What Is a Contusion?

A contusion, or bruise, occurs when you receive a direct blow or an impact on your body. When this occurs, the small blood vessels tear which causes blood to leak under your skin. There are several types of contusions that can affect any part of your body, including your skin, bones, lungs, heart, brain, and muscles.

Bruises are extremely common and it's likely you've experienced one or more contusions before. You might get a contusion for a variety of reasons: car accidents, falls, sports injuries, assault, fights, or domestic violence, among other causes. In most cases, a minor contusion on your skin or muscles will heal on its own with time without any treatment, aside from rest. But, other types of bruises that affect your organs will require medical attention.

Typically, healthcare providers will use multiple diagnostic tools to determine the extent and location of your bruising. For more traditional bruising like muscle contusions and bone bruises, treatment involves resting or icing the bruise. But, internal contusions that affect your organs often require hospitalization and more detailed treatment.

Types of Contusions

If you experience a forceful or blunt impact that's strong enough to break your blood vessels, you'll likely notice a bruise forming on your skin. The skin is normally still intact when you get a bruise, meaning that there are no cuts, wounds, or abrasions.

That said, contusions are not limited to the skin's surface. You can get contusions in many parts of the body, especially if you are in a motor vehicle accident, fall from a significant height, are battered or assaulted by another person, or are in an explosion. Some other types of contusions include:

• Muscle contusion: Bruise to the muscle that occurs when you receive a blunt impact or multiple impacts to your body that cause damage to your underlying muscle fibers and connective tissue. These types of bruises do not typically break the skin.
• Bone contusion: Sometimes referred to as a bone bruise, a bone contusion is a traumatic injury to your bone but is less severe than a fracture. When you have a bone bruise, blood and fluid will build up around the injured bone.
• Brain contusion: Brain contusions, also known as cerebral contusions, can often occur when you hit your head or experience a traumatic brain injury (TBI). They tend to be more serious than a skin or muscle contusion due to the location and function of your brain.
• Lung contusion: A contusion on one of your lungs, which is sometimes called a pulmonary contusion, is a bruise on your lungs that may occur when you receive a blow to your chest. Typically, lung contusions do not contain any tears or lacerations (cuts) to the lung tissue.
• Spinal cord contusion: When your spinal cord becomes bruised, the contusion can cause inflammation and swelling near the injury location. Your spinal cord is an essential part of your central nervous system, so damage to your spine can disrupt your nerve impulses. This can result in numbness, tingling, or complete loss of use of your limbs.
• Blunt cardiac injury: Formerly known as a cardiac contusion, blunt cardiac injury is the term used to describe a bruise on your heart or the tissue that surrounds it. You may experience a blunt cardiac injury after trauma to the chest. It's worth noting that this type of contusion is hard to diagnose because there are no standardized diagnostic criteria for these bruises.

Symptoms

While each type of contusion can cause its own set of symptoms, almost all bruises cause some level of pain. Sometimes this pain is mild, while other times it may feel more severe. Generally, the larger or deeper your bruise, the more painful your contusion may be. For instance, bruises on your skin are not as painful as a lung or brain contusion.

Depending on the type of contusion you have, you may experience the following symptoms:

• Skin contusion: Discoloration on the skin that may appear pink, red, blue, purple, or green
• Muscle contusion: Swelling, stiffness, and muscle weakness
• Bone contusion: Stiffness, aches, swelling, or a hard lump
• Brain contusion: Bleeding and swelling inside and around the brain, headaches, loss of consciousness, seizures, slurred speech, and trouble walking
• Lung contusion: Difficult breathing, coughing, or chest tenderness that usually appears six to 48 hours after the injury
• Spinal cord contusion: Pressure in the head, neck, or back, weakness, loss of balance, tingling sensation in the limbs, or
  
• Blunt cardiac injury: Chest pain, difficulty breathing, heart palpitations, and sometimes death

Keep in mind: contusions on vital organs are serious and require immediate medical attention. In most cases, your healthcare provider may recommend hospitalization for overnight care when a blunt force trauma affects your internal organs

Causes

Most of the time, contusions occur when the body is struck in some way either by an object, a person, or something else. You can get a bruise from anything that can cause blunt force trauma to your body. Some examples may include:

• Playing contact sports and getting injured
• Being in a car accident
• Tripping or falling down the stairs or on hard floors
• Experiencing domestic violence or assault by another person
• Having an accident during a recreational activity
• Wrecking a bicycle or a motorcycle
• Falling off a skateboard, bicycle, scooter, or other transportation device
• Getting hit by a falling object
• Living through war or explosions

Risk Factors

Anyone can get a bruise—and it's common to experience some type of contusion at least once in your life. But, your risk of a contusion increases if you aren't taking the proper safety precautions. For example, if you ride in a car without a seatbelt, do not wear a helmet while cycling, or engage in dangerous activities, you are more likely to get injured and experience a contusion.

