Muscle Contusion (Bruise) – OrthoInfo

Athletes in contact sports have many opportunities to get a muscle contusion (bruise). Contusions are second only to strains as a leading cause of sports injuries.

Most contusions are minor and heal quickly, without taking the athlete away from the game. Severe contusions, however, can cause deep tissue damage and lead to complications that may prevent an athlete from being able to play sports for months.

Contusions occur when a direct blow or repeated blows by a blunt object strike part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface.

A contusion may result from a direct blow to a muscle when players collide during sports.
getty images/Nikada

Contusions cause swelling and pain and can limit joint range of motion near the injury. Torn blood vessels may cause bluish discoloration. The injured muscle may feel weak and stiff.

Sometimes a pool of blood collects within damaged tissue, forming a lump over the injury (hematoma). If tissue damage is extensive, you may also have a broken bone, dislocated joint, sprain, torn muscle, or other injuries.

Contusions to the abdomen may damage internal organs.

See your doctor right away for complete diagnosis. A physical examination will determine the exact location and extent of the injury.

Diagnostic imaging tools may be used to better visualize inside the injured area of your body. These tools include x-rays, ultrasound, magnetic resonance imaging (MRI) scans, or computerized tomography (CT) scans.

For some injuries, your doctor may also need to check for nerve injury.

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To control pain, bleeding, and inflammation, keep the muscle in a gentle stretch position and use the RICE protocol:

• Rest. Protect the injured area from further harm by stopping play. You may also use a protective device (i. e., crutches, sling).
• Ice.  Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on the skin.
• Compression. Lightly wrap the injured area in a soft bandage or ace wrap.
• Elevation. Raise the injured area to a level above the heart.

Most athletes with contusions get better quickly with simple treatment measures. Your doctor may give you nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or other medications for pain relief. Do not massage the injured area.

During the first 24 to 48 hours after injury (acute phase), you will probably need to continue using rest, ice, compression bandages, and elevation of the injured area to control bleeding, swelling, and pain. While the injured muscle heals, be sure to keep exercising the uninjured parts of your body to maintain your overall level of fitness.

If there is a large hematoma that does not go away within several days, your doctor may drain it surgically to expedite healing.

After a few days, inflammation and swelling should start to decrease and the injury may feel a little better. At this time, your doctor may tell you to apply gentle heat to the injury and start the rehabilitation process. Remember to increase your activity level gradually.

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 healed enough, 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.

Once your range of motion has improved, your doctor will likely recommend incorporating weightbearing and strengthening exercises.

When you have normal, pain-free range of motion, your doctor may let you return to non-contact sports.

You may be able to return to contact sports when you get back your full strength, motion, and endurance. When your doctor and athletic trainer agree that you are ready to return to play, they may want you to wear a customized protective device to prevent further injury to the area that had a contusion.

Depending upon your sport, you may get special padding made of firm or semi-firm materials. The padding spreads out the force of impact when direct blows from blunt objects strike your body.

Getting prompt medical treatment and following your doctor’s advice about rehabilitation can help you avoid serious medical complications that occasionally result from deep muscle contusions. Two of the more common complications are compartment syndrome and myositis ossificans.

Compartment Syndrome

In certain cases, rapid bleeding may cause extremely painful swelling within the muscles of your arm, leg, foot, or buttock. Build-up of pressure from fluids several hours after a contusion can disrupt blood flow and prevent nourishment from reaching the muscle group. Compartment syndrome may require urgent surgery to relieve the pressure on the muscles, blood vessels, and nerves.

Myositis Ossificans

Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop myositis ossificans. This is a condition in which bone forms in the injured muscle.

Symptoms may include mild to severe pain that does not go away and swelling at the site of the injury. Abnormal bone formation can also reduce your flexibility. Vigorous stretching exercises may make the condition worse.

Rest, ice, compression, and elevation to reduce inflammation will usually help. Gentle stretching exercises may improve flexibility. Surgery is rarely required.

