Contusion: A Bruise, Hematoma, or Something Else?

A contusion (bruise) results from an injury that breaks the capillaries (tiny blood vessels) beneath the skin, causing bleeding and discoloration. A contusion often starts as a red or pinkish color. It then transitions to a black-and-blue mark and eventually appears yellow or greenish as the nearby tissues absorb the blood or the immune system clears it.

The term "hematoma" is often used interchangeably with "contusion," but it is different and more severe.

This article discusses contusions, what body parts they can affect, and explains how hematomas differ from contusions.

Contusion: Meaning of Injury

A contusion often occurs after an injury. If the injury breaks capillaries, the blood leaks from the broken capillaries and can be trapped near the injury location under the surface of the skin or in deeper tissues near bones or internal organs, resulting in discoloration associated with bruises.

Certain people are more prone to bruising than others, including:

• Older adults: The skin and blood vessels become more fragile and prone to injury as people age.
• Medications: Certain medications, like antiplatelet drugs or anticoagulants (blood thinners), corticosteroids, and some supplements (e.g., ginkgo biloba) can make you more prone to bruising.
• Sex: Women often bruise more easily than men.
• Nutritional deficiencies: People with vitamin C or vitamin K deficiencies may bruise more easily.

Muscle vs. Bone Contusion

Contusions mainly occur due to an injury, such as a fall. Muscle contusions are often seen closer to the skin's surface and cause the black-and-blue discoloration often associated with bruising.

Contusions can occur in deeper tissues near bone or internal organs, too. Bone contusions often happen as a result of direct trauma to the bone, such as your shin hitting a table. Contusions that occur closer to the bone may not produce any skin discoloration.

Bone contusions may or may not be associated with a fracture. They are often identified within the first couple of days after injury and can last for several months,

Symptoms: How Does a Contusion Feel?

Depending on the location, contusions may or may not hurt. The swelling associated with a contusion can cause a feeling of discomfort or pressure instead of pain, too. Often, over-the-counter pain relievers, like Tylenol (acetaminophen), can help alleviate discomfort or pain.

Healing From a Contusion

The body will naturally break down the leaked blood that causes a contusion. The tissues near the bruise absorb some of the capillaries' leaked blood, and the immune system also assists with contusion healing. The healing process can take several days to several weeks or months.

In the initial 24 to 48 hours of a contusion (the acute phase), the following may help with healing and managing any discomfort:

• Rest: To prevent further injury, minimize excessive activity.
• Ice: Use ice to minimize swelling. Only use ice for 20 minutes at a time, and don't put the ice directly on the skin.
• Elevation: Swelling from contusions can be minimized by elevating the injured area above the heart.

Is Treatment Needed?

Most of the time, a contusion is not dangerous and does not require treatment. However, there are some circumstances for which it is recommended to see a qualified healthcare provider for further evaluation. Seek medical attention if you experience one or more of the following:

• A bruise that doesn't fade or show signs of healing
• A bruise that increases in size or is very painful, especially right after the injury
• A large bruise or multiple minor bruises without any known injury or cause
• Bruising that occurs after taking a new medication
• Bruising that occurs more often or easily than usual
• Signs of an infection, such as fever, red streaks near, or drainage from, the contusion

A healthcare provider will likely perform a thorough physical examination and order laboratory testing to ensure your contusions are not a sign of a medical condition that requires additional treatment.

How Many Days Does a Contusion Take to Heal?

Depending on where the contusion occurs, healing time can vary. During the initial injury, the skin might appear reddened or pinkish, developing the stereotypical black-and-blue coloring associated with a contusion.

As the body absorbs the leaked blood and the immune system assists with breaking it down, the contusion might appear more greenish-yellow in color.

Contusions can take several days and even weeks to resolve. More significant contusions, such as bone contusions, can take up to six months to heal.

When to See a Healthcare Provider 

While contusions are typically not dangerous, contusions should be evaluated by a qualified healthcare provider if any of these things occur:

• Large, frequent, or many bruises that occur without injury
• Bleeding that persists after 10 minutes
• Recurrent nose bleeds, typically five or more in a year
• For women, heavy menstrual cycles or menses that last longer than seven days
• A family history of bruising or bleeding issues
  

Summary

Contusions primarily occur when capillaries leak blood after an injury of some kind. Due to swelling, a contusion might be uncomfortable or even painful. Still, over-the-counter medications like Tylenol, rest, and applying ice to the area for short periods can be effective.

Bruising does not usually need to be evaluated by a healthcare provider and heals within a few days to weeks. However, if bruising is occurring frequently or without known injury, or gets bigger or isn't healing as expected, it is recommended to see a qualified healthcare provider for evaluation.