Treatment of bruises of soft tissues and joints

Causes

Hemorrhage usually occurs after injury. This could be a bruise of the skin, internal organs, a concussion or bruise of the brain, an injection with thin (sharp) objects. Sometimes blood leaves the vessels and pours into the skin and internal organs as a result of infections, autoimmune diseases, and poisoning. The occurrence of hemorrhages and bruises is promoted by increased fragility of blood vessels, fasting, lack of vitamins in food, high blood pressure, and congenital bleeding disorders.

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Bruises

If we talk about external manifestations, then a clearly defined bruise will be visible. As a rule, it is usually called a bruise. It is blood that pours out from a damaged vessel and permeates the subcutaneous fatty tissue. This bruise becomes visible through the skin. If you look closely at the color of the bruise, you can determine the extent and duration of the injury. If we are talking about bright bruises with purple and red edges, then, as a rule, this indicates that the injury occurred quite recently. If the damage was serious, then the bruise will be more pronounced, and after some time the hematoma begins to acquire a bluish tint.

If a yellow bruise or bruise is visible on a person’s body, this indicates that the patient was injured about 7 days ago. If we are talking about hemorrhage that occurred in the mucous membrane of the eye, then in this case there will be no change in color. Even after several days, the hematoma will remain bright scarlet in color.

It is worth noting that people with thinner tissues are forced to cope with the severe consequences of bruises. On the other hand, those who have a predominance of thick muscle or fat tissue endure injuries much easier.

Symptoms

A bruise on the skin is always clearly visible. At first it has a purplish-blue color, and then begins to “bloom”, acquiring yellow and green colors. If a sufficiently large amount of blood accumulates under the skin, a protruding lump forms. At first it is very painful to feel, but later the pain goes away.

The outpouring of blood into the internal organs and into the substance of the brain is preceded by trauma. The main symptom is pain. In this case, the hematoma is not visible externally. If bleeding continues, the victim becomes pale, weak, and dizzy. With chronic internal bleeding, anemia comes to the fore. Bleeding in the brain is especially dangerous. Compression of brain structures may occur, sometimes leading to death.

What is this type of damage?

If we talk about what soft tissues are, then, by and large, these are almost all those areas of the human body that are skin, cartilage or bones. In turn, a bruise is an injury resulting from the impact of hard, blunt objects. In this case, a violation of the integrity of the skin occurs quite rarely.

As a rule, soft tissue most often includes fatty tissue and also muscle. They suffer to a lesser or greater extent from mechanical effects on the human body. At the same time, soft tissues perform a protective function and protect bones from serious damage.

During the bruise, soft tissue is destroyed. Large blood vessels are also damaged. Blood begins to pour out from the tissues that surround the affected area. In this case, a painful infiltrate forms, which is also called a hematoma. If we talk about the simplest example of a soft tissue bruise, then probably everyone has received a bump on their forehead at least once in their life.

It is also worth considering that in some situations in certain parts of the body, against the background of damage, fluid may begin to leak from the vessels. It begins to migrate from the area of ​​bruises to other parts of the human body. As a rule, this happens if the blow falls on an area where there is a small amount of fatty tissue or the skin is too thin. As a rule, severe bruises of the forehead or bridge of the nose can cause such effusions. In this case, damage occurs inside the eye sockets or infraorbital space.

If the patient was in a horizontal position and received a soft tissue bruise in the back or shoulder blades, then in this case the hematoma can even reach the lower back.

Predisposing factors

The formation of hematomas occurs after injuries, including pinching, blows, squeezing, and bruises. Subarachnoid hemorrhage does not fall into this category, since it does not appear due to trauma, but due to damage to an unchanged vessel. Often small hematomas appear due to eating large quantities of food or drinking alcoholic beverages. This is due to stretching of the gastrointestinal tract and the appearance of cracks.

The development of pathology is influenced by vascular weakness and problems with blood clotting. Often due to a weakened immune system due to infections or age-related changes, the likelihood of pus accumulating in the affected area increases.

Contusion of soft tissues of the face according to ICD-10

The international list contains a large number of pathologies associated with this type of damage:

• G57 – if we are talking about lesions in the area of ​​peripheral endings.
• M17 – indicates gonarthrosis or arthrosis of the knee joints.
• M22 – injuries of the patellas.
• M23 – intra-articular lesions.
• M66 - if this ICD code is indicated, a soft tissue bruise occurred due to a blow that led to rupture of the synovium or tendons.
• M70 – injury caused by too much stress.
• M76 – enthesopathy of the lower extremities (not including the foot).
• Q74 – congenital anomalies.
• S00.5 – code for bruise of soft tissues of the face.
• S80 – superficial injuries in the lower leg area (including closed bruises and hematomas).
• S81 – open wounds of the ankle.
• S83 – dislocations and sprains.

