Joint, Ligament and Muscle Disorders

Contusions or Bruises

Description

Muscle contusions, or bruises, are second only to strains as a leading cause of sports injuries. Most contusions are minor and heal quickly, without requiring the athlete to be removed from the game. However, severe contusions can cause deep tissue damage, which may lead to complications and/or keep the athlete out of sports for months.

Symptoms

Contusions cause swelling and pain, and limit joint range of motion near the injury. The injured muscle may feel weak and stiff, and torn blood vessels may cause bluish discoloration. A lump that forms over the injury (hematoma) indicates that a pool of blood has collected within the damage tissue. In severe cases, swelling and bleeding beneath the skin may cause shock. Extensive tissue damage may also occur along with a fractured bone, dislocated joint, sprain, torn muscle, or other injuries. Contusions to the abdomen may damage internal organs.

Causes

When a part of the body is struck by enough force to crush underlying muscle fibers and connective tissue without breaking the skin, a contusion may occur. A fall, jamming the body against a hard surface, a direct blow, or repeated blows from a blunt object are among the many common causes of contusions.

Diagnosis

A physical examination, and when needed, diagnostic imaging tools, such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans, will allow your physician to determine the extent of your injury and check for related nerve damage.

Nonsurgical Treatment

Most athletes with contusions get better quickly without surgery. Your doctor may give you nonsteroidal anti-inflammatory drugs (NSAIDs) or other medications for pain relief. Do not massage the injured area.

During the first 24 to 48 hours after injury (acute phase), keep the muscle in a gentle stretch position and use the RICE formula (rest, ice, compression and elevation) to help control pain, bleeding, swelling and inflammation. If there is a large hematoma that does not go away within several days, your doctor may consider draining it surgically to speed healing.

• Rest—Protect the injured area from further harm by stopping the activity. Use of a protective device, such as crutches or a sling, will relieve stress on the injured area.
• Ice—Apply ice wrapped in a clean cloth directly to the injured area for 15 to 20 minutes at a time, waiting at least one hour between icing sessions. Chemical cold products ("blue" ice) should not be placed directly on the skin and are not as effective.
• Compression—Lightly wrap the injured area in an Ace elastic bandage or other soft material.
• Elevation—Raise the injured area to a level above your heart to minimize swelling.

Rehabilitation

After a few days, inflammation should start to go down and the injury may feel a little better. At this time, the doctor may tell you to apply gentle heat to the injury and start the rehabilitation process. Remember to increase your activity level gradually. As the injury heals, exercising the uninjured parts of your body will help maintain your overall level of fitness. Depending upon the extent of your injuries, returning to your normal sports activity may take several weeks or longer. If you put too much stress on the injured area before it has sufficiently healed, excessive scar tissue may develop and cause more problems. In the first phase of rehabilitation, your doctor may prescribe gentle stretching exercises that begin to restore range of motion to the injured area. When your range of motion has improved, you may be given weight-bearing and strengthening exercises. Once you have normal, pain-free range of motion, you may be allowed to participate in noncontact sports.

Recovery

When you have returned to full strength, motion and endurance, you may be allowed to resume contact sports. Your physician may want you to wear a customized protective device to prevent further injury to the afflicted area. Depending on your sport, you may also need special padding to spread out the force of impact from any direct blows to the body.

Complications

Prompt medical treatment and following your doctor's advice regarding rehabilitation can help you avoid serious medical complications, such as compartment syndrome and myositis ossificans, that occasionally result from deep muscle contusions.

• Compartment syndrome—In certain cases, rapid bleeding may cause extremely painful swelling within the muscle group of your arm, leg, foot, or buttock. Build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group. Surgery may be required to drain these excess fluids and relieve pressure. Compartment syndrome is an emergency and must be addressed quickly to prevent permanent damge to the affected limb.
• Myositis ossificans—Sometimes a severe contusion can develop into a condition in which the bruised muscle grows bone instead of new muscle cells. Symptoms may include swelling, mild to severe pain that does not go away, and abnormal bone formations that reduce flexibility. Use of the RICE formula helps to reduce inflammation, and while vigorous stretching may worsen the condition, gentle stretching exercises can improve flexibility. Surgery is rarely required.