II. Pathophysiology
- Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue
III. Risk Factors
IV. Exam
- Does not blanch on pressure
- Contrast with a Vascular Skin Reaction (Erythema Multiforme, Urticaria) which does blanch
- Compare with Purpura or Ecchymosis which like a Contusion does not blanch
- Color (unreliable as an indicator of injury timing)
- Days 0-2: Swelling and tenderness
- Days 2-5: Red, blue or purple coloration
- Days 5-7: Greenish hue
- Days 7-10: Yellow appearance
- Days 10-14: Brown discoloration
- Days 14-32: Clear appearance
- Evaluate associated injuries
- Include examination of joint above and below the involved joint
- Include sensory, motor and vascular exam
- Include skin and compartment exam
- Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas
V. Differential Diagnosis
-
Purpura or Ecchymosis
- Non-Traumatic lesions that also do not blanch on pressure
VI. Precautions
- Always evaluate for more significant underlying injury
- Fracture
- Vascular compromise
- Neurologic deficit
- Compartment Syndrome
- Tendon rupture
- Ligament tear with joint instability
- Unexplained Bruising may be a sign of Child Abuse, Domestic Abuse or Elder Abuse
- Consider in Bruising outside of bony prominences (e.g. lateral arms, face, back)
VII. Management
VIII. Complications
- Associated more significant injury (see precautions above)
- Compartment Syndrome
-
Myositis Ossificans
- Ossification or calcification of muscle Hematoma
- Morel-Lavallee Lesion
- Local pressure tissue necrosis
- Decreased functional mobility (esp. elderly)
- Infection
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Related Studies
Definition (MEDLINEPLUS) |
A bruise is a mark on your skin caused by blood trapped under the surface. It happens when an injury crushes small blood vessels but does not break the skin. Those vessels break open and leak blood under the skin. Bruises are often painful and swollen. You can get skin, muscle and bone bruises. Bone bruises are the most serious. It can take months for a bruise to fade, but most last about two weeks. They start off a reddish color, and then turn bluish-purple and greenish-yellow before returning to normal. To reduce bruising, ice the injured area and elevate it above your heart. See your healthcare provider if you seem to bruise for no reason, or if the bruise appears to be infected. |
Definition (NCI) | A bruise due to trauma.(NICHD) |
Definition (NCI_CTCAE) | A finding of injury of the soft tissues or bone characterized by leakage of blood into surrounding tissues. |
Definition (NCI_FDA) | A bruise; an injury of a part without a break in the skin. |
Definition (NCI) | Injury of the soft tissues or bone without breaking the skin that is characterized by blood leakage into the surrounding area. |
Definition (MSH) | Injuries resulting in hemorrhage, usually manifested in the skin. |
Definition (CSP) | mechanical injury (usually caused by a blow) resulting in hemorrhage beneath unbroken skin; a bruise. |
Concepts | Injury or Poisoning (T037) |
MSH | D003288 |
ICD9 | 924.9 |
ICD10 | T14.8 |
SnomedCT | 269380009, 360235001, 271938003, 157539008, 37808005, 157440008, 269363005, 125667009, 308492005, 77643000 |
LNC | LA7423-2 |
English | Bruise, Contusion of unspecified site, Bruise NOS, bruising, contusion (physical finding), contusion, Contusion NOS, Contusions [Disease/Finding], contused wound, contusions, bruised, bruise, contus, bruises, contused, Bruises, Bruise NOS (disorder), Bruise (contusion) - lesion, Bruise (contusion) - lesion (qualifier value), Contusion (morphologic abnormality), Bruise (finding), Contused wound, BRUISE, CONTUSION, Contusion, Bruising, Bruise - lesion, Contusion - lesion, Contusion (disorder), Contusion - lesion (morphologic abnormality), Contusion, NOS, Bruise - lesion (morphologic abnormality), Contusions |
Portuguese | EQUIMOSE, Contusão de ponto NE, Machucadura, Ferida contundida, Contusão, Contusões, Machucado |
Dutch | kneuzing op niet-gespecificeerde plaats, blauwe plek, gekneusde wond, kneuzing, Contusie, Contusies, Kneuzing |
French | Contusion d'un site non précisé, Bleu, Bleus, ECCHYMOSES, Meurtrissures, Plaie contuse, Contusion, Contusions |
German | Prellung an unspezifischer Stelle, blauer Fleck, blaue Flecken, QUETSCHUNG, Kontusion, Kontusionen, Prellungen, Quetschwunde |
