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