A bruise or contusion or ecchymosis is a kind of injury, usually caused by blunt impact, in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. Normally minor but painful, bruises can be serious, leading to hematoma, or can be associated with serious injuries, including fractures and internal bleeding. Minor bruises are easily recognized by their characteristic blue or purple color in the days following the injury.

The word "bruise" is also used for fruit - a fruit is bruised when an impact breaks the internal water-containing structures, leading to a soft spot. More generally, "bruise" is used metaphorically to mean any minor injury: one's ego might be bruised if one's painting was not included in a gallery showing, for example. The implication is that the injury is minor but painful, but will recover on its own.

The presence of bruises may be seen in patients with platelet or coagulation disorders. Unexplained bruising may be a warning sign of child abuse or serious medical problems, such as leukemia and meningoccocal infection. Anybody with unexplained bruising needs urgent examination by a doctor.


Light bruises

When soft tissue is struck, the effect can vary greatly. The state of the tissue (tensed muscle versus relaxed muscle, for example) can make a large difference to the effects, as can the effect of being crushed against underlying bone. People also vary in the sturdiness of their capillaries - some people bruise more easily than others.

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Bruises change color over time - this one is nine days old.

When struck, the victim normally feels some pain, although it may not be sharp and may even go unnoticed. The flesh quickly becomes red, tender, and swollen (although this, like other effects, varies with the intensity of the bruising). Repeated impacts will aggravate the bruising. Over the course of the next day, blood will seep into the surrounding tissue while the capillaries are being repaired. The bruise will gradually darken. Over the course of a week or two, the bruise will darken to a livid red, then fade to purple, black, or blue, eventually fading to yellow and disappearing as healing progresses. Normal, light bruises heal completely in a week or two; more severe or deeper bruises may take longer. The striking colors of a bruise are due to hemoglobin and its breakdown products, bilirubin and biliverdin.

The treatment for light bruises is minimal. If swelling is severe, the application of ice or the elevation of the affected area may help to reduce swelling. Avoiding re-injury is of course essential to quick recovery, so rest is probably called for; usually the pain of having a bruise bumped is a sufficient reminder, but it is not appropriate to massage the bruised area.

Severe bruises

If bruising is severe, complications may arise. Excess fluid may accumulate, forming a hard lump called a hematoma. Swelling may also be severe, and pain may be a serious problem. If internal bleeding inside the tissue is very severe, compartment syndrome may occur, leading to disrupted blood flow due to swelling; this can require surgery. More seriously, the impacts that cause severe bruising can also cause other damage: impacts to the torso may damage internal organs, and impacts to the head can be very dangerous. Bones may be broken by similar impacts, and joints can be sprained or otherwise damaged as well. The symptoms of these injuries may appear to be those of simple bruising; if there is any possibility of one of these more severe injuries (difficulty moving an injured limb, severe abdominal bruising or a feeling of liquid under the skin) see a doctor immediately.

Treatments for severe bruising can include ice, elevation, rest, painkillers (particularly NSAIDs), and compression bandages. Massaging severe bruises will worsen the injury. Later in recovery, some light stretching exercises may be appropriate, but it is probably best to consult a doctor or physiotherapist about longer-term recovery. If a severely bruised muscle is used too early in the recovery process, bone tissue may be formed inside the muscle, leading to lasting stiffness and pain. Severe bruises can be expected to take longer to heal.

See also

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