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Bruise
Other namesContusion, ecchymosis[1][2]
Bruise on upper leg caused by a blunt object
SpecialtyEmergency medicine
TreatmentRICE (rest, ice, compression, and elevation)

A bruise, also known as a contusion, is a type of hematoma of tissue,[3] the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.[4][5]

Bruises are not to be confused with other similar-looking lesions. Such lesions include petechia (less than 3 mm (0.12 in), resulting from numerous and diverse etiologies such as adverse reactions from medications such as warfarin, straining, asphyxiation, platelet disorders and diseases such as cytomegalovirus);[6] and purpura (3–10 mm (0.12–0.39 in)), classified as palpable purpura or non-palpable purpura and indicating various pathologic conditions such as thrombocytopenia.[7] Additionally, although many terminology schemas treat an ecchymosis (plural, ecchymoses) (over 1 cm (0.39 in)) as synonymous with a bruise,[1] in some other schemas, an ecchymosis is differentiated by its remoteness from the source and cause of bleeding, with blood dissecting through tissue planes and settling in an area remote from the site of trauma or even nontraumatic pathology, such as in periorbital ecchymosis ("raccoon eyes"), arising from a basilar skull fracture or from a neuroblastoma.[8]

As a type of hematoma, a bruise is always caused by internal bleeding into the interstitial tissues which does not break through the skin, usually initiated by blunt trauma, which causes damage through physical compression and deceleration forces. Trauma sufficient to cause bruising can occur from a wide variety of situations including accidents, falls, and surgeries. Disease states such as insufficient or malfunctioning platelets, other coagulation deficiencies, or vascular disorders, such as venous blockage associated with severe allergies[9] can lead to the formation of purpura which is not to be confused with trauma-related bruising/contusion.[10] If the trauma is sufficient to break the skin and allow blood to escape the interstitial tissues, the injury is not a bruise but bleeding, a different variety of hemorrhage. Such injuries may be accompanied by bruising elsewhere.[11]

Signs and symptoms

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A woman's bruising after a severe fall

Bruises often induce pain immediately after the trauma that results in their formation, but small bruises are not normally dangerous alone. Sometimes bruises can be serious, leading to other more life-threatening forms of hematoma, such as when associated with serious injuries, including fractures and more severe internal bleeding. The likelihood and severity of bruising depends on many factors, including type and healthiness of affected tissues. Minor bruises may be easily recognized in people with light skin color by characteristic blue or purple appearance (idiomatically described as "black and blue") in the days following the injury.

Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimetres in size or larger, and are therefore larger than petechiae (less than 3 millimetres in diameter)[12] or purpura (3 to 10 millimetres in diameter).[13] Ecchymoses also have a more diffuse border than other purpura.[14] A broader definition of ecchymosis is the escape of blood into the tissues from ruptured blood vessels.[15][16] The term also applies to the subcutaneous discoloration resulting from seepage of blood within the injured tissue.

Bruise colors vary from red, blue, or almost black, depending on the severity of broken capillaries or blood vessels within the bruise site. Broken venules or arterioles often result in a deep blue or dark red bruise, respectively. Darker colored bruises may result from a more severe bleeding from both blood vessels. Older bruises may appear yellow, green or brown.[11][17]

Cause

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There are many causes of subcutaneous hematomas including ecchymoses. Coagulopathies such as hemophilia A may cause ecchymosis formation in children.[18] The medication betamethasone can have the adverse effect of causing ecchymosis.[19]

The presence of bruises may be seen in patients with platelet or coagulation disorders, or those who are being treated with an anticoagulant. Unexplained bruising may be a warning sign of child abuse, domestic abuse, hard blows during fighting sports,[20] shot by rubber bullets during protests, hit by falling objects/stuck inside rubble during earthquakes, hit by hailstones/falling volcanic debris caused by volcanic eruptions with alert level IV–V ("warning") and/or serious medical problems such as leukemia or meningoccocal infection. Unexplained bruising can also indicate internal bleeding or certain types of cancer. Long-term glucocorticoid therapy can cause easy bruising. Bruising present around the navel (belly button) with severe abdominal pain suggests acute pancreatitis. Connective tissue disorders such as Ehlers–Danlos syndrome may cause relatively easy or spontaneous bruising depending on the severity. Spontaneous bruising or bruising with minimal trauma in the absence of other explanations and together with other minor or major criteria suggestive of vascular Ehlers–Danlos Syndrome (vEDS) suggests genetic testing for the condition.[21]

During an autopsy, bruises accompanying abrasions indicate the abrasions occurred while the individual was alive, as opposed to damage incurred post mortem.

Size and shape

[edit]
Bruise caused by colliding with a handrail, typical of extreme sports such as skateboarding and rollerblading.
Bruise caused by a sprained ankle
Black eye and subconjunctival hemorrhage after a punch to the face

Bruise shapes may correspond directly to the instrument of injury or be modified by additional factors. Bruises often become more prominent as time lapses, resulting in additional size and swelling, and may grow to a large size over the course of the hours after the injury that caused the bruise was inflicted.

  • Condition and type of tissue: In soft tissues, a larger area is bruised than would be in firmer tissue due to ease of blood to invade tissue.
  • Age: elderly skin and other tissues are often thinner and less elastic and thus more prone to bruising.
  • Gender: More bruising occurs in females due to increased subcutaneous fat.
  • Skin tone: Discoloration caused by bruises is more prominent in lighter complexions.
  • Diseases: Coagulation, platelet and blood vessel diseases or deficiencies can increase bruising due to more bleeding.
  • Location: More extensive vascularity causes more bleeding. Areas such as the arms, knees, shins and the facial area are especially common bruise sites.
  • Forces: Greater striking forces cause greater bruising.
  • Genes: Despite having completely normal coagulation factors, natural redheads have been shown to bruise more, although this may just be due to greater visibility on commonly associated lighter complexion.[22]

Severity

[edit]

Bruises can be scored on a scale from 0–5 to categorize the severity and danger of the injury.

