Exam
Contusion
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Contusion
, Bruise, Soft Tissue Hematoma, Subcutaneous Hematoma, Subepidermal Hemorrhage, Bruising
See Also
Subcutaneous Hematoma Drainage
Musculoskeletal Injury
Purpura
Bleeding Disorder
Contusion
Vascular Skin Reaction
Pathophysiology
Blunt injury disrupts soft tissue (skin,
Muscle
) capillaries and venules, resulting in
Hemorrhage
into local interstitial tissue
Risk Factors
Bleeding Disorder
Connective Tissue Disorder
(e.g.
Ehlers-Danlos Syndrome
)
Systemic Corticosteroid
s
Cushing's Disease
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
Differential Diagnosis
Purpura
or
Ecchymosis
Non-
Trauma
tic lesions that also do not blanch on pressure
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)
Management
RICE-M
Subcutaneous Hematoma Drainage
Complications
Associated more significant injury (see precautions above)
Compartment Syndrome
Myositis Ossificans
Ossification or calcification of
Muscle
hematoma
Local pressure tissue necrosis
Decreased functional mobility (esp. elderly)
Infection
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