Italian | Contusione di sede non specificata, Contusione, Ferita contusa, Contusioni |
Spanish | Cardenales, Contusión de localización no especificada, Cardenal, CARDENAL, magulladura, moretón, SAI (trastorno), Bruise NOS, cardenal, moretón (hallazgo), contusión (anomalía morfológica), moretón, lesión traumática contusa, moretón, SAI, contusión - lesión traumática, contusión - lesión traumática (calificador), cardenal, SAI, Herida contusa, contusión (trastorno), contusión - lesión (anomalía morfológica), contusión - lesión, contusión, Contusión, Contusiones, Magulladura |
Japanese | 部位不明の挫傷, ザショウ, ブイフメイノザショウ, 挫傷, ザソウ, ざ傷, 打撲, 打撲傷, 挫創 |
Swedish | Blåmärken |
Czech | zhmoždění, Kontuze, Zhmožděnina, Zhmoždění, Kontuze blíže neurčeného místa, vulnus contusum, zhmožděná rána, Zhmožděná rána |
Finnish | Kontuusiot |
Russian | SINIAKI, USHIBY, KROVOPODTEKI, КРОВОПОДТЕКИ, СИНЯКИ, УШИБЫ |
Croatian | KONTUZIJE |
Polish | Zbicie, Stłuczenie |
Hungarian | Véraláfutás, Contusio, Nem meghatározott lokalizációjú zúzódás, Zúzott seb |
Norwegian | Blåmerker, Kontusjoner, Blodutredelser |
Ontology: Hematoma (C0018944)
Definition (NCI) | A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. |
Definition (NCI_NCI-GLOSS) | A pool of clotted or partially clotted blood in an organ, tissue, or body space, usually caused by a broken blood vessel. |
Definition (NCI_FDA) | A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. |
Definition (NCI_CDISC) | A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. |
Definition (NCI_CTCAE) | A disorder characterized by a localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. |
Definition (MSH) | A collection of blood outside the BLOOD VESSELS. Hematoma can be localized in an organ, space, or tissue. |
Concepts | Pathologic Function (T046) |
MSH | D006406 |
SnomedCT | 211530002, 35566002, 385494008 |
LNC | LA7439-8 |
French | HEMATOME, Hématome SAI, Hématome |
English | HAEMATOMA, Haematoma NOS, Hematoma NOS, Hematoma, hematoma (physical finding), hematoma, Hematomas, Hematoma [Disease/Finding], haematoma, haematomas, hematomas, HEMATOMA, Haematoma, Hematoma (disorder), Hematoma (morphologic abnormality), Haematoma, NOS, Hematoma, NOS |
Portuguese | HEMATOMA, Hematoma NE, Hematoma |
Spanish | HEMATOMA, Hematoma NEOM, hematoma (anomalía morfológica), hematoma (trastorno), hematoma, Hematoma |
German | HAEMATOM, Haematom NNB, Haematom, Bluterguß, Hämatom |
Dutch | hematoom NAO, hematoom, Bloedbuil, Bloeduitstorting, Haematoma, Hematoom |
Italian | Ematoma NAS, Ematoma |
Japanese | 血腫, 血腫NOS, ケッシュNOS, ケッシュ |
Swedish | Hematom |
Czech | hematom, Hematom, Hematom NOS |
Finnish | Hematooma |
Russian | GEMATOMA, ГЕМАТОМА |
Croatian | HEMATOM |
Polish | Krwiak |
Hungarian | Haematoma, Vérömleny k.m.n., Haematoma k.m.n. |
Norwegian | Blodoppfylling i vev, Hematom |
Ontology: Subcutaneous hematoma (C0520532)
Concepts | Acquired Abnormality (T020) |
SnomedCT | 5309003 |
Italian | Ematoma sottocutaneo |
Japanese | 皮下血腫, ヒカケッシュ |
English | SUBCUTANEOUS HAEMATOMA, SUBCUTANEOUS HEMATOMA, subcutaneous hematoma, hematoma subcutaneous, Subcutaneous haematoma, Subcutaneous hematoma, Subcutaneous hematoma (disorder) |
Portuguese | HEMATOMA SUBCUTANEO, Hematoma subcutâneo |
French | HEMATOME SOUS-CUTANE, Hématome sous-cutané |
Czech | Podkožní hematom |
Hungarian | Subcutan haematoma |
Spanish | hematoma subcutáneo (trastorno), hematoma subcutáneo, Hematoma subcutáneo |
Dutch | subcutaan hematoom |
German | subkutanes Haematom |
Ontology: Haemorrhage subepidermal (C0854108)
Concepts | Disease or Syndrome (T047) |
Italian | Emorragia subepidermica, Sanguinamento subepidermico |
Dutch | bloeding subepidermaal, subepidermale bloeding |
German | Blutung, subepidermal, Subepidermale Blutung, Blutung subepidermal |
Spanish | Hemorragia subepidermal, Sangrado subepidérmico, Hemorragia subepidérmica |
Japanese | 表皮下出血, ヒョウヒカシュッケツ |
Czech | Subepidermální hemoragie, Subepidermální krvácení |
English | Haemorrhage subepidermal, Hemorrhage subepidermal, Subepidermal bleeding |
Hungarian | Subepidermalis vérzés, Subepidermalis haemorrhagia |
French | Saignement sous-épidermique, Hémorragie sous-épidermique |
Portuguese | Sangramento subepidérmico, Hemorragia subepidérmica |