Bruise harm score
Harm score Severity level Notes
0 Light bruise No damage
1 Mild bruise Little damage
2 Moderate bruise Some damage
3 Serious bruise Dangerous
4 Extremely serious bruise Very dangerous
5 Critical bruise Risk of death

The harm score is determined by the extent and severity of the injuries to the organs and tissues causing the bruising, in turn depending on multiple factors. For example, a contracted muscle will bruise more severely, as will tissues crushed against underlying bone. Capillaries vary in strength, stiffness and toughness, which can also vary by age and medical conditions.

Low levels of damaging forces produce small bruises and generally cause the individual to feel minor pain straight away. Repeated impacts worsen bruises, increasing the harm level. Normally, light bruises heal nearly completely within two weeks, although duration is affected by variation in severity and individual healing processes;[23] generally, more severe or deeper bruises take somewhat longer.

Severe bruising (harm score 2–3) may be dangerous or cause serious complications. Further bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma. This has the potential to cause compartment syndrome in which the swelling cuts off blood flow to the tissues. The trauma that induced the bruise may also have caused other severe and potentially fatal harm to internal organs. For example, impacts to the head can cause traumatic brain injury: bleeding, bruising and massive swelling of the brain with the potential to cause concussion, coma and death. Treatment for brain bruising may involve emergency surgery to relieve the pressure on the brain.

Damage that causes bruising can also cause bones to be broken, tendons or muscles to be strained, ligaments to be sprained, or other tissue to be damaged. The symptoms and signs of these injuries may initially appear to be those of simple bruising. Abdominal bruising or severe injuries that cause difficulty in moving a limb or the feeling of liquid under the skin may indicate life-threatening injury and require the attention of a physician.

Mechanism

[edit]
Severe bruising resulting from yard work injury

Increased distress to tissue causes capillaries to break under the skin, allowing blood to escape and build up. As time progresses, blood seeps into the surrounding tissues, causing the bruise to darken and spread. Nerve endings within the affected tissue detect the increased pressure, which, depending on severity and location, may be perceived as pain or pressure or be asymptomatic. The damaged capillary endothelium releases endothelin, a hormone that causes narrowing of the blood vessel to minimize bleeding. As the endothelium is destroyed, the underlying von Willebrand factor is exposed and initiates coagulation, which creates a temporary clot to plug the wound and eventually leads to restoration of normal tissue.

During this time, larger bruises may change color due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. The striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color.[11] As these products are cleared from the area, the bruise disappears. Often the underlying tissue damage has been repaired long before this process is complete.

Treatment

[edit]
Healing of a black eye over a nine-day period caused by a wisdom tooth extraction

Treatment for light bruises is minimal and may include RICE (rest, ice, compression, and elevation), painkillers (particularly NSAIDs) and, later in recovery, light stretching exercises. Particularly, immediate application of ice while elevating the area may reduce or completely prevent swelling by restricting blood flow to the area and preventing internal bleeding. Rest and preventing re-injury is essential for rapid recovery.

Very gently massaging the area and applying heat may encourage blood flow and relieve pain according to the gate control theory of pain, although causing additional pain may indicate the massage is exacerbating the injury.[24] As for most injuries, these techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped, because although increasing blood flow will allow more healing factors into the area and encourage drainage, if the injury is still bleeding this will allow more blood to seep out of the wound and cause the bruise to become worse.

History

[edit]

Folk medicine, including ancient medicine of Egyptians, Greeks, Celts, Turks, Slavs, Maya, Aztecs and Chinese, has used bruising as a treatment for some health problems. The methods vary widely and include cupping, scraping, and slapping. Fire cupping uses suction which causes bruising in patients. Scraping (gua sha) uses a small hand device with a rounded edge to gently scrape the scalp or the skin. Another ancient device that creates mild bruising is a strigil, used by Greeks and Romans in the bath. Archaeologically there is no precedent for scraping tools before Greek archaeological evidence, not Chinese or Egyptian.[25]

Etymology and pronunciation

[edit]

The word ecchymosis (/ˌɛkɪˈmoʊsɪs/; plural ecchymoses, /ˌɛkɪˈmoʊsiːs/), comes to English from Neo-Latin, based on Greek ἐκχύμωσις, ekchymōsis, from ἐκχυμοῦσθαι, ekchymousthai, 'to extravasate blood', from ἐκ-, ek- (elided to ἐ-, e-) and χυμός, chymos, 'juice'.[26] Compare enchyma, "tissue infused with organic juice"; elaboration from chyme, the formative juice of tissues.

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Bruise

View on Grokipedia
from Grokipedia
A bruise, medically known as ecchymosis or contusion, is a common characterized by discoloration of the skin resulting from the rupture of small vessels (capillaries) beneath the surface, allowing to leak into surrounding tissues without breaking the skin itself. This typically occurs due to blunt force trauma, such as a bump, fall, or impact, leading to trapped that initially appears red or pinkish before turning , , or . Bruises can also result from non-traumatic factors, such as aging, certain medications, or underlying medical conditions. The color evolves to , , or over days as the body reabsorbs the , with most healing naturally within 2 to 4 weeks.