Thus, soft tissue contusion can be classified in a variety of ways in ICD-10. Therefore, it is important to make a correct diagnosis.

Classification of hematomas

In modern medicine, when classifying hematomas, the following are taken into account:

• Relation to the vessel - pulsating and non-pulsating hematomas.
• Localization - in the cranial cavity, internal organs, under the skin or mucous membrane.
• The state of the blood in the affected area is suppurated, clotted, fresh, infected.
• Symptoms – limited, encysted, diffuse.

There are hematomas that do not fall into this classification. For example, intracerebral, intracranial, intraventricular. They are of the epidural or subdural type and cause serious complications.

Pathogenesis

The process of cavity formation is based on the process of traumatic injury to a blood vessel (rupture) without the presence of an open wound or with a minor injury.

The reasons for violating the integrity of blood vessels are:

• 
  sharp intense local impact from impacts, falls and bruises;

• damage caused by bone fragments during fractures or confusion of one anatomical structure relative to another during dislocations.

Under pressure, blood flows out, forming cavities. Some of the leaked blood seeps through the surrounding tissue, causing specific changes in the color of nearby skin. Subsequently, under the influence of the breakdown of red blood cells, the color of the tissue may change (with deep hematomas, the color of the skin does not change).

Over time, the hematoma either resolves or undergoes a series of successive changes, ending with its complete scarring. When opening “fresh” formations, no change in the color and structure of the blood is observed (in rare cases, under the influence of platelets, the blood may thicken).

When old formations are drained, a change in the color and thickness of the blood is observed (it becomes dark burgundy or black). When a cavity is opened and the scarring process has begun, the blood takes the form of a dark, hard and difficult-to-separate substance, which is associated with the beginning of the process of degeneration of injured tissue into fibrous tissue. If the formation becomes infected, its cavity is filled with purulent exudate.

Soft tissue hematomas

Soft tissue hematomas are divided into 3 types:

• Lungs - appear 24 hours after injury and are accompanied by mild pain. No special treatment is required.
• Medium - appear within 5-6 hours and are accompanied by pain and swelling. The motor function of the limb deteriorates. Consultation with a traumatologist is required.
• Heavy - formed within 2 hours after tissue damage. The function of the limb is impaired, acute pain and diffuse swelling are observed. You should immediately consult a doctor to determine a treatment strategy.

Immediately after the injury, swelling appears, and the skin acquires a purplish-bluish tint. After 5 days, the skin takes on a green tint as hemoglobin breaks down. Gradually, the hematoma resolves and “flows” down.

If there are no complications, the hematoma will resolve on its own. In the worst case, a hard area appears that causes discomfort and impairs motor function. When an intramuscular lump forms, external symptoms are rarely observed, but the limb swells significantly and an area forms inside, the touch of which causes severe pain.

Note! For chronic intramuscular hematomas, an MRI is prescribed to determine the location and extent of tissue damage.

When large lumps form, surgical intervention is required. Treatment is carried out by a traumatologist. The opening of infected seals is performed by a surgeon after a comprehensive diagnosis. The operation is performed on an outpatient basis, but for large hematomas hospitalization is required. An autopsy is performed, during which blood clots are removed and washing is carried out. Drainage and suturing are required. Sutures are not applied only for infected hematomas. Antibiotics are often prescribed in combination to eliminate the infection.

First aid for soft tissue bruises

If a person has suffered from severe damage to the fingers, back, arms, legs, etc., then the pain syndrome must first be reduced. It is important to ensure that the affected area is kept at rest. The limb needs to be immobilized. If the patient has injured his back, it is recommended to lay him on his stomach.

You need to apply something cold to the injury site. However, you should not apply ice or other objects for a long time; 10-15 minutes is enough. After this, it is important to take a break and repeat the procedure.

If you experience severe pain, you should take an analgesic. Some people use compresses and other traditional medicine recipes, but it is important to consider the complexity of the damage.

Intracranial hematomas

Intracranial hematomas are divided into the following types:

• Epidural.
• Subdural.
• Intracerebral.
• Intraventricular.

Epidurals appear in 1-3% of cases and are due to injury to the middle meningeal artery. Pathology is often observed with skull fractures or depressed fractures. A hematoma develops in 2-3 hours or within 24 hours. Lack of treatment leads to coma. The first symptoms are confusion and weakness. Children rarely lose consciousness after a severe blow. Significant swelling of the brain does not lead to the detection of a light gap (which is rare in adults).

Subdurals appear in 1-7% of cases and pose a threat to human life, since death occurs in 60% of cases. There is an acute, subacute and chronic form of the pathology. Bleeding occurs due to a rupture of a vein or artery in the damaged area. People report nausea and severe headaches. Symptoms characteristic of compression of the brain stem are often observed. Lack of treatment and worsening symptoms lead to coma.

