WHAT IS IT?

A contusion, or more commonly called a bruise, is a crush injury to tissues beneath the skin caused by an object striking the body with sufficient force. The greater the impact force, the greater the tissue damage. If the blow is over a bony area, the bone itself may also be contused.

A contusion results in varying amounts of swelling and disability depending on a number of factors with the most important ones being the force and location of the blow. A contusion damages tissue cells and capillaries. This results in blood and waste products leaking into the area around the cells. These blood and waste products gradually travel to the skin, producing the characteristic "black and blue" discoloration to the area. Because of gravity, the "black and blue mark" may appear below the actual contusion. To locate the actual site of injury, gentle palpation should be used and treatment should be directed at the site of injury not the "black and blue mark".

When there is a lot of damage, large amounts of blood and waste products are produced. They may collect in a pool instead of dispersing throughout the tissue. This is a hematoma. Hematomas commonly form following a severe contusion over a relatively flat and muscular area such as the thigh. Blood loss can be sever in these cases and may result in shock. If you suspect a hematoma, remove the athlete from all activity and refer him/her to a medical professional.

As mentioned above, bone can also be contused. When this happens, swelling occurs between the covering of the bone, the periosteum, and the bone itself. Due to limited circulation, swelling reduces very slowly, and the contusion remains ver tender for an extended period of time. Relative rest for the athlete is necessary but consultation with a medical professional following extended time of discomfort will provide more relative advice regarding treatment and return to activity.

TREATMENT

Treatment for contusions is the same as for other musculoskeletal injuries and can be remembered by the acronym RICE: rest, ice, compression and elevation. The athlete should be removed from activity, and the injured area cooled, compressed and elevated as soon as possible to minimize damage to uninjured tissues. Do not permit the athlete to try to "run off" a contusion as the muscle activity may increase the bleeding in the contused area and worsen the injury. For further information regarding specific treatments, please refer to additional handouts: RICE, Ice application, and Ace-wrapping techniques for specific body parts. 

Athletes with minor contusions can often return to activity ver quickly. Serious contusions may impair an athlete for months. An accurate assessment of the seriousness of a contusion is likely beyond the scope of a non-medical person. However, if the athlete can use the uninjured body part with full strength and can move it through a full range of motion (equal to the un-injured site) with little or no discomfort, it is probably safe to return. 

When in doubt of the severity of the injury, DO NOT PERMIT an athlete to return to play.

This type of judgement error may complicate a simple injury.

PROTECTION

After a contusion, the injured area must be protected from further trauma. The use of additional pads or pads with a different design can provide this protection. For example, an athlete who repeatedly falls should wear kneepads. Football players may wear additional or larger pads. Sometimes, custom pads are made to protect a contused area, but this should be done by a medical professional. Not only do custom-made pads protect the injured athlete, but they are also designed to pose no threat to other athletes.

Obviously, the best treatment is prevention of the contusion in the first place. Sport-specific protective equipment should be appropriately sized and fitted to every athlete. Protective equipment that is either too small or too large is not effective.

It is the responsibility of the coach to ensure all athletes wear required protective equipment that fits properly and is in good condition. Equipment left in the locker does not do any good. Also, the fit and condition of protective equipment should be checked regularly. Improperly sized or worn-out equipment provides little or no protection and gives the athletes a false sense of security.

This information is not meant to take the place of medical consultation following injury. If the injury worsens or does not improve within 48 hours, you should seek medical advice. If there are questions or problems, contact your doctor or health professional at Skyline Hospital (509)493-1101.