Signs and Symptoms

Appearance and Characteristics

A bruise typically appears as a discolored area on the skin, initially presenting as or purple due to the presence of fresh, oxygen-rich from extravasated . As the bruise evolves, the color shifts to blue or black within 1-2 days from deoxygenated , then transitions to green around 5-10 days owing to the formation of during breakdown. Subsequently, it turns yellow or brown as converts to , fading back to the normal tone over 1-3 weeks as these pigments are cleared. These color changes occur more slowly in deeper tissues and can vary by tone, appearing darker or less vivid on individuals with melanin-rich . Bruises vary in size, ranging from small spots less than 1 cm in diameter, often classified as , to larger ecchymoses exceeding 1 cm, and extensive hematomas greater than 3 cm that form raised collections of . The size depends on the volume of leaked and the extent of tissue affected, with smaller bruises remaining flat and superficial while larger ones may elevate the skin due to pooled . In terms of and distribution, bruises often have irregular, feathered edges and can exhibit patterns that mirror the injuring object, such as linear marks from a belt or from a rod-like implement. Additionally, gravity influences distribution, causing the discoloration to migrate downward in dependent areas like the legs, leading to a spread or elongation over time. Bruises can involve different tissue layers, with subcutaneous types occurring just beneath the skin and producing prominent visible color changes and mild swelling upon palpation. In contrast, intramuscular bruises develop deeper within muscle tissue, often resulting in less distinct skin discoloration but notable findings on examination, including localized tenderness, firmness, and swelling that may limit movement. These deeper bruises can feel warm or spongy to the touch and are typically more painful during palpation compared to superficial ones.

Associated Pain and Sensations

A bruise typically begins with an immediate sharp at the site of impact due to the trauma to tissues and vessels. This initial sensation often transitions to a dull ache as swelling develops, with severity commonly peaking within the first 24 to 48 hours before gradually subsiding over 3 to 7 days. levels are frequently rated on a 0-10 scale, where minor bruises score around 1-3, reflecting tenderness rather than debilitating discomfort. Sensory changes accompanying a bruise may include temporary numbness, tingling, or in the affected area, resulting from swelling that compresses nearby . These sensations usually resolve within 3 to 14 days as decreases, aligning with the overall healing timeline of most bruises. Functional impacts from a bruise often involve reduced in the surrounding area, leading to or that limits daily activities. For instance, a bruise on the may cause difficulty bearing weight, resulting in limping or altered to avoid pressure on the tender site. Pain intensity can vary by location, with bruises over bony prominences such as the shin experiencing more acute discomfort due to minimal cushioning from , compared to those on fleshy areas like the where muscle provides greater protection.

Causes

Traumatic Causes

Traumatic causes of bruises primarily involve blunt force trauma, where external mechanical forces damage small vessels beneath the skin without breaking the surface. This occurs when a significant impact compresses tissues, leading to rupture and localized bleeding. Common scenarios include falls, sports-related collisions, and accidents, such as dashboard impacts during crashes that produce contusions on the lower extremities or . A particular form of traumatic bruising occurs in newborns during the delivery process. Bruises are common on the head, face, scalp, or limbs (such as the legs and feet in breech deliveries), resulting from pressure in the birth canal or the use of assistive instruments such as forceps or vacuum extractors. These birth-related bruises are typically benign and resolve spontaneously within a few days without intervention. Falls represent a leading cause across age groups; for instance, elderly individuals often sustain bruises from ground-level slips due to reduced balance and , while children may experience them during play activities like roughhousing or mishaps. In contact sports such as or football, repeated blunt blows to the body result in muscle contusions, with athletes particularly prone to thigh or bruising from tackles or punches. Motor vehicle accidents frequently cause widespread bruising from seatbelt restraints or contact, highlighting the role of high-velocity impacts in trauma. Bruises from traumatic causes are prevalent in settings, accounting for a notable portion of minor presentations; one study found that approximately 57% of injury-related visits involved superficial contusions like bruises, often from low-impact events. Among pediatric patients, bruising appears in about 3.5% of visits, frequently linked to accidental falls or play injuries, though rates vary by age and mobility. These statistics underscore the commonality of in routine healthcare encounters. Iatrogenic bruising arises from invasive medical procedures that inadvertently damage vessels, such as for blood draws or intramuscular injections, resulting in localized hematomas at the site. This complication occurs due to needle penetration or pressure during the procedure, affecting up to a significant minority of patients, with symptoms typically resolving within days to weeks. Common in routine , such bruising is more likely in individuals with fragile veins or those on anticoagulants, though it remains a benign procedural . In cases of non-accidental , such as child physical , bruises often exhibit distinct patterns indicative of inflicted trauma, including grip marks on the arms from forceful grabbing or loop-shaped contusions from objects like belts or cords. Forensic identifies these as suspicious when located on non-prominent areas like the , , or inner thighs, contrasting with accidental bruises typically on bony prominences like or . Such patterned injuries serve as key indicators in abuse assessments, prompting further investigation.

