Contusion; Hematoma

A bruise is an area of skin discoloration. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin.

There are three types of bruises:

1. Subcutaneous -- beneath the skin
2. Intramuscular -- within the belly of the underlying muscle
3. Periosteal -- bone bruise

Bruises can last from days to months, with the bone bruise being the most severe and painful.

Bruises are often caused by falls, sports injuries, car accidents, or blows received by other people or objects.

If you take a blood thinner, like aspirin or warfarin (Coumadin), you are likely to bruise more easily.

The main symptoms are pain, swelling, and skin discoloration. The bruise begins as a pinkish red color that can be very tender to touch. It is often difficult to use the muscle that has been bruised. For example, a deep thigh bruise is painful when you walk or run.

Eventually, the bruise changes to a bluish color, then greenish-yellow, and finally returns to the normal skin color as it heals.

• DO NOT attempt to drain the bruise with a needle.
• DO NOT continue running, playing, or otherwise using the painful, bruised part of your body.
• DO NOT ignore the pain or swelling.

Call your doctor immediately if you feel extreme pressure in a bruised part of your body, especially if the area is large or very painful. This may be due to a condition known as "compartment syndrome." Increased pressure on the soft tissues and structures beneath the skin can decrease the supply of vital blood and oxygen to the tissues. This is potentially life-threatening and you should receive emergency care promptly.

Also call your doctor if:

• You are bruising spontaneously without any injury, fall, or other reason.
• There are signs of infection around the bruised area including streaks of redness, pus or other drainage, or fever.

1. Place ice on the bruise to help it heal faster and to reduce swelling. Place the ice in a cloth -- DO NOT place ice directly on the skin. Apply the ice for up to 15 minutes per hour.
2. Keep the bruised area raised above the heart, if practical. This helps keep blood from pooling in the bruised tissue.
3. Try to rest the bruised body part by not overworking your muscles in that area.
4. If needed, take acetaminophen (Tylenol) to help reduce pain.

In the rare instance of "compartment syndrome," surgery frequently needs to be performed to relieve the extreme buildup of pressure.

Because bruises are usually the direct result of an injury, the following are important safety recommendations:

• Teach children how to be safe.
• Be mindful to avoid falls around the house. For example, be careful when climbing on ladders or other objects. Avoid standing or kneeling on counter-tops.
• Wear seat belts in motor vehicles.
• Wear proper sports equipment to pad those areas most frequently bruised (thigh pads, hip guards, and elbow pads in football and hockey; shin guards and knee pads in soccer and basketball).

Schafer Al. Approach to the patient with bleeding and thrombosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 178.

Buttaravoli P. Contusion: (Bruise). In: Buttaravoli P, ed. Minor Emergencies. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 137.

Bruises occur when blood vessels break, due to some kind of force, and leak blood into areas under the skin. The main symptoms of a bruise are pain, swelling, and skin discoloration. A bruise begins as a pinkish, red color that can be very tender to touch.

Within hours a bruise will turn into a dark blue or purple color. As the bruise begins to heal it changes colors. The color change is due to the biochemical breakdown of hemoglobin that is found in the blood. As the different components of the blood are broken down, different colors will appear in the bruise.

A bruise first begins as a pinkish, red color, changes to dark blue or purple, fades to violet, green, dark yellow, and turns a pale yellow until it completely disappears. A bruise will usually completely heal in 2 weeks.

Review Date: 05/01/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.