Bruise
Bruise | |
---|---|
Other names | Contusion, ecchymosis[1][2] |
Bruise on upper leg caused by a blunt object | |
Specialty | Emergency medicine |
Treatment | RICE (rest, ice, compression, and elevation) |
A bruise, also known as a contusion, is a type of
Bruises are not to be confused with other similar-looking
As a type of hematoma, a bruise is always caused by internal bleeding into the interstitial tissues which does not break through the skin, usually initiated by
Signs and symptoms
Bruises often induce pain immediately after the trauma that results in their formation, but small bruises are not normally dangerous alone. Sometimes bruises can be serious, leading to other more life-threatening forms of hematoma, such as when associated with serious injuries, including
Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimetres in size or larger, and are therefore larger than petechiae (less than 3 millimetres in diameter)[12] or purpura (3 to 10 millimetres in diameter).[13] Ecchymoses also have a more diffuse border than other purpura.[14] A broader definition of ecchymosis is the escape of blood into the tissues from ruptured blood vessels.[15][16] The term also applies to the subcutaneous discoloration resulting from seepage of blood within the injured tissue.
Bruise colors vary from red, blue, or almost black, depending on the severity of broken capillaries or blood vessels within the bruise site. Broken venules or arterioles often result in a deep blue or dark red bruise, respectively. Darker colored bruises may result from a more severe bleeding from both blood vessels. Older bruises may appear yellow, green or brown.[11][17]
Cause
There are many causes of subcutaneous hematomas including ecchymoses.
The presence of bruises may be seen in patients with
During an
Size and shape
Bruise shapes may correspond directly to the instrument of injury or be modified by additional factors. Bruises often become more prominent as time lapses, resulting in additional size and swelling, and may grow to a large size over the course of the hours after the injury that caused the bruise was inflicted.
- Condition and type of tissue: In soft tissues, a larger area is bruised than would be in firmer tissue due to ease of blood to invade tissue.
- Age: elderly skin and other tissues are often thinner and less elastic and thus more prone to bruising.
- Gender: More bruising occurs in females due to increased subcutaneous fat.
- Skin tone: Discoloration caused by bruises is more prominent in lighter complexions.
- Diseases: Coagulation, platelet and blood vessel diseases or deficiencies can increase bruising due to more bleeding.
- Location: More extensive vascularity causes more bleeding. Areas such as the arms, knees, shins and the facial area are especially common bruise sites.
- Forces: Greater striking forces cause greater bruising.
- Genes: Despite having completely normal coagulation factors, natural redheads have been shown to bruise more, although this may just be due to greater visibility on commonly associated lighter complexion.[21]
Severity
Bruises can be scored on a scale from 0–5 to categorize the severity and danger of the injury.
Harm score | Severity level | Notes |
---|---|---|
0 | Light bruise | No damage |
1 | Mild bruise | Little damage |
2 | Moderate bruise | Some damage |
3 | Serious bruise | Dangerous |
4 | Extremely serious bruise | Very dangerous |
5 | Critical bruise | Risk of death |
The harm score is determined by the extent and severity of the injuries to the organs and tissues causing the bruising, in turn depending on multiple factors. For example, a contracted muscle will bruise more severely, as will tissues crushed against underlying bone. Capillaries vary in strength, stiffness and toughness, which can also vary by age and medical conditions.
Low levels of damaging forces produce small bruises and generally cause the individual to feel minor pain straight away. Repeated impacts worsen bruises, increasing the harm level. Normally, light bruises heal nearly completely within two weeks, although duration is affected by variation in severity and individual healing processes;[22] generally, more severe or deeper bruises take somewhat longer.
Severe bruising (harm score 2–3) may be dangerous or cause serious complications. Further bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma. This has the potential to cause
Damage that causes bruising can also cause bones to be broken, tendons or muscles to be strained, ligaments to be sprained, or other tissue to be damaged. The symptoms and signs of these injuries may initially appear to be those of simple bruising. Abdominal bruising or severe injuries that cause difficulty in moving a limb or the feeling of liquid under the skin may indicate life-threatening injury and require the attention of a physician.
Mechanism
Increased distress to tissue causes
During this time, larger bruises may change color due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. The striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color.[11] As these products are cleared from the area, the bruise disappears. Often the underlying tissue damage has been repaired long before this process is complete.
Treatment
Treatment for light bruises is minimal and may include
Very gently massaging the area and applying heat may encourage blood flow and relieve pain according to the Gate control theory of pain, although causing additional pain may indicate the massage is exacerbating the injury.[23] As for most injuries, these techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped, because although increasing blood flow will allow more healing factors into the area and encourage drainage, if the injury is still bleeding this will allow more blood to seep out of the wound and cause the bruise to become worse.
In most cases hematomas spontaneously revert, but in cases of large hematomas or those localized in certain organs (e.g., the brain), the physician may perform a puncture of the hematoma to allow blood to exit.[citation needed]
History
Etymology and pronunciation
The word ecchymosis (
See also
- Blunt trauma
- Black eye
- Blister
- Burn
- Cerebral contusion – bruising of brain tissue
- Kissing contusion – contusions of both surfaces of the knee joint
- Love-bite – bruising created by excessive suctionof a particular area of skin, associated with an individual kissing or sucking the affected area beforehand
- Myocardial contusion – bruising of the heartmuscle
- Pulmonary contusion – bruising of lung tissue
- toenail
- Subconjunctival hemorrhage
- Welts
References
- ^ ISBN 978-81-8056-526-7.
- ISBN 978-0-7234-3793-2.
- ^ "contusion" at Dorland's Medical Dictionary
- ^ Harrison's Principles of Internal Medicine (17th ed.). McGraw-Hill Professional. 2008.
- ^ "Easy Bruising Symptoms".
- PMID 25661311.
- S2CID 43261698.
- S2CID 5921.
- ^ Turley, Lois (2004-03-10). "Shiners-dark circles & swollen eyes". Archived from the original on 2009-12-12. Retrieved 2009-10-08.
- ^ "UCSF Purpura Module" (PDF). Archived from the original (PDF) on 2013-10-02. Retrieved 2013-01-13.
- ^ a b c
Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 86 ISBN 978-1-4160-2973-1
- )
- )
- ^ "Case Based Pediatrics Chapter". Retrieved 2009-01-08.
- ^ Merriam-Webster Dictionary. http://www.merriam-webster.com/dictionary/ecchymosis; accessed 1/2/2012
- ^ Gould, George M. The Practitioner's Medical Dictionary, P. Blakiston's Son & Co., 1916 et seq.; p. 311
- ^ "WebMD article on bruises".
- PMID 18581014.
- ^ "betamethasone" (PDF). F.A. Davis. Archived from the original (PDF) on 2017-09-08. Retrieved 2020-02-11.
- ^ Byers PH. Vascular Ehlers-Danlos Syndrome. 1999 Sep 2 [Updated 2019 Feb 21]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2020. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK1494/
- PMID 16368849.
- ^ Voorhees, Benjamin W. (2007-08-31). "Medical Encyclopedia – Bruise healing". Retrieved 2007-09-09.
- ^ "WebMD article on bruise treatment".
- ^ Kotera-Fayer "Die Strigilis" 93
- ^ Merriam-Webster, Merriam-Webster's Collegiate Dictionary: "ecchymosis", Merriam-Webster.
External links
- What is a bruise? for kids
- Bruises in sports