Definition and Characteristics of Bruises
- A bruise, also known as a contusion or ecchymosis, is a discoloration of the skin caused by bleeding underneath due to damaged blood vessels.
- Most bruises occur close enough to the epidermis to cause visible discoloration.
- Bruises can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.
- Bruises should not be confused with other similar-looking lesions such as petechia or purpura.
- Bruises often induce pain immediately after the trauma, but small bruises are not normally dangerous alone.
- Bruises can be serious when associated with fractures or more severe internal bleeding.
- The severity and appearance of bruises depend on factors such as type and healthiness of affected tissues.
- Minor bruises may have a characteristic blue or purple appearance in the days following the injury.
- Bruises can vary in size and shape depending on the instrument of injury and additional factors.
- Bruises often become more prominent over time, resulting in additional size and swelling.
- The area bruised is larger in soft tissues compared to firmer tissue.
- Bruising is more common in females due to increased subcutaneous fat.
- Bruises can be scored on a scale from 0-5 to categorize their severity and danger.
- The harm score depends on the extent and severity of injuries to organs and tissues causing the bruising.
- Factors such as contracted muscles, tissues crushed against underlying bone, and capillary strength affect the severity of bruises.
Causes and Risk Factors of Bruises
- Bruises can be caused by a wide variety of situations, including accidents, falls, and surgeries.
- Coagulopathies and certain medications can cause the formation of bruises.
- Presence of bruises may indicate platelet or coagulation disorders, anticoagulant treatment, or serious medical problems.
- Unexplained bruising can be a warning sign of child abuse, domestic abuse, internal bleeding, or certain types of cancer.
- Long-term glucocorticoid therapy and connective tissue disorders can also cause easy bruising.
- Certain medical conditions, like blood clotting disorders or Ehlers-Danlos Syndrome, can make individuals more prone to bruising.
- Medications like betamethasone can also increase the risk of bruising.
- People with red hair may have a slightly higher rate of bruising, but their coagulation tests are usually normal.
Mechanism and Treatment of Bruises
- Increased distress to tissue causes capillaries to break under the skin, allowing blood to escape and build up.
- Blood seeps into the surrounding tissues, causing the bruise to darken and spread.
- Nerve endings within the affected tissue detect the increased pressure, which may be perceived as pain or pressure.
- The damaged capillary endothelium releases endothelin, a hormone that causes narrowing of the blood vessel to minimize bleeding.
- Coagulation is initiated, creating a temporary clot to plug the wound and eventually leading to restoration of normal tissue.
- Treatment for light bruises may include RICE (rest, ice, compression, and elevation) and painkillers.
- Immediate application of ice while elevating the area may reduce or prevent swelling.
- Light stretching exercises may be recommended during recovery.
- Gentle massaging and heat application may encourage blood flow and relieve pain.
- Techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped.
Symptoms, Diagnosis, and Classification of Bruises
- Symptoms of a bruise include pain, tenderness, and a visible discoloration of the skin.
- Bruises usually go through distinct color changes as they heal, starting with red, then turning purple or blue, and finally fading to yellow or green.
- A doctor can diagnose a bruise through a physical examination and by asking about the circumstances that led to the injury.
- In some cases, additional tests may be performed to rule out underlying medical conditions or to assess blood clotting function.
- Classification of bruises is done using the ICD-10 codes S00-S90 and T14.0.
Prevention and Additional Resources on Bruises
- Taking precautions to prevent falls or accidents can help reduce the risk of bruises.
- Wearing protective gear, such as helmets or knee pads, during sports or physical activities can minimize the impact of injuries.
- Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can contribute to overall skin health and resilience.
- Managing underlying medical conditions, such as blood clotting disorders, can also help prevent excessive bruising.
- Avoiding medications or substances that increase the risk of bruising, unless prescribed by a healthcare professional, is advisable.
- The Medical Encyclopedia provides information on bruise healing.
- WebMD offers articles on bruises, including their causes and treatment.
- Merriam-Webster's Collegiate Dictionary defines ecchymosis, another term for a bruise.
- The GeneReviews® website provides comprehensive information on vascular Ehlers-Danlos Syndrome, a condition associated with increased bruising.
- Wiktionary, the free dictionary, has entries on bruise, contusion, and ecchymosis.
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.
| Bruise | |
|---|---|
| Other names | Contusion, ecchymosis |
 | |
| Bruise on upper leg caused by a blunt object | |
| Specialty | Emergency medicine |
| Treatment | RICE (rest, ice, compression, and elevation) |
Bruises are not to be confused with other similar-looking lesions. Such lesions include (1) petechia (less than 3 mm (0.12 in), resulting from numerous and diverse etiologies such as adverse reactions from medications such as warfarin, straining, asphyxiation, platelet disorders and diseases such as cytomegalovirus); and (2) purpura (3–10 mm (0.12–0.39 in)), classified as palpable purpura or non-palpable purpura and indicating various pathologic conditions such as thrombocytopenia. Additionally, (3) although many terminology schemas treat an ecchymosis (plural, ecchymoses) (size, more than 1 cm (0.39 in)) as synonymous with a bruise, in some other schemas, an ecchymosis is differentiated by its remoteness from the source and cause of bleeding, with blood dissecting through tissue planes and settling in an area remote from the site of trauma or even nontraumatic pathology, such as in periorbital ecchymosis ("raccoon eyes"), arising from a basilar skull fracture or from a neuroblastoma.
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 blunt trauma, which causes damage through physical compression and deceleration forces. Trauma sufficient to cause bruising can occur from a wide variety of situations including accidents, falls, and surgeries. Disease states such as insufficient or malfunctioning platelets, other coagulation deficiencies, or vascular disorders, such as venous blockage associated with severe allergies can lead to the formation of purpura which is not to be confused with trauma-related bruising/contusion. If the trauma is sufficient to break the skin and allow blood to escape the interstitial tissues, the injury is not a bruise but bleeding, a different variety of hemorrhage. Such injuries may be accompanied by bruising elsewhere.
