Definition & Overview
If a blow to the skin breaks small blood vessels underneath the tissue, it results in a bruise, also called a “contusion.” Most bruises that result from a blow to the body aren’t serious enough to require medical attention, but some can be life threatening and thus require immediate medical attention.
A bruise is classified according to the layer of tissue it affects. A subcutaneous bruise affects the skin, otherwise known as the epidermis, dermis, and subcutaneous layers while an intramuscular bruise affects the underlying muscle. Meanwhile, a periosteal bruise affects the bone.
Bruises often appear red at the onset, but the color changes as the bruise heals. Within 24 hours, the bruise will turn purple. After a couple of days, it will turn bluish black. Between 5 to 10 days, the color will change to green and finally yellow before the bruise disappears completely.
It’s important to remember that a bruise may not necessarily reflect the severity of the trauma. In fact, deep bruises that are caused by severe trauma, such as in a vehicular accident, might only appear on the skin after a couple of days; sometimes not at all.
Cause of Condition
Most cases of bruise contusions are caused by blunt force trauma such as those obtained from playing active sports and physical activities. However, other cases are caused by underlying medical conditions. A good example is a bleeding and clotting disorder called purpura that results in marks that are similar to a bruise. Other conditions that may produce symptoms similar to a bruise are:
- Blood and tissue infections
- Other clotting disorders, such as hemophilia, thrombocytopenia, and von Willebrand’s disease
- Hodgkin’s Disease
- Multiple Myeloma
The primary symptoms of bruises that were caused by blunt force trauma are pain, swelling, and skin discoloration. In most cases, the symptoms will disappear as the bruise heals even without medical intervention. Meanwhile, extreme pain is usually felt if the condition has affected the bone or damaged an internal organ. Such cases are considered a medical emergency.
Bruises of unknown origins may or may not be accompanied by other symptoms, such as pain and swelling. Nevertheless, these types of bruises should be a concern because they are symptoms of an underlying medical disorder.
Who to See & Types of Treatment Available
Minor bruises do not typically require medical attention and can be treated with cold therapy (ice compress) and by taking over-the-counter pain medications. Elevating the bruised area above the heart is also helpful to prevent blood from pooling.
Meanwhile, immediate medical attention is required if:
- The bruises are accompanied by extreme pain and fever, which could be an indication that the bone was affected or fractured.
- There are red streaks near the bruise
- The patient also suffered a laceration. In which case, the wound must be treated immediately to prevent infections.
- The bruise occurs in the head and facial areas. Head injuries can be fatal and must be checked and monitored by a doctor even if the patient does not display any serious symptoms.
- The patient experiences disorientation, nausea, or vomiting following a bruise in the head.
The bruise has no apparent cause. Bruises that are not caused by blunt force trauma are usually a symptom of a more serious medical condition. These are diagnosed with CT-scan, MRI, ultrasound, and blood tests.
Brinker MR, O’Connor DP, Almekinders LC, et al. Physiology of injury to musculoskeletal structures: 1. Muscle and tendon injury. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa.: Elsevier Saunders; 2009:chap 1, section A.