Bruises and Sprains: How to Recognize and Treat Blunt Injuries and Bruises

A contusion (ICD code T14.05) is a blunt injury without an open skin wound. The skin remains intact on the outside, although underlying structures may be damaged. The skin, fatty tissue, muscles, tendon insertions, or a joint are often affected. The blunt force causes damage to small blood vessels as well as blood and lymph vessels, disrupting blood flow. This leads to bleeding, fluid accumulation, and the formation of a bruise.

This type of injury is generally harmless. Although it is accompanied by pain and temporary tissue damage, it usually heals on its own.

A mild contusion often causes only brief discomfort. A severe contusion or a bone contusion, on the other hand, can be painful for a longer period and should be evaluated by a doctor.

A bruise is a common symptom of a contusion © frenta / Fotolia

Such injuries are usually caused by direct impact. Typical causes include falls, blows, kicks, a finger getting caught, or being struck by a falling object.

Sports enthusiasts, in particular, are at a higher risk for contusions or sprains. This is especially true for contact sports such as soccer, handball, or ice hockey. 

Whether from a fall while cycling or a ball hitting the eye during tennis, contusions are among the most common sports injuries of all.

Athletes should therefore protect themselves well. Depending on the sport, there are various types of protective gear, such as

• helmets
• back protectors, or
• shin guards

In the thigh area, a muscle contusion is colloquially referred to as a “horse bruise.” This can result in a hematoma forming between individual muscle fibers, causing the muscle to harden painfully and leading to bruising.

Areas of the body where bones are covered only by a thin layer of skin and tissue—such as the shin, elbow, or knee—are particularly susceptible to bruises and fractures. 

A contusion is typically accompanied by pain of varying intensity. Other typical symptoms include tenderness and swelling caused by a hematoma.

The pain varies depending on the affected area of the body: 

• Joint contusions cause pain that worsens with movement.
• Bruises on the back can cause pain when walking or sitting.
• With coccyx contusions, sitting is particularly difficult.
• Skull contusions can cause headaches, among other symptoms; however, they can also lead to serious symptoms such as loss of consciousness and seizures. In such cases, medical treatment should be sought immediately.
• Contusions of the eyeball can impair vision.
• If the ribs or chest are bruised, those affected often experience pain when breathing in and coughing. A bruised rib can be extremely painful, even if there is no fracture.
• A knee contusion can lead to pain during movement, tenderness, visible swelling, or a bruise.

How is a contusion visible externally?

Joint contusions often result in a bruise within the joint capsule. Externally, this is indicated by

• swelling of the joint,
• marked tenderness, and
• the formation of a bruise

. The area where the greatest force was applied is sometimes also visible, as the skin there may be reddened and swollen. Medical professionals also refer to this skin change as a contusion mark. What is typical of a contusion mark, however, is that the skin remains intact on the outside. If, on the other hand, there is an open skin wound, the condition is referred to as a bruise.

Virtually any part of the body can be affected by a contusion, though the most common are the superficial parts of the body. However, internal organs can also be contused, although this generally requires a significantly greater force. Examples of organ contusions include

• liver or spleen contusions from blows to the abdomen (e.g., from falling onto a bicycle handlebar) or
• lung contusions following a fall onto the chest.

What are the most common contusions?

Areas of the body—and especially bones—that are covered only by a thin layer of skin are particularly susceptible to bruising. The most common types of bruises are therefore

• rib contusions
• Knee contusion 
• Skull contusion
• Shoulder contusion
• Elbow contusion
• Foot contusion

If it is just a simple contusion with mild pain, a visit to the doctor is not necessary. In these cases, the symptoms of contusions usually resolve on their own within a few days, or within two to three weeks at the latest.

However, if you experience severe and persistent pain that does not improve significantly within a few days and may be accompanied by other symptoms, you should definitely see a doctor. There is a risk that this is not just a simple contusion, but rather a more serious injury. Possible examples include a broken bone, a torn tendon, or a torn ligament.

If the skull is involved, there may also be brain damage, particularly a concussion (commotio), and you should generally seek medical advice.

First and foremost, it is particularly important to inquire about the circumstances of the accident, also known as the accident history. You will first be asked how the injury occurred and what specific symptoms have arisen. Questions about pre-existing conditions and the use of specific medications are also part of the medical history.

The affected area should be rested, cooled, and monitored. You should see a doctor if you experience severe pain, increasing swelling, numbness, persistent limited mobility, large hematomas, a suspected fracture, or if your symptoms do not improve significantly within a few days.

Particularly in cases of head injuries, it is very important to know whether the patient is taking blood-thinning medications, as these can cause internal bleeding within the skull that is not visible from the outside. This bleeding can cause serious complications—particularly, though not exclusively, in older patients—and may be fatal. 