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Symptoms, Tests, and Treatment of Muscle Strain

Written by WebMD Editorial Contributors

In this Article

• Muscle Strain Overview
• Muscle Strain Symptoms
• Grades and Severity of Muscle Strains
• When to Seek Medical Care
• Exams and Tests
• Muscle Strain Treatment Self-Care at Home
• Medical Treatment
• Next Steps Prevention
• Outlook

Muscle strain, muscle pull, or even a muscle tear means that there is damage to a muscle or the tendons attached to it. This type of injury can happen if you put too much pressure on muscles, whether you’re doing normal daily activities, lifting something heavy, working out, or playing a sport. It doesn’t only happen to athletes. 

Muscle damage can take different forms. You might have torn some or all of the muscle fibers and the tendons attached to that muscle. And when a muscle tears, it can damage small blood vessels, causing local bleeding, or bruising, and pain caused by irritation of the nerve endings in the area.

Symptoms of muscle strain include:

• Swelling, bruising, or redness due to the injury
• Pain at rest
• Pain when the specific muscle or the joint in relation to that muscle is used
• Weakness of the muscle or tendons
• Inability to use the muscle at all

While all muscle strains hurt, some are more severe than others. Here’s a quick look at the grades of muscle strains:

Grade 1 muscle strain: This is a mild strain with minimal impact on strength or motion.  

Grade 2 muscle strain: While this is more severe than a grade 1 muscle strain, the muscle hasn’t completely torn. Still, you’ll have lost strength and motion in that muscle and it may take 2-3 months to recover.

Grade 3 muscle strain: The muscle or tendon has completely torn. You might need surgery.

Call your doctor if you have a significant muscle injury (or if home remedies bring no relief in 24 hours).

Seek emergency treatment if you hear a “popping” sound with the injury, cannot walk, or there is significant swelling, pain, fever, or open cuts.

The doctor will ask you about what happened and about your medical history. They’ll also give you a physical exam.  They will check on whether the muscle is partially or completely torn, which can involve a much longer healing process, possible surgery, and a more complicated recovery.

You may not need X-rays or lab tests unless trauma was involved or there are signs of infection.

Apply ice packs to the area soon after the injury and keep the strained muscle in a stretched position. This will help manage the amount of swelling or local bleeding into the muscle (from torn blood vessels).You can use heat when the swelling has lessened. Using heat earlier than that can increase swelling and pain.

Never apply ice or heat to bare skin. Always use a protective covering such as a towel between the ice or heat and the skin.

Pain relievers. Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen to reduce pain and improve your ability to move around. Do not take NSAIDs if you have kidney disease or a history of gastrointestinal bleeding or if you are also taking a blood thinner (such as Coumadin ) without first talking with your doctor. In that case, it is safer to take acetaminophen, which helps lessen pain but does not reduce inflammation.

Protection, rest, ice, compression, and elevation (known as the PRICE formula) can help the affected muscle. Here’s how: 

• Remove all constrictive clothing and jewelry in the area of the muscle strain. 
• Protect the strained muscle from further injury.
• Rest the strained muscle. Avoid the activities that caused the strain and other activities that are painful.
• Ice the muscle area (20 minutes every hour while awake). Ice is a very effective anti-inflammatory and pain reliever. Small ice packs, such as packages of frozen vegetables or water frozen in foam coffee cups, applied to the area may help decrease inflammation.
• Compression can be gently applied with an elastic bandage, which can both provide support and decrease swelling. Do not wrap tightly.
• Elevate the injured area to lessen swelling. Prop up a strained leg muscle while sitting, for example.
• Activities that increase muscle pain or work the affected body part are not recommended until the pain has eased up.

Assuming that you don’t have a severe muscle injury that needs surgery, medical treatment is similar to the treatment at home. But a doctor can give you valuable advice, such as:

• Tell you the extent of muscle and tendon injury
• Let you know if you need crutches or a brace to help healing
• Whether you need to restrict your activity or take days off work
• Determine whether rehabilitation exercises or physical therapy are needed to help you recover and prevent reinjury.

• Help avoid injury by stretching daily.
• Start an exercise program in consultation with your doctor.
• Stretch after you exercise.
• Establish a warm-up routine prior to strenuous exercise, such as gently running in place for a couple of minutes.

In most cases, with proper treatment, most people recover completely from muscle strain. More complicated cases should be handled by a doctor.

