Clinical manifestations
Swelling of the ankle
An ankle bruise can affect different structures of the joint - external, internal. The clinical picture can be observed not only on the surface of the skin. Tendons, synovium, and ligaments are injured. A serious injury disrupts the integrity of blood vessels and even nerve fibers.
In general, the clinical picture appears as follows:
- pain syndrome of varying intensity, which becomes more pronounced with any movement;
- visually noticeable lameness that occurs against the background of the fact that the victim tries to transfer his own weight to a healthy limb;
- hematoma;
- rapidly growing swelling.
Only a traumatologist can correctly interpret the listed signs.
Bruised leg
Common symptoms of bruises are pain, swelling and loss of limb function. Sharp pain occurs at the moment of injury, subsequently decreases within a few hours, and with the development of significant swelling, it intensifies again after a few days. The severity of edema varies significantly. Significant swelling usually occurs when segments with large muscle volume are bruised.
For mild bruises, the swelling is insignificant and disappears after 3-4 days; for severe bruises, the swelling is extensive and increases over 2-3 days. Swelling can be combined with changes in skin color and the formation of subcutaneous and intradermal hemorrhages. The damaged segment first acquires a purple tint, then becomes bluish. Functional limitation is usually moderate.
Hip contusion
Occurs when falling on one side or receiving a direct blow. Usually, soft tissues located in the area of the greater trochanter are affected; areas of other bony protrusions are less often injured: the ischial tuberosity, the iliac crest, or the branch of the pubic bone. It is accompanied by pain, local swelling and limitation of movements of varying severity - from slight stiffness due to fear of increasing the pain syndrome to lameness. The support is preserved. Hemorrhages often form in the affected area. Hematomas are uncommon.
Bruised hip
Hip bruises most often occur as a result of a direct blow from a heavy object. Injury can also be caused by falls during sports, traffic accidents, and other high-energy impacts. In the thigh area there are large, massive muscles with a good blood supply, which determines some of the characteristics of a bruise in this anatomical zone. Such leg bruises are accompanied by significant swelling, extensive hemorrhages and the formation of hematomas. In this case, hematomas can be located both under the skin and in the thickness of the muscles.
The patient complains of pain. With minor bruises, the pain syndrome is local; with severe injuries, the pain is diffuse, spreading over the entire surface of the thigh (front, back or side) with an area of maximum pain at the point of impact. The thigh is enlarged and bruising may be visible on the skin. Movements are limited, support is usually preserved, and lameness is observed. Palpation of soft tissues is painful, there is no crepitus, the symptom of axial load is negative.
Knee contusion
Such leg bruises occur as a result of a fall, or less often – with a direct blow to the knee and are the result of a household or sports injury. Knee bruises are accompanied by swelling, pain, difficulty moving, and sometimes hemarthrosis. Hemorrhages are often detected (usually on the anterior or anterolateral surface of the joint).
Support is preserved, lameness is possible. On palpation, local pain is determined, palpation of the bony protrusions is painless, there is no crepitus. With hemarthrosis, the joint increases in volume and takes on a spherical appearance. Balloting of the patella, a symptom of fluctuation, is detected.
Shin bruise
A shin bruise is most often caused by a direct blow. Swelling, local pain and some limitation of movement are detected. Possible lameness. Hemorrhages may appear on the skin. Hematomas quite often form on the lower leg, as well as on the thigh, but the muscles here are less massive, so hematomas are usually small and easily diagnosed. With severe bruises, soft tissue detachment sometimes occurs.
Bruises of the ankle and foot
Occurs when a heavy object hits or falls. Accompanied by cyanosis, pain and swelling of soft tissues. Bruising often occurs on the skin. Walking is difficult due to the heavy load on the distal part of the foot when rolling, palpation is painful. A characteristic feature of foot injuries is the high intensity of pain caused by tissue tension due to hemorrhage in the subungual bed, soft tissues or the cavity of small joints.
Diagnostics
X-ray of the ankle to identify an injury
The listed clinical signs of an ankle bruise according to ICD-10 are also characteristic of other types of joint injuries. For example, the development of edema, the formation of a hematoma and severe pain often indicate that the victim has torn ligaments or a crack has formed on the surface of the bone that forms the joint. There may have been a fracture of the distal ends of the tibia.
To prescribe the correct therapy, the traumatologist must determine the severity of the ankle injury as quickly as possible.
The main diagnostic method is x-ray examination. The picture will definitely show a fracture or crack. However, it is impossible to identify a ligamentous injury and its degree on an x-ray. For this purpose, a magnetic resonance imaging device is used. MRI images show damage to the joint capsule, blood vessels and ligaments. The extent of the tear can also be determined solely by MRI.