Intracerebral are observed extremely rarely with severe traumatic brain injuries. The light gap is not visible, the development of pathology occurs quickly. Hemiplegia or hemiparesis often occurs, as well as extrapyramidal symptoms.

Intraventricular diseases are rarely diagnosed due to the serious condition of patients. There are acute disturbances of consciousness, an increase in body temperature, a decrease in heart rate, and an increase in blood pressure. To establish a diagnosis, a survey of close people is carried out, since the patient is unconscious. To establish the location of the hematoma, MRI is used. In the most severe cases, lombal puncture is used.

Complications

If the patient's condition has not improved after a few days, this may be a warning sign. You should immediately consult a doctor if:

• The hematoma did not shrink, but instead began to pulsate even more. This indicates that there is a risk of bleeding.
• The patient developed case syndrome. In this case, muscle compression occurs. Against the background of this syndrome, necrosis of muscle tissue may even occur.
• Deposition of salts and calcium. This is a sign of myositis. The limb begins to gradually ossify.

Diagnostics

A hematoma is diagnosed by visual examination. If the hemorrhage is located deep under the skin, in internal organs, or in a joint, it is often very difficult to assess its size and possible consequences.

Patients are prescribed an examination, which may include:

• Ultrasound of internal organs, joints;
• computed tomography and magnetic resonance imaging;
• puncture (puncture with a needle): for example, a puncture of the knee joint is often done if there is a suspicion that blood has accumulated in it after an injury.

Classification of bruises

In addition to how serious the damage is, it is also worth paying attention to the location of the damage and other parameters. As a rule, experts distinguish between bruises of the feet, fingers, knee joints, legs, arms, and back. If we are talking about bruises of the upper extremities, then such situations occur most often in medical practice. In this case, small swellings appear on the hands, which are accompanied by quite strong painful sensations. With severe injuries there is a risk of loss of motor functions. This is also dangerous for bruises of the soft tissues of the leg.

The most unpleasant thing is if a person suffers from a bruised finger. When this area is swollen, a person is unable to use almost the entire limb. You should also take extra care if you have back bruises. Most often, this causes injury to the spine. As a rule, men aged 35 to 50 years are at risk.

The damage can also be mild, moderate or severe. This often occurs in the context of car accidents, although sometimes men suffer during a fight, jumping from a height, or due to intense sports activities.

Often in medical practice there are injuries to the hip joint. In this case, severe redness occurs in the area where the ischial tuberosity is located. Because of this, patients begin to limp a little. This is explained by the fact that muscles that help a person move are attached to the ischial angle of the tubercle.

There is also a bruise of the soft tissues of the thigh. In this case, the quadriceps muscle located in the hip joint suffers. If the blow fell on the front or outer lateral area, then in this case the patient suffers from severe pain. Bruises in the hip area are considered quite serious injuries. If a person does not consult a specialist in a timely manner or receives a serious blow, then in this case surgical intervention cannot be avoided. However, it is better not to start this pathology.

There are also bruises of the knee joints. If a person does not carry out timely treatment, this often leads to arthrosis. There is also a high risk of bleeding in the joint capsules. Therefore, if a person seriously bruises his knee, then in this case there is a risk of developing deforming osteoarthritis. In addition, when a knee is bruised, ligaments sometimes rupture. In this case, measures must be taken immediately, since otherwise the person may also lose the ability to move normally.

In addition, experts highlight foot bruises. In this case, there are some peculiarities. In this area, the periosteum is located quite close to the skin. As a result of damage, pain becomes more pronounced. It is worth noting that the ankle joint is very important, since it is only thanks to it that the entire body is supported. If a foot or ankle is bruised, this problem is often confused with a fracture. In the first minutes after the incident, patients experience severe pain, but gradually the discomfort goes away.

Often, damage to the nail plate occurs against the background of a bruise. This causes the person to experience severe pain for a longer period of time. This is explained by the fact that the hematoma begins to develop directly under the nail plate. Many people note the appearance of painful pulsation in the toes. If a person does not receive timely treatment, the nail may peel off.

Damage to soft tissues with internal hemorrhage are considered the most dangerous. Therefore, even if a bruise appears, you need to carefully monitor the affected area.

Treatment

Minor bruises can be treated conservatively: physiotherapeutic procedures and medications are prescribed.

In case of large accumulations of blood, the hematoma is treated surgically: it is opened, the blood or pus is evacuated, washed with antiseptics and drainage is installed. Antibiotics are prescribed if necessary.

When hemorrhaging into internal organs, it is often necessary to perform surgical intervention, during which it is necessary not only to remove the spilled blood, but also to stop the bleeding.

The multidisciplinary CELT clinic employs experienced traumatologists and surgeons who perform operations on hematomas of various locations. Modern techniques used in our clinic help provide effective treatment and minimize the risk of complications.

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