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Sprains and Muscles – ASmedtrade

Sprains and Muscles of the Lower Extremities

A sprain occurs when a joint is bent too hard or straightened out. This usually happens with sudden movements or overloads.
Symptoms of sprained muscles and ligaments of the lower extremities
The symptoms of a sprain can be similar, although there are some signs that distinguish one injury from another. So, for example, if the joint is in the wrong position and pain occurs immediately, then this may be a sprain, and in some cases even a fracture. But if muscle pain appeared the next day after intense training or sports, then this is muscle strain.
The symptoms of a sprain are:
• pain during movement of the damaged joint;
• swelling;
• bruising or redness;
• sensitivity when touching the damaged area;
Muscle strain symptoms are:
• moderate swelling;
• severe pain;
• difficulty in movement and soreness;
• change in skin color.
The type of injury depends on the degree of tendon rupture. There are 3 gap levels:
1. Part of the tendon fibers is torn, but the mechanical integrity is preserved and there is no hemorrhage. Swelling and swelling of the damaged joint is practically not noticeable.
2. Most of the tendon fibers are torn, and the capsule may also be affected. The formation of bruising and swelling is not excluded. The joint is limited in movement, and if movements occur, then pain instantly arises.
3. Complete rupture of the tendon, accompanied by swelling, bruising under the skin, pronounced pain.
What to do in case of a sprain
The damaged joint should not be loaded, and warm compresses should not be applied for the first 3 days, as this will aggravate the injury. And, of course, you should not delay seeking medical help, as an error in diagnosis and improper treatment will slow down the healing process. Most often, there is a sprain of the shoulder, ankle and knee ligaments and fingers. Treatment of a sprain can take 3-5 weeks, and rehabilitation for sprained muscles and ligaments of the lower extremities from 9weeks to 5 months, depending on the degree of stretching.
Treatment and rehabilitation for sprained muscles and ligaments of the lower extremities of the first degree can be carried out at home, observing the following rules:
• The use of a caliper – a special orthopedic bandage, which are for a particular joint. Such a bandage protects the damaged joint, thereby ensuring unhindered recovery. You can also use an elastic bandage, this will reduce swelling, reduce joint mobility. If the injury is of moderate severity, then a splint should be used, if you have an ankle sprain, then for more effective treatment and rehabilitation, you need to use special shoes.
• Peace. Damaged joints need isolation from exercise and mobility. After an injury, the injured area needs rest for 24-72 hours. Then, over time, mobility must be increased gradually, include physical exercises gradually. Also, do not keep the joint alone for a long time, as this will lead to muscle dystrophy. Pain – that’s what you should pay attention to, if pain occurs or increases with an increase in load, it should be reduced.
• Cold. If, after spraining the ligaments or muscles, it is possible to apply cold – excellent. Due to the cold, pain is dulled, inflammation is suppressed and bruising is reduced. During the first 24 hours after injury, ice should be applied every 2-3 hours. It is important that the ice does not remain on the affected area for a long time, as this is fraught with the appearance of a cold burn.
• High position. With an injury to the ligaments of the legs, it is better to keep the damaged joint as high as possible. To fix the affected limb, a chair, pillow, etc. is suitable, this position of the limb improves venous outflow, dulls pain and reduces swelling.
What are the contraindications for the treatment of sprained ligaments and joints?
The first 72 hours after injury to the lower extremities should be avoided:
• baths, saunas, hot compresses, warm baths, which can slow down the recovery process;
• alcohol, which increases swelling and bleeding, which slows down the healing process of tissues;
• excessive mobility. If physical activity is abused in the stretch area, then you can only make it worse and earn a new stretch. Only at the stage of rehabilitation are special exercises allowed.
• massage is possible only at the stage of rehabilitation of the lower extremities. As you know, massage increases blood circulation in the body, which can cause swelling in the affected area.
Today, about 90% of patients after the treatment of sprains, torn ligaments and muscles can return to an active lifestyle and sports. After surgery, the rehabilitation period can last from 3 to 6 months. In the first postoperative days, a special bandage is applied to the injured limb, which is able to provide the rest necessary for tissue repair. Only with the permission of the doctor, the patient can begin to develop muscles and perform physiotherapy exercises.

