Exam

Contusion

Contusion, Bruise, Soft Tissue Hematoma, Subcutaneous Hematoma, Subepidermal Hemorrhage, Bruising, Hematoma

Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue

Does not blanch on pressure
1. Contrast with a Vascular Skin Reaction (Erythema Multiforme, Urticaria) which does blanch
2. Compare with Purpura or Ecchymosis which like a Contusion does not blanch
Color (unreliable as an indicator of injury timing)
1. Days 0-2: Swelling and tenderness
2. Days 2-5: Red, blue or purple coloration
3. Days 5-7: Greenish hue
4. Days 7-10: Yellow appearance
5. Days 10-14: Brown discoloration
6. Days 14-32: Clear appearance
Evaluate associated injuries
1. Include examination of joint above and below the involved joint
2. Include sensory, motor and vascular exam
3. Include skin and compartment exam
4. Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas

Purpura or Ecchymosis
1. Non-Traumatic lesions that also do not blanch on pressure

Always evaluate for more significant underlying injury
1. Fracture
2. Vascular compromise
3. Neurologic deficit
4. Compartment Syndrome
5. Tendon rupture
6. Ligament tear with joint instability
Unexplained Bruising may be a sign of Child Abuse, Domestic Abuse or Elder Abuse
1. Consider in Bruising outside of bony prominences (e.g. lateral arms, face, back)