Consumer Information

Contusion

GENERAL INFORMATION:

What is a contusion? A contusion, also called a bruise, is a result of bleeding into your child's soft tissue, muscle, or bone. It is an injury that can happen when a body part hits or is hit by a blunt (not sharp) object. A bruise occurs when the blood vessels in your child's skin or muscles are damaged. A bruise in the skin is seen as a change in skin color. A muscle bruise happens when muscle cells are damaged and causes bleeding in the muscle. A bone bruise is when a bone is damaged or hurt without it being broken. Most bruises get better without treatment. Your child's caregiver will tell you if your child needs his bruises treated. Treatment may help decrease pain and swelling, and can help the injured area heal.

What causes a contusion? A bruise may be caused by a fall, bump, or direct blow, such as being kicked or hit. Bruises are common in contact sports, such as football and hockey. Young children may slip, trip, and fall as they learn to crawl or walk. This can cause bruising. A bruise may also be caused by physical abuse (child abuse). Medical problems such as hemophilia and von Willebrand disease may also cause or increase your child's risk of having bruises. If your child takes non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin he may bruise more easily.

What are the signs and symptoms of a contusion?

Soft tissue bruises: The most common sites of soft tissue bruising in children are the head and lower legs. He may have a red, blue, or black mark on his skin. The color may change to brown, yellow, or green after a few days. He may also have pain and swelling over the area.
Muscle bruises: Muscle bruises most often happen in the buttocks or thighs. A lump may be felt under your child's skin. He may have pain, swelling, and spasms in the area. The area may feel stiff, and the stiffness may get worse when he moves.
Bone bruises: Bone bruises often occur in the bones of the ankles, hips, feet, and spine. Your child may have pain and swelling in the area. He may also feel pain when the area is touched. He may have pain when moving the body part that is bruised.

How is a contusion diagnosed? Your child's caregiver will ask you about your child's health. Tell him if your child has a medical condition and what medicines he is taking. Tell him when and how your child was injured. Your child's caregiver will look at the bruise and the area around it. He may need to undress your child to look for signs of muscle and bone bruises. Your child may also have any of the following tests:

Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.
Bone scan: This is used for bone bruises. During this test, pictures are taken of your child's bones. Your child is given a small amount of radioactive dye in his vein (blood vessel) before this test is done.
Computed tomography scan: This is also called CT scan. It may be used for muscle and soft tissue bruises. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's bones, muscles, and blood vessels. Before taking the pictures, your child may be given dye through his vein.
Magnetic resonance imaging: This is also called MRI. This may be used for bone and muscle bruises. During an MRI, pictures are taken of your child's bones, muscle, joints, and blood vessels. Dye may be given so the pictures of your child's body show up better. He will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
X-ray: This is a picture of the bones and tissues in your child's body. It may be done to check for bone bruising, broken bones, or other problems.

How is a contusion treated? Treatment for your child's bruise will depend on how bad it is and where it is on his body. Treatment may include the following:

RICE: This may be done to help treat any bruise. Rest, ice, compression, and elevation (RICE) may help decrease pain and swelling.
- Rest: Tell your child to try not to move the injured area. For muscle bruises, your child should avoid moving the injured area for a short period of time. Your child may need to rest for 24 hours (one day) if the bruise is mild, and for 48 hours (two days) if the bruise is very bad. Your child may start moving the body part slowly if he does not feel any pain.
- Ice: Place an ice pack on the injured area. The ice pack may be used in the first few hours after bruising for soft tissue injuries. A package of frozen peas or other small vegetables can be used instead of an ice pack. Put the towel over the body part next to your skin, and then place the ice pack on top of the towel. Do not leave ice or an ice pack right on top of your child's skin.
- Compression: Apply pressure to your child's injured muscle by wrapping it with an elastic bandage. Do not wrap it too tightly. Ask your caregiver for more information about elastic bandages.
- Elevation: Place your child so that his injured body part is raised. For example, if his arm is bruised, have him lie down with his arm propped up, resting on pillows. Raise the bruised area above the level of your child's heart if possible.
Pain medicines: Your child's caregiver may give him pain medicines. Follow the instructions for how much, and how often to give it to your child. Ask your child's caregiver how long the medicine should be used, and for more information about it. Tell the caregiver if your child's pain does not go away or comes back after taking this medicine. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell the caregiver if your child is allergic to any medicine.