Fact: not all clinics are equipped with expensive MRI machines, so radiography and the professionalism of the traumatologist continue to dominate in the diagnosis of bruises.
First aid
Cold compress on the ankle to relieve swelling
Proper first aid will reduce recovery time.
How to help the victim:
- Apply a tight bandage to the injured limb, which will reliably fix the joint, but will not limit the blood supply. It is most convenient to use an elastic bandage. They need to cover the third part of the lower leg, as well as part of the foot (to the toes);
- for 2-3 hours, apply a cold compress to the bruise site at regular intervals for 20 minutes. Cold spasms blood vessels, which reduces the volume of a hematoma or completely eliminates the possibility of its formation.
It is important to get the victim to the hospital as soon as possible.
In some cases, ankle joint injuries of various ICD-10 codes are supplemented by injuries to other parts of the foot. First aid in this case does not differ from the described algorithm.
S90—S99 Injuries to the ankle and foot area
S90 Superficial injury to the ankle and foot area
- S90.0
Contusion of the ankle joint - S90.1
Bruised toe without damage to the nail plate - S90.2
Bruised toe with damage to the nail plate - S90.3
Contusion of another and unspecified part of the foot - S90.7
Multiple superficial injuries of the ankle and foot - S90.8
Other superficial injuries of the ankle and foot - S90.9
Superficial injury of ankle and foot, unspecified
S91 Open wound of the ankle and foot area
- S91.0
Open wound of the ankle joint - S91.1
Open wound of the toe without damage to the nail plate - S91.2
Open wound of the toe with damage to the nail plate - S91.3
Open wound of other parts of the foot - S91.7
Multiple open wounds of the ankle and foot
S92 Fracture of the foot, excluding ankle fracture
- S92.00
Closed calcaneal fracture - S92.01
Open calcaneal fracture - S92.10
Fracture of the talus, closed - S92.11
Open fracture of the talus - S92.20
Fracture of other tarsal bones, closed - S92.21
Open fracture of other tarsal bones - S92.30
Closed metatarsal fracture - S92.31
Open fracture of the metatarsal bones - S92.40
Closed fracture of the big toe - S92.41
Open fracture of the big toe - S92.50
Fracture of the other toe, closed - S92.51
Open fracture of the other toe - S92.70
Multiple fractures of the foot, closed - S92.71
Multiple open fractures of the foot - S92.90
Foot fracture, unspecified, closed - S92.91
Foot fracture, unspecified, open
S93 Dislocation, sprain and overstrain of the capsular-ligamentous apparatus of the ankle and foot
- S93.0
Dislocation of the ankle joint - S93.1
Dislocation of toe - S93.2
Ligament rupture at ankle and foot level - S93.3
Dislocation of other and unspecified part of the foot - S93.4
Sprain and strain of ankle ligaments - S93.5
Sprain and overstrain of the capsular-ligamentous apparatus of the joints of the toe and toe - S93.6
Sprain and strain of the capsular-ligamentous apparatus of other and unspecified joints of the foot
S94 Nerve injury at ankle and foot level
- S94.0
Injury to the external [lateral] plantar nerve - S94.1
Injury to the internal [medial] plantar nerve - S94.2
Injury to the deep peroneal nerve at the level of the ankle and foot - S94.3
Injury to cutaneous sensory nerve at ankle and foot level - S94.7
Injury to multiple nerves at ankle and foot level - S94.8
Injury to other nerves at ankle and foot level - S94.9
Injury to unspecified nerve at ankle and foot level
S95 Injury to blood vessels at the level of the ankle and foot
- S95.0
Trauma to the dorsal artery of the foot - S95.1
Injury of the plantar artery of the foot - S95.2
Injury to the dorsal vein of the foot - S95.7
Injury to multiple blood vessels at ankle and foot level - S95.8
Injury to other blood vessels at ankle and foot level - S95.9
Injury of unspecified blood vessel at the level of the ankle and foot
S96 Injury to muscle and tendon at ankle and foot level
- S96.0
Injury to the flexor digitorum longus and its tendon at the level of the ankle and foot - S96.1
Injury to the extensor digitorum longus and its tendon at the level of the ankle and foot - S96.2
Injury to intrinsic muscle and tendon at ankle and foot level - S96.7
Injury of several muscles and tendons at the ankle and foot level - S96.8
Injury to other muscle and tendon at ankle and foot level - S96.9
Injury to unspecified muscles and tendons at ankle and foot level
S97 Crushed ankle
- S97.0
Crushing ankle - S97.1
Crushing toe(s) - S97.8
Crush of other parts of the ankle and foot
S98 Traumatic amputation of the ankle and foot
- S98.0
Traumatic amputation of the foot at the ankle level - S98.1
Traumatic amputation of one toe - S98.2
Traumatic amputation of two or more toes - S98.3
Traumatic amputation of other parts of the foot - S98.4
Traumatic amputation of foot, level unspecified
S99 Other and unspecified injuries of the ankle and foot
- S99.7
Multiple ankle and foot injuries - S99.8
Other specified ankle and foot injuries - S99.9
Injury of ankle and foot, unspecified
Possible complications
Arthrosis of the ankle joint
If the victim ignores the injury, severe complications may develop:
- Hemarthrosis (bleeding) forms in the joint cavity. This is a consequence of untreated damage to the joint capsule;
- arthrosis – observed against the background of numerous injuries that were left unattended;
- inflammation of the synovium. Often observed immediately after injury. It can be recognized by swelling and pain with minimal pressure.