Medical and Non-Traumatic Causes

Bruises can arise from various medical conditions that impair blood clotting or vessel integrity, independent of external trauma. disorders, such as hemophilia, involve deficiencies in clotting factors like or IX, leading to prolonged and spontaneous bruising even from minor pressure. , the most common inherited disorder, results from deficient or defective , which aids platelet adhesion, causing easy bruising and lumpy ecchymoses. , characterized by low platelet counts, heightens bruising risk; counts below 50,000/μL significantly increase the likelihood of spontaneous subcutaneous , with severe risks emerging under 10,000/μL. Certain medications disrupt and promote non-traumatic bruising. Anticoagulants like inhibit vitamin K-dependent clotting factors, leading to easy bruising and prolonged bleeding. Aspirin and other antiplatelet drugs impair platelet aggregation, increasing the incidence of ecchymoses without injury. Corticosteroids thin the skin, increasing susceptibility to bruising even with minor trauma. Vitamin C deficiency, as in , weakens in vessel walls, resulting in perifollicular hemorrhages and widespread bruising. Systemic diseases often manifest with unexplained bruising due to widespread hematologic or vascular effects. , particularly acute types, causes from bone marrow infiltration, leading to spontaneous petechiae and bruises. impairs synthesis of clotting factors II, VII, IX, and X, resulting in large subcutaneous ecchymoses. inflames walls, causing non-traumatic leakage and purpura-like bruises on the skin. Aging and nutritional factors contribute to fragility-related bruising in older adults. Senile or actinic , due to dermal and sun-damaged vessels, affects approximately 12% of individuals over 50 years, rising to up to 30% after age 75, often presenting as spontaneous purple patches on sun-exposed areas. Easy bruising is not typically caused by dehydration or acute low blood sugar (hypoglycemia). Malnutrition can cause easy bruising due to resulting vitamin deficiencies (e.g., vitamin C or K), but this usually develops over weeks to months rather than short-term. Short-term causes more commonly include medications (e.g., blood thinners, corticosteroids), initiation of new medications, or acute conditions such as infections leading to thrombocytopenia. hinders production of clotting factors, exacerbating bruising in malnourished or antibiotic-treated elderly patients.

Pathophysiology

Formation Mechanism

A bruise forms when applies sufficient force to disrupt the of small vessels in the soft tissues, primarily capillaries and small venules, through mechanisms such as or hydraulic pressure that exceed the vessels' tensile strength. This rupture allows of red cells (RBCs) from the vascular space into the adjacent interstitial tissue, where the accumulates without breaching the skin surface. The extent of vessel damage depends on the impact's magnitude, duration, and the tissue's biomechanical , with fragile capillaries being particularly susceptible due to their thin walls and lack of muscular support. Immediately following the injury, an acute inflammatory response is initiated to contain the damage and recruit repair cells. Extravasated RBCs undergo , releasing that oxidizes to and ferrylhemoglobin, which act as proinflammatory agents by upregulating adhesion molecules on endothelial cells and promoting leukocyte . This is amplified by proinflammatory cytokines, including interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), secreted by activated macrophages and endothelial cells, which enhance leukocyte and sustain the inflammatory milieu in the initial 24-72 hours. The extravasated RBCs undergo in the tissue, releasing that is subsequently phagocytosed by infiltrating macrophages. Within these cells, enzymatic degradation occurs: heme oxygenase-1 converts hemoglobin-derived into , which is then reduced to by biliverdin reductase, initiating the biochemical changes responsible for the bruise's evolving discoloration. The timing and visibility of the bruise are influenced by the injury's depth within tissue layers. Subcutaneous injuries, occurring just beneath the , allow rapid of to the surface due to minimal overlying barriers and lower , often becoming apparent within hours. In contrast, deeper lesions in intramuscular or subfascial tissues exhibit delayed appearance, typically 12-48 hours post-injury, as must migrate upward against gradients and through denser planes before reaching the skin.

Healing and Resolution Process

Following the initial formation of a bruise through vascular leakage and , the begins with the clearance of extravasated blood components via . Macrophages migrate to the site and engulf damaged red blood cells and debris, breaking down into biliverdin, , and eventually over approximately 5-10 days. This phagocytic activity results in deposition within macrophages, leading to the characteristic temporary yellow-brown pigmentation observed in resolving bruises. As clearance progresses, tissue repair mechanisms activate to restore the and vascular integrity. Fibroblasts proliferate and synthesize and other matrix components to rebuild the disrupted , while limited may occur to form new capillaries if significant vascular damage is present. These processes typically lead to full resolution of a bruise within 2-4 weeks, with color progression from purple-blue to green-yellow reflecting the enzymatic degradation and of breakdown products. Several factors influence the efficiency of this resolution. In older individuals, healing is often slower due to age-related reductions in collagen production and impaired fibroblast function, prolonging the presence of pigmentation and tissue recovery. Bruises in areas with robust blood supply, such as the face, tend to resolve more quickly than those in less vascular regions like the lower legs, owing to enhanced oxygen delivery and cellular activity. Nutritional status also plays a role; adequate vitamin C intake supports collagen synthesis by fibroblasts, potentially accelerating matrix repair and overall healing. Reabsorption dynamics further shape recovery, with facilitating the downward drainage of and products in dependent limbs like the legs, which can influence the bruise's spread and eventual clearance. In severe contusions involving deeper tissue damage, persistent inflammation may lead to , where excessive activity results in scar-like deposition that hinders complete restoration.

