Exam

Contusion

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Contusion, Bruise, Soft Tissue Hematoma, Subcutaneous Hematoma, Subepidermal Hemorrhage, Bruising

  • See Also
  1. Subcutaneous Hematoma Drainage
  2. Musculoskeletal Injury
  3. Purpura
  4. Bleeding Disorder
  5. Contusion
  6. Vascular Skin Reaction
  • Pathophysiology
  1. Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue
  • Risk Factors
  1. Bleeding Disorder
  2. Connective Tissue Disorder (e.g. Ehlers-Danlos Syndrome)
  3. Systemic Corticosteroids
  4. Cushing's Disease
  • Exam
  1. Does not blanch on pressure
    1. Contrast with a Vascular Skin Reaction (Erythema Multiforme, Urticaria) which does blanch
    2. Compare with Purpura or Ecchymosis which like a Contusion does not blanch
  2. Color (unreliable as an indicator of injury timing)
    1. Days 0-2: Swelling and tenderness
    2. Days 2-5: Red, blue or purple coloration
    3. Days 5-7: Greenish hue
    4. Days 7-10: Yellow appearance
    5. Days 10-14: Brown discoloration
    6. Days 14-32: Clear appearance
  3. Evaluate associated injuries
    1. Include examination of joint above and below the involved joint
    2. Include sensory, motor and vascular exam
    3. Include skin and compartment exam
    4. Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas
  • Differential Diagnosis
  1. Purpura or Ecchymosis
    1. Non-Traumatic lesions that also do not blanch on pressure
  • Precautions
  1. Always evaluate for more significant underlying injury
    1. Fracture
    2. Vascular compromise
    3. Neurologic deficit
    4. Compartment Syndrome
    5. Tendon rupture
    6. Ligament tear with joint instability
  2. Unexplained Bruising may be a sign of Child Abuse, Domestic Abuse or Elder Abuse
    1. Consider in Bruising outside of bony prominences (e.g. lateral arms, face, back)
  • Management
  1. RICE-M
  2. Subcutaneous Hematoma Drainage
  • Complications
  1. Associated more significant injury (see precautions above)
  2. Compartment Syndrome
  3. Myositis Ossificans
    1. Ossification or calcification of Muscle hematoma
  4. Local pressure tissue necrosis
  5. Decreased functional mobility (esp. elderly)
  6. Infection