Soft tissue hematoma – symptoms, causes and treatment

The surgeon deals with the treatment of this disease

• What is it?
• About disease
• Types of soft tissue hematoma
• Symptoms
• Causes
• Diagnostics
• Expert opinion
• Treatment
• Surgical treatment
• Prevention
• Rehabilitation
• Q&A

About the disease

Local hemorrhages can be small or large in size. In some cases, they are localized superficially – in the subcutaneous or submucosal layer. In other cases, they lie in the thickness of the muscle layer or in the internal cavities of the body. The more vessels are damaged, the heavier and more extensive the hematoma.

Symptoms of local hemorrhage appear almost immediately after traumatic exposure. Usually, the first signs are limited swelling, intense pain on pressure, and no fluctuation symptom. Hematomas are most often formed in places prone to trauma – lower leg, occipital region of the head (when falling back), face (direct blow). Spontaneous soft tissue hematomas can have different localization and are often a complication of more intensive anticoagulant therapy.

Diagnosis in most cases is straightforward and is based on a visual assessment of the damaged area. With a deep occurrence of a hematoma, imaging diagnostics are performed – ultrasound, X-ray or magnetic resonance.

Most cases are treated conservatively. Surgical intervention may be required only for large hematomas with ongoing bleeding.

Types of soft tissue hematoma

The following types of soft tissue hematomas are distinguished:

• traumatic hematomas;
• spontaneous hematomas.

Spontaneous hematoma is the accumulation of blood in soft tissues due to a violation of the integrity of the vessel, not associated with trauma or medical intervention.

Hematomas can vary in severity. There are 3 main ones:

• Light, which is characterized by moderately severe pain in the injury zone, which appear during the first 24 hours. Such hemorrhages usually resolve on their own within 5-10 days.
• Medium. Typical symptoms appear within a few hours (up to 5 hours). The formation of puffiness and the appearance of quite intense pain are characteristic. Specialized medical care is required, because. increased frequency of complications.
• Severe, which is usually associated with significant mechanical stress on the tissue. Objective and subjective signs appear within the first 2 hours after injury. Edema often does not have clearly defined boundaries, and palpation delivers intense pain. In this situation, the earliest possible contact with a traumatologist is required. It is important to prescribe symptomatic treatment in a timely manner and determine possible indications for surgery.

Symptoms

What does a hematoma look like? Shortly after leaving the blood in the interstitial space, edema appears, which gradually increases in size. Due to severe pain, restrictions in the adjacent joints are reflexively limited. In the area of ​​blood outflow, a person feels internal tension and the presence of a seal. Immediately after the appearance of the hematoma, it may have a bright red color or even purple with a lilac tint. Often the color is heterogeneous, darker on the periphery.

If at the initial stage the skin has a red color in the area of ​​vascular rupture, then gradually it acquires a purple hue (to bluish). After 2-3 days, the phenomenon of “blooming” of the bruise appears, and the color changes to purple with blue. Approximately on the 5th day after the formation of a hematoma, due to the destruction of hemoglobin, the bruise becomes yellowish-green. At this stage, the hematoma can also descend under the influence of gravity (if there are no anatomical formations that will limit it in this direction).

Causes

The most common cause of local hemorrhage is damage to a blood vessel. This can happen due to a compression injury, a bone fracture, a direct or indirect blow. At the site of application of a mechanical force that exceeds the reserve of tissue strength, vascular rupture occurs. Blood flows into the interstitial space (subcutaneous tissue, intermuscular zone), but does not damage the skin.

Predisposing factors for the development of spontaneous hematomas may be coagulopathy (impaired blood clotting), high blood pressure, cough, vasculitis (inflammatory damage to the vascular wall), excessive exercise. Sometimes spontaneous hematoma develops in the absence of obvious causes. In addition, there is information about the presence of COVID-19-associated coagulopathy as a cause of spontaneous soft tissue hemorrhage.