Diagnosis

Clinical Evaluation

Clinical evaluation of a bruise begins with a comprehensive history to elucidate the and rule out underlying disorders. Clinicians inquire about the onset and timing of the bruise, details of any preceding trauma including the mechanism and force involved, patterns of recurrence or multiple sites, and associated symptoms such as epistaxis, gingival bleeding, or that may indicate a . A thorough review is essential, focusing on anticoagulants, antiplatelet agents like aspirin, nonsteroidal drugs, or supplements that could predispose to easy bruising. Family history of bleeding tendencies and recent illnesses or procedures are also assessed to identify potential inherited or acquired conditions. The physical examination focuses on non-invasive bedside assessment to characterize the bruise and detect systemic involvement. Inspection evaluates the bruise's location, pattern (e.g., linear or grip-like suggesting non-accidental injury), size, and color evolution, which typically progresses from red to purple, green, and yellow over days to weeks. Palpation assesses depth, underlying fluctuance, tenderness, and crepitus, while avoiding excessive pressure to prevent further extravasation. Vital signs are checked for signs of hypovolemia or infection, such as tachycardia or fever. If the bruise overlies a nerve distribution, a pinprick test using a sterile needle can evaluate sensory integrity to identify associated neuropathy. In vulnerable populations like children or the elderly, a full skin survey is performed to document all lesions. Tools such as the TEN-4-FACESp rule, a validated screening tool for children under 4 years, assist in identifying bruising patterns suggestive of abuse. The rule flags high-risk bruising including any bruise in infants ≤4 months, bruising to the torso, ears, or neck (TEN); bruising to the frenulum, angle of jaw, cheeks, eyelids, or subconjunctivae (FACES); and patterned bruising (p). Red flags warranting urgent further investigation include multiple unexplained bruises, particularly in various stages of healing; lesions in protected areas like the back, , or inner arms where accidental trauma is unlikely; or spontaneous bruising without trauma history. In non-mobile infants (typically under 6-9 months, particularly under 4-5 months), bruises are uncommon and warrant medical evaluation for potential abuse, bleeding disorders (e.g., vitamin K deficiency bleeding in newborns without prophylaxis), or other conditions. Bruises in newborns (first few weeks) attributable to birth trauma (e.g., on the head, face, scalp, or limbs) are often normal and benign, resolving spontaneously. Any bruise in a non-mobile infant raises suspicion for , with specific concern for bruises on the torso, ears, neck, face (including cheeks, eyelids, frenulum), buttocks, or genitalia; patterned bruises (e.g., handprints, bites); multiple or large bruises; or bruises inconsistent with the child's developmental stage or explained cause. In the elderly, bruising may signal frailty, , or elder mistreatment. These findings prompt consideration of non-traumatic causes such as coagulopathies or malignancies. Differentiation from other conditions relies on clinical features and evolution. Bruises (ecchymoses, >1 cm) result from trauma and change color over time, unlike petechiae (<3 mm, flat red spots from rupture, often platelet-related) or (3-10 mm, non-blanching due to vessel fragility). Fractures may present with overlying bruises accompanied by focal bony tenderness, , or limited , distinguishing them from soft-tissue contusions.

Diagnostic Tests

Diagnostic tests for bruises are indicated when clinical evaluation reveals red flags suggesting an underlying , nutritional deficiency, or other systemic issue beyond simple trauma. These objective assessments help quantify severity, identify contributing factors, and guide further management. evaluations form the cornerstone, followed by if structural damage is suspected, with invasive procedures like reserved for atypical presentations. Blood tests begin with a complete blood count (CBC), which evaluates for or by measuring levels, , and platelet counts; low platelets below 150,000/μL may indicate increased bruising risk due to impaired clot formation. A coagulation panel, including (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), assesses the extrinsic, intrinsic, and common pathways of ; prolonged PT suggests factor VII deficiency or issues, while extended aPTT points to deficiencies in factors VIII, IX, or XI. Platelet function assays, such as platelet function analyzer () or light transmission aggregometry, detect qualitative defects like or drug-induced dysfunction by evaluating platelet aggregation response to agonists like ADP or . Specific assays target potential clotting abnormalities or deficiencies. Fibrinogen levels measure the concentration of this key clotting protein, with values below 150 mg/dL indicating hypofibrinogenemia that can exacerbate bruising; testing detects degradation products to evaluate for (DIC) or , where elevated levels above 500 ng/mL signal activity. For nutritional causes, plasma vitamin C levels below 0.2 mg/dL confirm , which manifests as perifollicular hemorrhages and easy bruising due to synthesis impairment; vitamin K status is inferred from prolonged PT with normalization after a vitamin K challenge (e.g., 5–10 mg intravenously), as direct assays are less routine but may show levels under 0.5 nmol/L in deficiency states leading to hemorrhagic tendencies. Imaging modalities assess bruise extent and complications non-invasively. is preferred for superficial , providing real-time evaluation of depth, volume, and vascular flow with high sensitivity for fluid collections; it uses a high-frequency linear (7-12 MHz) to delineate echolucent areas without . is indicated if is suspected alongside bruising, revealing bony discontinuities or formation in the affected region with standard anteroposterior and lateral views. For deeper involvement, () excels in visualizing , muscle tears, or changes using T2-weighted sequences to highlight hyperintense signals; computed tomography (CT) is useful for acute or osseous pathology, detecting hyperdense acute or with multiplanar reformats. Biopsy is rarely performed for routine bruises but is considered in cases of recurrent or atypical bruising suspicious for or . For suspected cutaneous , a 4-mm punch of a fresh (within 24-48 hours of onset) is obtained under , with samples sent for and direct to identify leukocytoclastic changes or immune deposits; this confirms diagnoses like IgA when clinical features alone are inconclusive. In rare instances of -related bruising, such as leukemia-associated or paraneoplastic , skin or may be pursued; the procedure involves excisional sampling of persistent lesions for microscopic examination of atypical cells or infiltrates, often guided by prior imaging.