What other treatments may be given for the contusion?

Soft tissue bruise:
- Cold pack: This may decrease the pain and swelling. You may apply an ice bag to the injured area for about 20 minutes. Do this several times for the first few hours after the injury. Put a towel next to your child's skin before placing the ice bag on it. Do not put ice right on top of your child's skin as it might cause frost bite.
Muscle bruise:
- Non-steroidal anti-inflammatory drugs: This medicine, also called NSAIDs, may help decrease pain and swelling. You may give it to your child for a short period of time (less than a week). This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before giving it to your child.
- Steroids: Steroid medicine may be given to decrease inflammation which is redness, pain, and swelling. Be sure you understand why your child needs steroids. Stopping use of this medicine without the caregiver's OK may cause problems. Your child may take it for a short period of time, such as less than a week. Ask your child's caregiver how long your child needs to take this medicine, and for more information about it.
- Aspiration: If too much blood has pooled in your child's muscle , aspiration (draining) may be done. This will help prevent increased pressure in your child's muscle.
- Surgery: Your child's caregiver may repair tears in your child's muscle using surgery.
- Rehabilitation: This is a program that helps your child's injured muscle heal faster. Caregivers teach your child special exercises to stretch and strengthen his muscles.
Bone bruise:
- Rehabilitation: This is a program that helps your child's injured bone heal faster. Caregivers teach your child special exercises to stretch his muscles and strengthen his bones. Exercises that bear weight and increase range of motion may be done as your child's pain decreases. For bone bruises in the legs and thighs, your child should wait for a time before full weight bearing exercise. He may need to use crutches to walk, and stop playing sports for a time. This can help decrease pain, and prevent the bone from breaking. Ask caregivers for more information about using crutches.

What problems can a contusion cause?

Soft tissue bruise: A soft tissue bruise may cause pain that can last for months.
Muscle bruise: A muscle bruise may lead to a hematoma (swelling filled with blood) inside the muscle. This may increase the pressure inside his muscle and squeeze the nerves in his injured arm or leg. This is called compartment syndrome. Your child may have pain and not be able to move the injured part. A muscle bruise may also cause a growth (lump) in the injured muscle. This may make it harder for your child to move the body part.
Bone bruise: A bone contusion may cause osteoarthritis (joint swelling). Your child may have a hard time moving the injured area because of the swelling. It may cause pain that can last for months to years.

How can a contusion be prevented? To help prevent injuries including bruises in children, do the following:

Do not leave your baby alone on the bed or couch. Watch him closely as he starts to crawl, learns to walk, and when he plays.
Have your child do warm-up exercises before, and stretching exercises after sports practices and games. This helps prepare the muscles for a change in activity.
Make sure that your child is drinking enough liquid. He should be drinking liquids before and during exercise. Good liquids for most children to drink include water, juice and milk.
Make sure your child wears proper padding and protective gear such as shin guards when playing sports. Teach your child about safe equipment and places to play, and teach him to follow safety rules.
As a very young child learns to walk, he is more likely to get injured if there are hard items such as tables in the area. Remove these items, or place soft pads over sharp edges and hard items in your home.
Take your child to his caregiver for a medical check up before he begins playing a sport. The caregiver will make sure he is ready for the sport, and check if your child has medical problems that may put him at risk for injuries.

When should I call my child's caregiver? Call your child's caregiver if:

The injured area is warm to touch.
There is more pain, swelling, and redness, and your child has more trouble moving the injured area 2 to 3 weeks after the injury.
Your child begins to complain of pressure or a tight feeling in his injured muscle.
Your child has a fever.
Your child still has pain from a muscle bruise after 4 to 5 days of treatment including R.I.C.E.
You have questions or concerns about your child's condition and treatment.

When should I seek immediate help? Seek care immediately or call 911 if:

Your child suddenly cannot feel or move his injured arm or leg.
Your child suddenly has more pain when he moves the injured area.
Your child has sudden and severe pain in the area of the bruise.

Where can I find more information? Contact the following for more information:

American Academy of Family Physicians
PO Box 11210
Shawnee Mission, KS 66207-1210
Phone: 1-913-906-6000
Web Address: http://www.aafp.org

American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 600184262
Phone: 1-847-8237186
Web Address: http://www.aaos.org/

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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