DEFINITION--Bruising of skin and underlying tissue of the wrist caused by a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue.
BODY PARTS INVOLVEDWrist tissues, including blood vessels, muscles, tendons, nerves, covering to bone (periosteum) and connective tissue.
SIGNS & SYMPTOMS
Wrist swelling--either superficial or deep.
Wrist pain and tenderness.
Feeling of firmness when pressure is exerted on the injury site.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted wrist motion proportional to the extent of injury.
CAUSESDirect blow to the wrist, usually from a blunt object.
RISK INCREASES WITH
Violent contact sports, especially with inadequate protection of the wrist.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective gear and equipment, such as wrapped elastic bandages, tape wraps or leather gauntlet gloves, during competition or other athletic activity if there is risk of a wrist contusion.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Self-care for minor contusions, and following serious contusions during the rehabilitation phase.
Physical therapy following serious contusions.
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the injured area to assess total injury to soft tissue and to rule out the possibility of underlying fracture. The total extent of injury may not be apparent for 48 to 72 hours.
Excessive bleeding leading to disability. Infiltrative-type bleeding can sometimes lead to calcification and impaired function of injured muscles and tendons.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but the average healing time for a wrist contusion is 2 days to 2 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Wrap an elasticized bandage over a felt pad on the injured area. Keep the area compressed for about 72 hours.
Continue ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling. Stroke from the fingers toward the heart.
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
Injured wrist doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.