tissues, the degree of their blood supply, the age of the patient and other factors.

What are the symptoms of a bruise?

Pathologically, a contusion is characterized by partial destruction of subcutaneous fat, small blood and lymphatic vessels, hemorrhage into soft tissues, up to the formation of hematomas.

The victim who received a bruise complains of pain at the site of injury; the intensity of pain varies: the more pronounced the hematoma and swelling, the stronger the pain syndrome due to compression of nerve endings and stretching of tissues.

How to recognize a bruise?

Anamnesis

The anamnesis indicates trauma.

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Inspection and physical examination

At the site of injury, where there is a bruise, swelling is localized due to hemorrhage and inflammatory edema. The size of the swelling is greater where there is more loose subcutaneous tissue. Examples include swelling of the face, the back of the hand, and the area of some joints. Hemorrhages are also more pronounced in these areas. They are detected on the 2nd-3rd day in the form of blue spots (bruises), as the blood elements disintegrate and are absorbed, changing color to blue-purple, green, yellow.

Palpation of the swelling where there is a bruise is painful. In places where the tissues are denser, enveloped in aponeurotic sheaths (for example, the forearm), compression of nerve endings by hemorrhage and edema causes particularly severe pain.

Impairment of function is most evident when the limbs are damaged.

In some cases, when blows are delivered tangentially, the skin separates from the underlying tissues (sometimes over a large area), which changes the picture of the bruise. A cavity filled with exudate mixed with blood and lymph forms under the skin. Clinically, extensive fluctuating swelling is determined.

Another special form is a joint contusion, in which bleeding occurs not only in the periarticular tissues, but also in the joint cavity - hemarthrosis. The joint is enlarged in volume, its contours are smoothed, the swaying indicates the presence of free fluid in the joint cavity. If there is a knee joint contusion, balloting (springing oscillation) of the patella is detected. It is detected in this way: if you grasp the knee joint with your palms, simultaneously pressing it with your thumbs, the patella seems to be suspended in liquid and is separated from the femur.

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How to treat a bruise?

Bruise: treatment with conservative methods

A bruise is treated by resting the injured part of the body, applying cold during the first 24 hours to prevent hemorrhages and swelling, and using resorption and restorative therapy afterwards.

Immediately after the injury, cold is applied to the bruise in the form of chlorethyl irrigation or ice packs. Every 2-3 hours, the packs are removed for 30 minutes to avoid cold vascular paresis. A pressure bandage is applied, which is changed to a plaster cast if necessary in a medical facility. From the 2nd or 3rd day, UHF is prescribed to the site of the bruise, later (as the pain syndrome decreases), thermal procedures are used (ozokerite, baths, compresses, rubbing), electro- or phonophoresis with painkillers, anti-inflammatory, antihistamines and absorbable agents (procaine, antibiotics, diphenhydramine, sodium heparin), exercise therapy without forced and violent movements. In case of severe pain, procaine blockades are necessary, sodium metamizole is prescribed.

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Bruise: surgical treatment

If the bruise is accompanied by the formation of extensive hematomas and cavities when the skin is peeled off, it is punctured with a thick needle, the contents are removed, antibiotics in a procaine solution are administered, and pressure bandages are applied.

Hemarthrosis is also eliminated by joint puncture, after which plaster immobilization is mandatory. Contusion often ends with the development of contractures. In order to avoid their development, early functional treatment is used.

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Approximate period of incapacity

If a person has received a bruise, the time frame for treatment and recovery of working capacity is determined individually. Most often, they range from 3 days to 4 weeks.

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