Treatment and Management

Initial Care

The initial care for a common bruise focuses on reducing , swelling, and further through the RICE protocol, which stands for , , compression, and . involves avoiding use of the affected area to prevent additional trauma and allow initial to begin. should be applied using a cloth-wrapped pack for 15-20 minutes every 2-3 hours during the first 24-48 hours to constrict blood vessels and minimize swelling. For bruises on the face, apply a cold compress (ice wrapped in a cloth) for 10-15 minutes, repeating several times in the first 24-48 hours to reduce swelling and bruising. Ensure the compress is not applied directly to the skin to avoid cold injury. Compression with an helps limit fluid buildup, but it must be snug without cutting off circulation. Elevation of the bruised area above heart level, when possible, promotes drainage of excess fluid and reduces . For pain management, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen at 400 mg every 4-6 hours as needed may be used if there are no contraindications like stomach ulcers or kidney issues, as it addresses both and . Aspirin should be avoided, as it can exacerbate and prolong bruising due to its stronger antiplatelet effects. Acetaminophen is a suitable alternative for without the blood-thinning risks associated with NSAIDs. Monitoring the bruise is essential to detect any complications early; seek medical attention if the bruise increases in size, shows no signs of fading after 2 weeks, or is accompanied by severe pain, numbness, or swelling that worsens. Symptoms like persistent swelling may indicate an underlying issue requiring professional evaluation. Home remedies such as gel or supplements have been explored for bruise relief, but evidence for their efficacy is limited and mixed, with some studies showing minor reductions in swelling while others find no significant benefit over . For topical application of arnica gel, a thin layer can be applied to the affected area, including the face, 2-3 times per day and gently massaged in, avoiding contact with eyes and mucous membranes; consult a healthcare provider before use on the face. These should not interfere with standard healing processes and are best used as adjuncts rather than primary treatments. After the first 48 hours, warm compresses applied for 15-20 minutes several times a day can promote circulation and aid in the reabsorption of blood.

Advanced Interventions

For severe or expanding hematomas associated with bruises, needle aspiration may be performed to relieve pressure and alleviate pain, typically under guidance to minimize complications. This procedure involves inserting a large-bore needle (e.g., 16-gauge) connected to a to withdraw liquefied blood, often repeated if reaccumulation occurs, though it carries risks such as or rebleeding due to the invasive nature. Aspiration is indicated when the hematoma causes significant tension, neurovascular compromise, or failure to respond to conservative measures, but it is generally reserved for subcutaneous or intramuscular collections in contusions rather than routine use. Pharmacological interventions target underlying coagulopathies contributing to severe bruising. In cases of vitamin K deficiency leading to excessive bruising, subcutaneous or intravenous injections of vitamin K1 (phytonadione) at doses of 1-10 mg can correct impaired clotting factor synthesis and promote hemostasis, with effects observable within 6-24 hours. For patients on anticoagulants like unfractionated heparin experiencing bleeding manifestations such as large bruises, protamine sulfate serves as a specific reversal agent, administered intravenously at 1-1.5 mg per 100 units of heparin to neutralize its effects rapidly within minutes and halt ongoing hemorrhage. These agents are indicated only when diagnostic evaluation confirms deficiency or iatrogenic coagulopathy, and dosing must account for heparin half-life to avoid over-reversal. Surgical options are employed for life-threatening complications from bruises, such as arising from intramuscular that elevate intracompartmental pressure. Emergent with evacuation is the definitive treatment, involving longitudinal incisions to release fascial compartments and direct removal of clotted blood to restore and prevent irreversible muscle . Indications include clinical signs of neurovascular compromise, such as severe on passive stretch, , or absent pulses, often confirmed by intracompartmental pressure measurements exceeding 30 mmHg. For expanding or organized without , ultrasound-guided minimally invasive evacuation using a small incision and arthroscopic tools can decompress the area, particularly in athletes, though it requires expertise to avoid iatrogenic muscle injury. Supportive therapies enhance recovery in complicated cases. Hyperbaric oxygen therapy (HBOT), involving 100% oxygen at 2-3 atmospheres for 90-minute sessions, is utilized for non-healing bruises or chronic hematomas in diabetic patients by improving tissue oxygenation, reducing , and promoting in hypoxic wounds. Clinical evidence supports its use in diabetic foot ulcers, which may include bruised or hematomatous components, showing increased healing rates (up to 66%) and reduced major amputations compared to standard care. is essential for restoring mobility after severe muscle contusions, incorporating progressive exercises, stretching, and modalities like or starting 5-7 days post-injury to rebuild strength, prevent , and facilitate return to function without stiffness. These interventions are tailored based on diagnostic imaging and clinical progress to optimize outcomes in non-resolving cases.

Complications and Prognosis

Potential Complications

While most bruises heal without issue, certain complications can arise, particularly if the injury involves broken skin or underlying vulnerabilities. Infection, such as , may develop when bacteria enter through an associated open wound or abrasion accompanying the bruise. This bacterial infection of the deeper skin layers presents with signs including increasing redness, warmth, swelling, fever, and chills. The risk is notably higher in individuals with due to impaired and poor , with diabetes patients facing up to an 80% lifetime chance of skin complications, many of which are skin and infections. Compartment syndrome represents a serious acute complication from severe muscle contusions or deep bruises, where and swelling cause pressure buildup within the fascial compartments of the limbs. This elevated intracompartmental pressure, often exceeding 30 mmHg, compromises blood flow, leading to muscle and ischemia. If untreated, it progresses to tissue necrosis, potential , and even ; urgent surgical intervention via is required to relieve pressure and restore , ideally within 6 hours for optimal limb salvage. Chronic effects can emerge from deeper or extensive bruises, including post-inflammatory , where residual discoloration persists due to deposition in the healing skin. may also occur in subcutaneous tissues following , resulting in localized and formation of firm lumps or oil cysts that typically resolve spontaneously but can mimic more serious conditions. In rare cases, deep muscle bruises lead to , a benign heterotopic where bone forms within the , causing persistent , swelling, and restricted motion; this self-limiting process often requires conservative management with rest, NSAIDs, and , though may be needed if symptoms endure. In patients with bleeding disorders, such as hemophilia or , even minor bruises carry systemic risks, potentially progressing to internal hemorrhage. For instance, retroperitoneal can develop from unchecked bleeding into the , leading to hemodynamic instability, , and shock if the accumulation is significant. Prompt recognition and hemostatic management are essential to prevent life-threatening expansion.