A powerful causative factor in non-traumatic hematoma is anticoagulant, thrombolytic therapy, widely used for the prevention and treatment of patients with acute vascular thrombosis (coronary vessels, pulmonary artery, peripheral arteries, etc.). The incidence associated with coagulopathy and soft tissue hematoma is increasing every year, so you should be especially careful about your health.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:

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Treatment is carried out in accordance with clinical guidelines

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Comprehensive assessment of the nature of the disease and treatment prognosis

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Diagnosis

Imaging diagnosis of soft tissue hematomas can be performed using the following examination methods:

• Ultrasound – Ultrasound scanning is a non-invasive and safe diagnostic method that allows you to assess the extent of soft tissue hemorrhage and the involvement of adjacent tissues;
• CT – computed tomography is performed in complex clinical cases, often supplemented by the introduction of contrast;
• MRI – magnetic resonance imaging is aimed at a detailed assessment of the condition of soft tissues, while the scanning step is only 1-2 mm.

Expert opinion

Soft tissue hematomas in most cases do not pose a serious danger. However, sometimes spontaneously formed hemorrhages can be the first sign of a disease of the blood system, when blood clotting is disturbed. Do not delay a visit to the doctor if you notice that even a slight touch to the skin is accompanied by bruising, or spontaneous bleeding from the nose or gums may occur. The sooner a problem is identified, the lower the risk of potential complications.

Olimi Shirinbek

Surgeon, phlebologist, MD, leading specialist. Deputy chief physician for surgery at the SM-Clinic in Staropetrovsky proezd

Treatment

Treatment for soft tissue hemorrhage is determined by the location, spread, size, and stability of the hematoma.

Conservative treatment

Small hematomas are treated conservatively.

Emergency care consists in the immediate application of cold to the area of ​​local hemorrhage. The duration of exposure is 20 minutes, the procedure should be repeated with a frequency of 1 time in 2 hours. cold leads to vasospasm, therefore, it helps to reduce the size of the hematoma and the severity of the edematous syndrome. The next stage in first aid is a tight bandage that puts pressure on damaged vessels and thereby prevents re-bleeding.

The acute stage is replaced by the stage of encysted (organized) hematoma. At this stage, other therapeutic actions are required. Warm compresses are applied to the affected area (cold is replaced by heat), which promotes the resorption of the outflowing blood. At this stage, you can also use special ointments. In the case of an uncomplicated course, the hematoma disappears after a few days. It is worth considering that large hemorrhages resolve rather slowly (up to several weeks), complications are sometimes possible, therefore it is recommended that the doctor evaluate the dynamics of the process.

Surgery

Large hematomas are rare. They can lead to hemodynamic instability and be life-threatening. Such conditions require urgent medical attention. In this case, angiography and targeted endovascular embolization may be required.

Surgical treatment is also indicated in the presence of a large volume of chest hematoma and compression syndrome of adjacent organs.

Prevention

Taking into account possible risk factors, the prevention of hematomas consists of the following measures:

• protection from injuries using special safety equipment;
• rational selection of the dose of anticoagulants;
• timely detection and treatment of vasculitis.

Rehabilitation

After surgery for a hematoma, regular antiseptic treatment of the wound and change of aseptic dressings are carried out.

Q&A

Specialized diagnosis and treatment of this condition is carried out by an orthopedic traumatologist. However, doctors of different specialties can help with such a problem.

In most cases, hematomas resolve without a trace within a few weeks. However, sometimes they can turn into a chronic condition. A pseudocapsule is formed around the old hematoma, inside which clotted blood is contained, which gradually lyses and a cyst may form.

Sharafislamov I.F., Klyushkin I.V., Klyushkina Yu.A., Mikhailova O.N., Badretdinova A.R. Spontaneous hematoma of the anterior abdominal wall in the clinic of emergency surgery. sonographic aspects. Bulletin of modern clinical medicine. 2018;11(5):149–153.

Galstyan M. Coagulopathy in COVID-19. Pulmonology. 2020;30(5):645–657.

Zagainov V.E. Vasenin S.A., Nekrasova T.A., Grigoryan I.G. Strongin L.G. A case of giant spontaneous thyroid hematoma with life-threatening complications. Clinical and experimental thyroidology. 2008;4(2):52–54.

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