Contusions

Contusions or Cork injuries, are a type of bruise formed as a result of direct trauma or related blows by a blunt object to a certain body part. When this happens, the muscle fibres, small blood vessels, and connective tissue (soft tissue structures) are crushed and injured, without breaking the skin. The blood leaks out of the capillaries forming the bruise which is characteristic of this kind of injury.

Intramuscular –  In this kind of injury the surrounding fascia remains intact, thus containing the damage. Bleeding stops sooner due to the increased pressure, and there is little to no bruising depending on the location of the injured cells. The area becomes hardened and may be more painful to contract or stretch.

Intermuscular – This kind of injury occurs when the trauma damages the fascia along with the muscle fibres and vessels. Due to the fact that the fascia is torn, the blood is not contained and is allowed to leak out, this type of contusion bruises much more but the area does not feel hard.

Symptoms

• Swelling
• Bruising
• Pain and stiffness with movement
• Painful muscle contraction
• Pain with stretching
• Tender to touch or pressure applied to injury site
• Decreased ROM of associated joints
• Muscle weakness secondary to pain
• In severe cases, swelling and bleeding beneath the skin may cause shock
• Contusions to the abdomen may damage internal organs

The colour of the bruises

The contusion bruising will change colours throughout the healing process. The general progression of the colouring goes as follow:

• Red or purple colour soon after injury.
• Black, blue or purple colour in the first few days, usually darkest at the first 24 hours.
• Yellowish colour begins to show between days 2 and 3.
• Yellowish or greenish bruise between days 5 and 10.
• Brown or lighter coloured bruise between days 10 and 14. This is when the bruise is in its fading stages.

Causes

Contusions are caused by trauma by a blunt object or surface this may be due to:

• Accidents
• Falls
• Tackle injuries in contact sports such as football (soccer), rugby, martial arts, etc.
• Assault/Domestic violence.

Prevention

Most of these injuries are accidental and difficult to anticipate and thus, prevent. In sports where it is applicable, prevention is done through wearing the appropriate protective equipment, and ensure it is worn correctly and well maintained.

Diagnosis

Diagnosis is generally made by observation, most people can see and identify a contusion when they see one. Examination may involve palpation to the area, and some imaging. Imaging such as X-rays, MRI’s may be requested in cases of severe trauma or trauma in the abdominal area to exclude fractures or internal bleeding respectively.

Treatment

Contusions may heal and dissolve on their own, but due to the nature of the injury treatment should start immediately after the injury. The first 48 hours after a contusion are the most important phase of the treatment, the earlier you start, the sooner you should be able to return to sports. We advise you seek immediate medical attention to rule out fractures or other complications.

First 24 hours – 48 hours:

• PRICE
  • Protection: Stop activity immediately. Some contusions may need immobilisation.
  • Rest: Rest the affected limb. Gentle movements* Take it slow and easy and let pain guide your activities. Do not try to push through pain. Complete rest is not advisable.
  • Ice: Ice for 15-20 minutes every 1-2 hours, as possible.
  • Compression: Use/wear compression bandages/garments.
  • Elevation: Elevate the affected limb above the level of your heart, as much as possible.
• Physiotherapy: To assist with pain and swelling, releasing areas that might be in spasm. Taping for the bruising.
• Avoid exercise, heat, going for massages, trying to “run it off” and alcohol consumption during the first 48 hours.

Continued Management – After the first 48 hours

• Gentle massages
• Isometric muscle contractions
• Physical activity guided by pain allows, can push into some discomfort but not into pain.
• Activities such as walking, swimming, cycling and gentle runs.
• Physiotherapy: Soft tissue release for muscles and scar adhesions, stretching and strengthening exercises as well as rehabilitation to return to sport.

Complications

Most contusions are minor and generally do not pose any danger. However, some contusions may cause complications and in some rare cases may pose a danger to life. Poor management of contusions may lead to certain complications, these usually occur when the area of the contusion is loaded more than it can bear, too soon (before it has healed enough to handle such loads). Some of the complications (listed in no particular order) are:

Compartment Syndrome – a condition characterised by pressure build-up within muscle compartments due to excessive bleeding and/or swelling. It commonly occurs in intramuscular contusions, as fascia does not expand easily. The pressure build-up is so much that it starts cutting blood and nerve supply to and from the area and in severe cases may require emergency surgery. The common areas affected are arms, legs and abdomen. Signs include:

• A deep and persistent pain or ache
• Numbness and pins and needles in the limb
• Swelling and tightness
• Difficulty moving the limb, contraction or stretching the muscles may be very painful.

Myositis Ossificans – a condition where a certain area of soft tissue, specifically muscle, ossifies. This happens because as the area is healing the body lays down bone cells instead of muscle cells. Often triggered by loading a severe contusion too soon. Signs of MO are:

• Unresolved contusion with palpable lump 2 weeks after injury, lump is visible on X-ray
• Mild to severe pain and swelling in the injury site.
• Decreased flexibility and range of motion.

Rhabdomyolysis –  A condition characterised by the release of myoglobin (a protein) from damaged muscles into the blood, which can cause kidney damage. This happens when the injury is extensive or there are multiple contusions. Symptoms include:

• Dark red or brown urine.
• Decreased urine.
• Muscle ache, especially in shoulders, thighs and lower back.
• Muscle weakness, difficulty moving limbs.

Deep Vein Thrombosis (DVT) – a rare complication of contusions, but important to note. This is a condition where a blood clot is formed, often in the deep veins of the lower leg, but may affect other parts of the leg and even arms. The blood clot may dislodge and travel to the lungs, and cause a block to the blood flow (pulmonary embolism). This is a medical emergency, it needs immediate attention. Symptoms include:

• Tenderness in the area
• Warm and red skin
• Swelling in the area and in extremities.

These complications need medical attention and should not be ignored.

Contusions are a type of injury we often overlook, we grow up seeing bruises and how they often disappear on their own, or without much intervention needed. This sense of familiarity often leads us to not pay attention to it and, sometimes, miss the signs of possible complications. In the sporting world, contusions also affect our ability to return-to-play, and therefore need to be treated with attention and receive proper treatment.

We hope you find this article useful.