Factors Affecting Outcome

Several patient-specific factors influence the duration and quality of bruise recovery. Advanced age is associated with prolonged times due to thinner , reduced production, and diminished elasticity, often extending resolution beyond two weeks in elderly individuals compared to one to two weeks in younger adults. Comorbidities such as impair vascular function and , significantly delaying bruise resolution, potentially taking up to twice as long or more through mechanisms like hyperglycemia-induced and poor tissue . Poor nutritional status, particularly deficiencies in or iron, exacerbates bruising susceptibility and extends recovery by hindering synthesis and oxygen transport, as seen in cases of where supplementation rapidly improves outcomes. The characteristics of the injury itself also play a critical role in outcome. Superficial bruises, involving only the skin's outer layers, typically resolve within one week through natural of extravasated , whereas deeper contusions affecting muscle or can take four to six weeks or longer due to greater volume and slower clearance. Location matters as well; bruises on the head or carry higher risks for concealed complications like underlying expansion, potentially prolonging monitoring and resolution compared to extremity injuries, owing to anatomical constraints on dispersal and proximity to vital structures. External lifestyle factors can either hinder or support bruise healing. Smoking impairs circulation by vasoconstriction and reduces oxygen delivery to tissues, thereby slowing the breakdown of hemoglobin and extending recovery times. Similarly, alcohol consumption exacerbates initial bleeding through platelet dysfunction and delays subsequent repair by disrupting inflammatory and proliferative phases of healing. On the positive side, adequate hydration promotes tissue perfusion and waste clearance, facilitating faster resolution when combined with elevation and rest. Prognostically, most minor bruises resolve completely without scarring or long-term sequelae, reflecting the body's efficient macrophage-mediated clearance of extravasated .

Prevention

General Strategies

Preventing bruises, which often result from traumatic impacts to soft tissues, involves adopting protective measures during high-risk activities such as . Wearing appropriate protective gear, including helmets and padding, significantly reduces the incidence of contusions in contact ; have been shown to lower rates by 56% during falls. Similarly, non-slip plays a crucial role in averting falls that lead to bruising, with slip-resistant soles reducing slip incidents by 37% among workers in slippery environments, a benefit that extends to older adults navigating daily hazards. Modifying the home environment to eliminate common tripping hazards is another effective strategy for bruise prevention across all ages. Securing or removing loose rugs and clutter from walkways can minimize fall risks, as environmental interventions targeting such obstacles have been associated with overall reductions in fall-related injuries. Improving , particularly in hallways and stairways, further enhances and has demonstrated a 43% decrease in fall rates among older adults in care settings, underscoring its value for those prone to low-light accidents. Adhering to safe activity guidelines helps build resilience against impacts that cause bruising. Gradually increasing allows muscles and joints to adapt, reducing the likelihood of accidental trauma during physical exertion. Incorporating balance training into routines is particularly efficacious, with programs that include such exercises lowering fall rates by 24% in community-dwelling older adults. For individuals with , hip protectors offer targeted protection, reducing hip fracture risk by up to 60% when properly worn during falls, thereby mitigating associated bruising from impacts. Maintaining optimal bone health through lifestyle choices supports the body's ability to absorb minor impacts without severe bruising. Adequate intake of calcium and promotes , which can moderate bone loss and enhance skeletal resilience to trauma, as evidenced by studies showing a 1-2% increase in density with supplementation in older women. A balanced diet rich in vitamins and can also help prevent easy bruising by supporting strength and clotting function, particularly in those at risk of deficiencies.

Special Considerations

In pediatric care, preventing bruises requires tailored strategies emphasizing supervision and education. Close adult supervision during playtime helps mitigate accidental impacts that commonly cause bruising in young children, as unsupervised activities increase the likelihood of falls or collisions on playgrounds and at home. Additionally, proper use of age-appropriate car seats reduces the risk of crash-related injuries, including bruising, by 71–82% compared to use alone, according to data from the Centers for Disease Control and Prevention. Abuse prevention education for parents and caregivers is vital, as unexplained or patterned bruising often signals physical maltreatment, and community programs promoting recognition of such signs have been shown to facilitate early intervention. For older adults, who face heightened bruising risks due to fragile and balance issues, prevention focuses on environmental and safeguards. Routine fall risk assessments by healthcare providers identify modifiable factors like poor lighting or uneven surfaces, enabling targeted home modifications that can reduce falls, with studies showing up to 31% fewer falls in intervened groups. Assistive devices, such as walkers or canes fitted to the individual's needs, may provide stability and help reduce fall risk when used correctly, though improper fitting can exacerbate risks and evidence on overall effectiveness is mixed. Medication reviews are particularly critical for those on anticoagulants, as these drugs amplify bruising and from minor trauma; guidelines recommend balancing stroke prevention benefits against fall-related hemorrhage risks through dose adjustments or alternatives. Patients with underlying medical conditions demand specialized preventive measures to avoid excessive bruising. For individuals with hemophilia, avoiding high-contact like football or wrestling is a cornerstone recommendation, as these activities heighten the chance of traumatic bleeds manifesting as deep bruises; instead, low-impact options such as are encouraged to maintain fitness without undue risk. Similarly, long-term users, whose skin thins and bruises easily, benefit from diligent routines, including daily application of moisturizers, sun protection via broad-spectrum sunscreen or clothing, and gentle handling to preserve dermal integrity. In occupational settings, particularly where blunt force traumas are prevalent, customized safety protocols yield measurable reductions in bruising and related injuries. Employers implementing padding on tools and machinery, alongside mandatory like padded vests and helmets, address impact hazards directly; for instance, such measures have contributed to reductions exceeding 30% in certain injury types like falls in high-risk environments. Broader adoption of training and risk mitigation strategies, including site-specific hazard analyses, has been associated with up to 50% fewer workplace injuries across industries, underscoring the value of compliance with standards from bodies like the .