After taking the medical history, a physical examination is performed. Ideally, this begins at a slight distance from the injury site, as the bruised areas are often very painful. 

Specifically, the following are checked:

• there is swelling,
• fluid accumulation, such as joint effusions, is present,
• the injured area is tender to pressure, and
• whether the patient’s range of motion is limited.

An ultrasound examination (sonography) is helpful when joint effusions or injuries to the muscles and their bony attachments (tendons) are suspected; it is quick to perform and has no significant side effects.

If a bone fracture is suspected, an X-ray is taken. To rule out ligament injuries or if a brain contusion is suspected, additional imaging procedures may be used. These include, for example, a CT (computed tomography) scan or an MRI (magnetic resonance imaging).

A contusion rarely requires invasive (= surgical) treatment; the measures used are generally symptomatic, which means they relieve pain and support healing. The so-called RICE rule has proven effective here:

• P - Rest
• E – Ice
• C - Compression
• H - Elevation

Rest, especially from sports activities, goes without saying, as certain movements and physical activities can worsen pain symptoms and should therefore be avoided voluntarily. Sports should be off-limits for the time being after a contusion. Only once the contusion has fully healed can you resume physical activity. 

Cooling the affected area is also advisable, as it relieves pain and reduces swelling. This can be done, for example, with

• a cold pack
• a cold washcloth, or
• ice cubes wrapped in a cloth

.

For bruises on the extremities, you should apply an elastic compression bandage. Afterward, elevate the arm, foot, or leg, as this helps reduce swelling and alleviate pain. 

Pills or ointments can help relieve pain. An anti-inflammatory ointment containing ibuprofen or a herbal preparation with arnica is often available at the pharmacy. If you are treating a bruise, you should not take pain relievers long-term without consulting a doctor. If symptoms are severe or worsening, medical treatment is necessary. Severe bruises, eye injuries, head injuries, or bruises to an organ may require inpatient monitoring.

When is inpatient treatment at a hospital necessary?

Medical treatment depends on the type and severity of the contusion. For example, in the case of a contusion of the eyeball, special medications may be required that can only be administered under inpatient supervision. These medications lower intraocular pressure. If the retina has detached, surgery is usually unavoidable.

In the case of a concussion (commotio), the patient is usually admitted to the hospital for a few days (at least 24 hours).

This ensures that staff can act quickly in the event of severe symptoms or a worsening of the patient’s condition. In particular, the use of blood-thinning medications should prompt prompt and very generous inpatient monitoring.

The healing process depends on the severity and the affected area of the body; a simple contusion often subsides significantly after a few days. As a rule, the injury heals completely within 2–3 weeks without serious consequences.

In cases of severe injuries, deep muscle contusions, or large bruises, healing can take more than a month. A muscle contusion, rib contusion, or knee contusion can also cause symptoms for a longer period because the affected area and surrounding tissue are constantly moved or stressed during daily activities.

It is important to resume physical activity gradually. Pain and other symptoms are warning signs. If you exercise too soon, you risk causing the bruises to bleed further and delaying the healing process.

For an initial assessment, general practitioners, orthopedic surgeons, trauma surgeons, and sports medicine specialists are appropriate points of contact.

For eye injuries, an ophthalmologist should be consulted; for head injuries, depending on the severity, an emergency room or neurology department should be sought. 

Organ contusions should be treated by experienced trauma surgeons or internal medicine specialists.

Specialists determine whether the injury is indeed just a contusion or if there are accompanying injuries. These include ligament injuries, tendon tears, bone fractures, joint effusions, or internal injuries. This helps prevent complications and ensures the appropriate treatment is initiated.

What provides the fastest relief from symptoms?

The most important steps are rest, ice, compression, and elevation, following the RICE protocol. Pain relievers can also help. If symptoms are severe, you should see a doctor to determine whether there is more than one contusion.

How can you recognize the injury?

Typical symptoms include pain, tenderness, swelling, and often a hematoma. The skin remains intact. However, a bruise can only be reliably distinguished from a fracture or torn ligament through a medical examination and, if necessary, imaging.

When should you see a doctor?

It’s advisable to see a doctor if you experience severe pain, increasing swelling, large hematomas, numbness, limited range of motion, head injuries, eye injuries, or symptoms that do not improve after a few days.

What’s the difference between a bruise and a sprain?

In a contusion, tissue is compressed by direct force. In a sprain, a joint is overstretched. Both injuries can cause similar symptoms.

How long should you avoid sports?

You should take a break from sports until the pain, swelling, and limited range of motion have significantly subsided. Minor bruises often improve after a few days, while more severe injuries may take several weeks to heal.