Bruise

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
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Bruise
Synonyms	Contusion, ecchymosis
Pronounce	N/A
Specialty	N/A
Symptoms	Skin discoloration, pain, swelling
Complications	Hematoma, compartment syndrome
Onset	Sudden
Duration	Days to weeks
Types	N/A
Causes	Trauma, blunt force
Risks	Coagulopathy, anticoagulant use
Diagnosis	Physical examination, medical history
Differential diagnosis	Fracture, hematoma, deep vein thrombosis
Prevention	Protective gear, fall prevention
Treatment	RICE, pain management
Medication	N/A
Prognosis	Generally good
Frequency	Very common
Deaths	N/A

Severe bruise

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Bruise (also known as a contusion) is a common type of soft tissue injury resulting from blunt trauma. It occurs when small blood vessels (capillaries) are damaged, leading to blood leakage into the surrounding tissues. Bruises can appear on the skin, muscles, bones, or internal organs, with varying degrees of severity.

Pathophysiology

A bruise occurs due to:

• Blunt trauma causing damage to the capillaries beneath the skin or tissue.
• Extravasation of blood from damaged capillaries into interstitial spaces.
• Inflammatory response involving immune cells that clear the leaked blood over time.

Causes

Bruises can result from various factors, including:

• Trauma – Accidental falls, sports injuries, motor vehicle accidents.
• Medical conditions – Hemophilia, von Willebrand disease, leukemia, and thrombocytopenia.
• Medications – Blood thinners such as aspirin, warfarin, heparin, and corticosteroids.
• Nutritional deficiencies – Vitamin C (scurvy) and Vitamin K deficiency can lead to increased bruising.
• Age-related factors – Older adults have thinner skin and more fragile capillaries, leading to easier bruising.

Clinical Presentation

Bruises typically progress through the following color changes due to hemoglobin breakdown:

• Red/Purple (0-2 days) – Fresh extravasated blood rich in oxygenated hemoglobin.
• Blue/Purple (2-5 days) – Breakdown of hemoglobin to deoxygenated forms.
• Green (5-7 days) – Conversion of hemoglobin to biliverdin.
• Yellow/Brown (7-14 days) – Final breakdown to bilirubin, before reabsorption.

Bruises may also present with:

• Swelling – Due to localized inflammation.
• Tenderness – Pain around the affected area.
• Skin discoloration – Depending on depth and severity.
• Limited movement – If the bruise affects muscles or joints.

Types of Bruises

Bruises are classified based on location and severity:

• Subcutaneous bruise – Located under the skin, often superficial.
• Intramuscular bruise – Deeper, affecting muscle tissue.
• Periosteal bruise – Affects the outer layer of bones, causing prolonged pain.
• Hematoma – More severe form with significant blood accumulation, often forming a lump.

Diagnosis

Diagnosis is primarily clinical, based on history and physical examination. Additional tests may be required in unexplained or frequent bruising:

• Complete Blood Count (CBC) – To evaluate for thrombocytopenia or leukemia.
• Coagulation tests – Prothrombin time (PT), Activated Partial Thromboplastin Time (aPTT), International Normalized Ratio (INR), and Factor assays to assess clotting function.
• Imaging (Ultrasound or MRI) – In cases of deep tissue or periosteal bruises.

Management

Most bruises resolve spontaneously. However, management can include:

• Immediate Care (R.I.C.E. protocol):
• Rest – Avoid further trauma.
• Ice – Apply cold compresses (15-20 min every 2-3 hours) to reduce swelling.
• Compression – Use elastic bandages if swelling is present.
• Elevation – Keep the affected area elevated to minimize blood pooling.
• Pain management:
• NSAIDs (e.g., ibuprofen, naproxen) – Reduce inflammation and pain.
• Acetaminophen (Paracetamol) – Alternative pain reliever, avoiding anticoagulant effects.
• Topical treatments:
• Arnica gel – Herbal remedy believed to reduce inflammation.
• Vitamin K cream – May help with faster resolution in some cases.
• Medical intervention:
• If an underlying bleeding disorder is suspected, hematologic evaluation is necessary.
• Large hematomas may require needle aspiration or surgical drainage.

Complications

Although most bruises heal without complications, severe cases can lead to:

• Compartment syndrome – Increased pressure within a muscle compartment causing ischemia.
• Myositis ossificans – Abnormal calcification of muscle after repeated trauma.
• Deep vein thrombosis (DVT) – In rare cases of significant vascular injury.
• Persistent ecchymosis – May indicate an underlying systemic disorder.

Prevention

Preventive measures include:

• Avoiding trauma – Wearing protective gear in sports and using safety precautions.
• Optimizing nutrition – Ensuring adequate intake of Vitamin C, Vitamin K, and Iron.
• Managing medications – Monitoring anticoagulant use under medical supervision.
• Regular medical check-ups – Especially for individuals with frequent unexplained bruising.

When to Seek Medical Attention

Seek medical care if:

• Bruising occurs spontaneously without trauma.
• Excessive or frequent bruising is noticed.
• Bruises do not heal within 2 weeks.
• Pain and swelling worsen over time.
• Signs of systemic bleeding (nosebleeds, gum bleeding, blood in urine/stool) appear.

Related Conditions

• Ecchymosis – Larger bruises covering a broader area.
• Petechiae – Small pinpoint hemorrhages in the skin.
• Hematoma – Localized blood accumulation forming a palpable lump.
• Purpura – Widespread bruising associated with bleeding disorders.
• Hemophilia – Genetic clotting disorder leading to excessive bruising.