Historical and Linguistic Aspects

Historical Perspectives

In , medical texts such as the , dating to approximately 1550 BCE, documented treatments for wounds and injuries, including abrasions and bruising, using natural substances like , which was applied topically to promote healing and reduce inflammation. This approach reflected early empirical observations of 's antibacterial and soothing properties, often combined with grease or lint for dressings. Around 400 BCE, , the foundational figure in Western medicine, described ecchymoses—subcutaneous hemorrhages manifesting as "black and blue marks" on the skin—in the context of injuries such as fractures and contusions, within the framework of humoral theory where imbalances in the four bodily humors (blood, phlegm, yellow bile, and black bile) contributed to disease and injury outcomes. These views integrated injury with humoral theory, guiding initial assessments and interventions focused on restoring balance through diet, purgatives, or rest. During the medieval and periods, European medicine continued to rely on humoral principles, employing to treat inflammatory conditions and perceived excesses of humors associated with swelling from trauma. Practitioners used lancets or leeches to draw blood from specific veins, aiming to reduce and prevent complications like suppuration in injured areas, a practice documented in surgical texts and widely applied across social classes. In the , challenged some Galenic traditions by emphasizing chemical and herbal remedies, advocating poultices from various plants to treat injuries, promote resorption of extravasated blood, and accelerate healing without invasive procedures. His approach shifted focus toward specific, plant-based applications tailored to the injury's nature, influencing practices and early . The marked a transition to cellular , with Rudolf Virchow's seminal work in the providing the foundation for understanding bruises and other injuries as resulting from mechanical damage to cells and vessels, leading to of blood cells into surrounding tissues, detailed through microscopic examination and studies. This cellular perspective replaced humoral explanations with verifiable mechanisms, enabling more precise of bruise from to , , and based on breakdown. The discovery of X-rays by in 1895 further advanced diagnosis by revealing underlying skeletal injuries often accompanying severe bruises, such as fractures undetectable by external inspection alone. In the , milestones in addressed pathological bruising, particularly in hemophilia; discoveries in the 1910s identified prothrombin's role in clotting, while the 1930s saw isolation of antihemophilic globulin () from plasma, allowing targeted transfusions to prevent spontaneous or trauma-induced ecchymoses in affected individuals. Post-1960s, increasingly utilized bruise analysis in investigations, following C. Henry Kempe's 1962 description of the "battered ," where patterns, ages, and distributions of bruises provided critical evidence of non-accidental injury, prompting mandatory reporting laws and multidisciplinary protocols.

Etymology and Pronunciation

The English word "bruise" originates from the verb brȳsan or brysan, meaning "to crush" or "to injure by pounding," which derives from the Proto-Germanic root brusjaną ("to crush") and ultimately from the bhreu- ("to smash, cut, or break up"). By the period (circa 1100–1500 CE), the term had evolved into "brusen" or "bruisen," referring to the resulting mark or discoloration from such an injury, influenced partly by Anglo-French bruiser ("to break" or "smash"), possibly of Celtic origin. Related medical terminology includes "contusion," which entered English around 1400 from contusion, borrowed from Latin contūsiōnem (accusative of contūsiō), the noun form of contundō ("to beat" or "to pound"), composed of com- ("together") and tundō ("to beat"), thus literally denoting a crushing or bruising without breakage. Another term, "ecchymosis," dates to the mid-16th century via New Latin ecchymōsis, directly from ekkhúmōsis ("" or "pouring out"), derived from ekkhéō ("to pour out"), combining ek- ("out") and khéō ("to pour"), emphasizing the seepage of into tissues. In pronunciation, "bruise" is typically rendered as /bruːz/ in both American and , though some British dialects may approximate /bruːs/ with a shorter or unvoiced ending; the noun and verb forms share this phonetic pattern. For "ecchymosis," the standard medical pronunciation is /ˌɛkɪˈmoʊsɪs/ in (often vocalized as "ek-ih-MOH-sis") and /ˌɛkɪˈməʊsɪs/ in , reflecting its Greek roots with stress on the third . Historically, "bruise" has been synonymous in and literature with descriptive phrases like "black-and-blue," evoking the discoloration stages of the injury, as seen in medieval texts and proverbs where such marks symbolized misfortune or rough handling.

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  149. https://pmc.ncbi.nlm.nih.gov/articles/PMC4623854/
  150. https://www.etymonline.com/word/bruise
  151. https://ahdictionary.com/word/search.html?q=bruise
  152. https://www.oed.com/dictionary/bruise_v
  153. https://www.merriam-webster.com/dictionary/bruise
  154. https://www.etymonline.com/word/contusion
  155. https://en.[wiktionary](/page/Wiktionary).org/wiki/contusion
  156. https://en.[wiktionary](/page/Wiktionary).org/wiki/ecchymosis
  157. https://www.dictionary.com/browse/ecchymosis
  158. https://dictionary.cambridge.org/us/pronunciation/english/bruise
  159. https://www.oxfordlearnersdictionaries.com/us/definition/english/bruise_1
  160. https://www.merriam-webster.com/dictionary/ecchymosis
  161. https://www.oed.com/dictionary/ecchymosis_n
  162. https://www.wordhippo.com/what-is/another-word-for/bruise.html
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