Due to the fact that the injury requires restriction of motor activity, a disruption of the blood supply to the limb may occur. If the victim ignores physical therapy, the skin changes color and swelling progresses.
Bruised finger
First aid
First aid for a bruised finger is simple.
If there is a ring on your finger, it must be removed immediately, since due to increasing swelling in the future this will become impossible. Apply ice to your finger or place it under running cold water. Cold water can only be used as a means to relieve acute pain; soaking your finger for a long time (for example, making cold compresses) is not recommended, as this will negatively affect the skin. An ice pack will help narrow the blood vessels, reduce bleeding and prevent severe swelling. If there are small wounds or abrasions in the finger area, they must be treated with iodine or brilliant green. It is not necessary to “cover” the entire finger prophylactically, trying to protect it from infection - this will only complicate the examination by a traumatologist.
If the nail plate is partially detached, the wound should be washed and a bandage applied to avoid further injury. You should not fix the torn part of the nail plate with an adhesive plaster - this increases the risk of it tearing off when removing the bandage. There is also no need to try to open hematomas. After first aid is provided, the patient is taken to the emergency room to exclude more severe injuries (fractures, dislocations).
At the stage of first aid for a bruised toe, the same measures are taken as for a bruised toe: cold, elevated position of the limb, treatment of abrasions with brilliant green or iodine. It should be borne in mind that small wounds on the legs suppurate more often than on the hands, so the finger must be thoroughly rinsed under running water to remove dirt from the area of abrasions. You should not open hematomas yourself. It is necessary to consult a doctor immediately after an injury to rule out more serious injuries.
Specialized treatment
Treatment of finger bruises is carried out on an outpatient basis. Intradermal hematomas are opened; for small subungual hematomas, the nail is pierced with a needle, releasing the accumulated blood. Large subungual hematomas may require nail removal. The patient is advised not to put any strain on the arm, if possible, keep it in an elevated position and apply cold first, and then dry heat. Painkillers are usually not required; in case of severe pain, you can take analgin, ketorolac or any other analgesic once. The period of incapacity for work ranges from 1 to 2-3 weeks.
In case of subcutaneous rupture of the extensor tendon, immediately after the injury, apply a plaster splint or a special bandage, fixing the straightened finger in a state of hyperextension. In some cases, the finger is immobilized, keeping the middle phalanx in flexion and the nail in extension. The immobilization period is 4 weeks. If, after this period, active extension of the finger remains impossible, surgical treatment is indicated - suture of the tendon followed by fixation with a Kirschner wire or plaster splint.
Treatment of bruised toes is outpatient in the emergency room. Subcutaneous and subungual hematomas are opened; for large subungual hematomas, the nail plate is removed and an aseptic bandage is applied. For mild bruises, it is recommended to step on the foot less and maintain an elevated position of the limb. For severe bruises of several fingers, in some cases a plaster cast is applied to ensure rest of the affected segment. For acute pain, it is recommended to take analgesics. The patient is referred to UHF. The period of incapacity for work is usually 1-3 weeks.
Treatment tactics
Therapeutic exercise for quick recovery
Depending on the condition of the victim and the extent of the damage, treatment is possible at home or in the hospital. If hospital treatment is required, the tight figure-of-eight bandage is replaced with a plaster splint.
Regardless of the method of fixing the joint, on the third day it is recommended to begin physical treatment, for example, UHF, ozokerite, thermal baths, phono- and electrophoresis with the use of painkillers. Massage and physical therapy are useful.
If the victim has extensive hematomas with bleeding into the joint cavity, punctures are required to pump out the contents.