|  | Conditions & Treatments | Neurological Disorders

Contusion (Bruise): Causes, Symptoms, Treatment, and When to Seek Care

What Is a Contusion?

A contusion (bruise) is a closed soft tissue injury caused by blunt trauma that damages capillaries and small vessels, allowing blood to extravasate into surrounding tissues (skin, subcutaneous fat, muscle) without breaking the skin.

Pathophysiology

  1. Impact causes mechanical disruption of microvasculature.
  2. Blood leaks into the interstitial space.
  3. Inflammatory response: macrophages phagocytose red blood cells, breaking down hemoglobin.
  4. Color evolution: Red/purple (oxy/deoxyhemoglobin) → Blue/black → Green (biliverdin) → Yellow/brown (bilirubin) → resolution.

Symptoms

  • Pain and tenderness at the site
  • Swelling (edema plus blood)
  • Color changes over days (as above)
  • Warmth (from inflammation)
  • Limited range of motion if over a joint or muscle belly

Severity Grading

GradeDescription
I (Mild)Minimal pain/swelling, no functional loss
II (Moderate)Moderate pain/swelling, some functional limitation
III (Severe)Severe pain, significant swelling, hematoma, loss of function; possible deep muscle or periosteal involvement

Treatment (RICE/POLICE)

  • Protection/Optimal Loading: Avoid re-injury; gentle movement as tolerated.
  • Ice: 15–20 minutes every 2–3 hours for 48 hours (constricts vessels, reduces bleeding and swelling).
  • Compression: Elastic bandage (not too tight).
  • Elevation: Above heart level.
  • Analgesia: Acetaminophen preferred; avoid NSAIDs for the first 24–48 hours (may increase bleeding).
  • Topical: Arnica (limited evidence), heparin gel (may speed resolution).

When to Seek Medical Care

  • Very large or expanding hematoma (possible arterial bleed)
  • Severe pain disproportionate to the injury
  • Inability to move a joint or bear weight
  • Numbness or tingling (nerve compression)
  • Signs of infection (increasing redness, warmth, pus, fever)
  • Bruising without trauma (possible coagulopathy, leukemia, or abuse)
  • On anticoagulants or antiplatelets with significant trauma
  • Head injury with bruising behind ears (Battle's sign) or periorbital (raccoon eyes)—suggests skull base fracture

Healing Timeline

  • 2–4 weeks for resolution; deeper muscle contusions take longer.
  • Myositis ossificans (heterotopic ossification) is a rare complication of severe quadriceps contusion.

Neurological Disorders - Related Articles