Likewise, those who play contact sports or serve in the military also are at risk for contusions. Muscle contusions are the second most common type of sports injuries. Meanwhile, those in the military are most at risk for lung contusions due to blasts or explosions.

Diagnosis

If you have a bruise on your skin, you likely don't need to see a healthcare provider for medical care. But, if your bruise doesn't go away within a few days or is large and deep, it's a good idea to reach out to your provider. If you're experiencing symptoms of a contusion that may be affecting your bones, muscles, or internal organs, it's important to get the medical attention you need.

When you see a healthcare provider, the first step of the diagnostic process is to conduct a physical exam. This test helps determine the extent of the injury and its location. From there, your healthcare provider may order imaging tests to learn more about the severity of your contusion and how to best treat the bruise. They may order one or more of the following tests:

• X-ray: Takes pictures of your internal organs and looks for signs of lung and bone contusions
• Magnetic resonance imaging (MRI): Creates detailed images of your organs to check for bone, spinal, lung, or cardiac-related contusions
• Computerized tomography (CT) scans: Another imaging test that is often used to check for and evaluate the severity of brain contusions and identify any blood clots or internal bleeding
• Glasgow coma scale: An important tool for determining the severity of a brain injury or contusion by assessing your ability to follow directions
• Myelogram: A special type of X-ray that checks for spinal cord injuries
• Electrocardiogram (ECG/EKG): Rcords the electrical signals from the heart and is often the first test healthcare providers use if they suspect a blunt cardiac injury

Treatment

Just like how the symptoms, causes, and diagnostic measures for each type of contusion are different, treatment options for bruises also vary. Your exact treatment plan will depend on the location and severity of your injury. Treatments for every kind of bruise include:

• Skin and muscle contusions: Using the RICE protocol (resting, icing, compressing, and elevating the location of the bruise) or taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain relief
• Bone contusion: Applying ice to the injury, elevating to reduce swelling, wearing a brace to limit movement or further injury, and eating foods rich in calcium, protein, or vitamin D to promote bone health
• Lung contusion: Supportive care from your healthcare team, consistent monitoring of your lung health to prevent lung failure and other complications, and chest pain management
• Brain contusion: Resting, managing swelling, reducing pressure in your brain, preventing the risk of seizures, and in some cases, getting surgery to remove the contusion
• Spinal cord contusion: Currently, there is no treatment available to repair a damaged or bruised spinal cord, so healthcare providers try to manage the injury and reduce swelling by using medications like corticosteroids or recommending physical therapy
• Blunt cardiac injury: Surgical repair of the heart to reduce the risk of life-threatening complications or heart failure and sometimes inserting a pacemaker to prevent the heart from beating too slowly

How to Prevent Contusions

While some contusions are outside of your control and can't always be prevented, there are some things you can reduce your risk of experiencing a bruise. These prevention strategies include:

• Wearing a seatbelt in the car and keeping children safe by keeping them in an infant carrier, car seat, or booster seat
• Refraining from operating a motor vehicle under the influence of alcohol or drugs
• Using a helmet when riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle
• Preventing falls by practicing balance exercises, fall-proofing your home, and getting your hearing and vision checked
• Utilizing appropriate headgear when playing sports or activities like football, hockey, boxing, baseball, softball, horseback riding, snowboarding, rock climbing, and skiing
• Making your home safer by using window guards and safety gates
• Prioritizing healthy, respectful, and non-abusive relationships or getting support to get out of a violent relationship
• Learning how to manage anger and problem-solve without aggression

Complications

Complications of contusions will depend on the type of bruise you've had. Some complications include:

• Compartment syndrome: Rapid bleeding and swelling that can occur after a severe muscle contusion
• Myositis ossificans: A bone that forms inside the injured muscle if you do not allow a muscle contusion to heal like it should or push a quick recovery
• Avascular necrosis of the bone: Partial or complete death of bone that can occur when large bone bruises block blood flow to the bone
• Acute respiratory distress syndrome (ARDS): Low blood oxygen that can occur after blunt force trauma that affects your lungs

A Quick Review

When you receive a direct blow or blunt impact to your body, you can develop a contusion or a bruise. Typically, contusions are caused by car accidents, falls, sports injuries, fighting, and assault. In most cases, a contusion on your skin or muscles doesn't require additional treatment aside from rest, icing, compressing, or elevating—known as the RICE protocol. But, contusions that affect your internal organs do require medical attention and ongoing treatment.