Bruising is usually a minor problem, which does not require a medical diagnosis. However, when extensive bruising, bruising with no apparent cause, or bruising in certain locations (such as around the ears or the navel) is present, a doctor will evaluate the individual's health using blood tests, such as blood clotting and platelet counts. If the area of the bruise becomes hard, an x-ray may be required.
signs and symptoms
The main symptoms of bruising are pain,
swelling, and skin discoloration. The bruise begins as a pinkish red color that may be very tender to touch. A bruised muscle is often difficult to use. For example, patients may exhibit difficulty walking with a thigh muscle bruise.
Eventually, the bruise changes to a bluish color, then greenish-yellow, and finally returns to the normal skin color as it heals.
Generally, with impacts to the body, the harder force of the impact, the larger the bruise. However, if an individual bruises easily, a minor bump can result in substantial discoloration. Arms and legs are typical locations for bruises.
Bruising may also indicate something more serious, such as a blood-clotting problem, a blood disease, major trauma or injury, or physical abuse. It is recommended by healthcare professionals to see a doctor if: the individual has unusually large or painful bruises, particularly if bruises seem to develop for no known reason; the individual is bruising easily and experiencing abnormal bleeding elsewhere, such as from the nose, gums, or intestinal tract; or the individual has no history of bruising but suddenly experience bruises, particularly if they recently started a new medication.
These signs and symptoms can indicate that the individual has low levels or abnormal function of platelets. Platelets are components of blood that help it clot after an injury.
Bruising that occurs around the navel may indicate dangerous internal bleeding; bruising behind the ear, called Battle's sign, may be due to a skull fracture; and raised bruises may point to autoimmune disease such as systemic lupus erythematosus (lupus).
Occasionally, the area of a bruise will become firm and may actually start increasing in size instead of going away. The bruise may also continue to be painful. There are two major causes for a bruise that gets worse. First, if a large collection of blood is formed under the skin or in the muscle, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood. Hematomas may need to be drained by a healthcare professional.
Getting prompt medical treatment and following a doctor's advice about rehabilitation can help an individual avoid serious medical complications that occasionally result from deep muscle contusions and bruises. These complications include compartment syndrome and myotosis ossificans.
Compartment syndrome: In certain cases, rapid bleeding may cause extremely painful swelling within the muscle group of the arm, leg, foot, or buttock. The build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group underneath the bruise. Compartment syndrome may require urgent surgery to drain the excess fluids.
Myositis ossificans: Myositis ossificans is a condition in which the bruised muscle grows bone instead of new muscle cells. Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop this condition. Symptoms may include mild to severe pain that does not go away and swelling at the injury site. Abnormal bone formations can also reduce flexibility. Vigorous stretching exercises may make the condition worse. Rest, ice, compression, and elevation to reduce inflammation will usually help. Gentle stretching exercises may be used to improve flexibility. Surgery is rarely required.
causes and risk factors
Anyone can get a bruise. Some individuals, including women, are more prone to bruising than are others. Easy bruising in women is thought to be due to hormonal changes. As an individual gets older, several factors may contribute to increased bruising, including aging capillaries and thinning skin. Over time, the tissues supporting these vessels weaken, and capillary walls become more fragile and prone to rupture. During the aging process, the skin becomes thinner and loses some of the protective fatty layer that helps cushion blood vessels against injury. Excessive exposure to the sun can thin the skin much like aging, as does smoking and lack of hydration (water).
Medications: The amount of bruising may also be affected by medications that interfere with blood clotting. Thus, medications may cause more bleeding into the skin or tissues. Certain drugs, medications, substances, and toxins may cause bruising. It is recommended by healthcare professionals to always advise a doctor and/or pharmacist of any medications or treatments being used, including prescription, over-the-counter (OTC), and integrative therapies (including herbs and vitamins). Medications that may cause an increase in bleeding include: blood thinning medications, such as warfarin (Coumadin®), clopedigrel (Plavix®), and aspirin; birth control pills, such as estrogen and progesterone combinations; non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil®), naproxen (Naprosyn®, Aleve®), celecoxib (Celebrex®), and indomethacin (Indocin®); some diuretics (drugs that increase fluid loss), such as furosemide (Lasix®); and corticosteroids or steroids, such as prednisone (Deltasone®).
Certain dietary supplements such as vitamin E, fish oil, ginkgo (Ginkgo biloba), ginger (Zingiber officinalis), and garlic (Allium sativum) also may increase the risk of bruising. These and many other supplements may have a blood-thinning effect. It is highly recommended by healthcare professionals to tell a pharmacist or doctor when taking dietary supplements along with prescription medications, such as those that may thin the blood.
The following are some of the possible causes of bruising as a symptom: sports-related injuries; accidents; falls; physical abuse; bleeding disorders, such as hemophilia and Von Willebrand's disease; Ehlers-Danlos syndrome, which is a genetic defect in collagen and connective-tissue synthesis and structure; immune disorders, such as human immunodeficiency virus (HIV); leukemia (cancer of the blood); liver diseases, such as cirrhosis; drug and alcohol addiction; aplastic anemia (lack of red blood cell production); disseminated intravascular coagulation (DIC, or blood coagulation throughout the body); and scurvy (a condition caused by a lack of vitamin C).