By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.
Contusions are bruises to the muscle usually caused by direct trauma. Trauma to the area causes the muscle to bleed, causing diffuse swelling, tenderness and discoloration over the affected area. If bleeding is excessive a hematoma (a collection of blood) may develop. Overlying redness and severe tenderness may be present. Difficulty ambulating due to stress on the muscle is usually seen.
- Immediate application of ice and compression with an ace bandage are needed to lessen the bleeding and swelling in the affected area.
- Most hematomas, following injuries to the muscle that are mild will absorb spontaneously over a period of 6-8 weeks. On rare occasions the bump present, which is a collection of blood that is organized into a firm clot, may persist for a long period of time.
- Immobilization in a surgical boot with or without crutches may be necessary depending on the muscle affected and the symptoms. Most of the pain associated with the injury resolves over a one-week period of time. However, localized tenderness to touch will be present for many weeks. If a significant amount of redness and swelling develop in that area surgical evacuation of the hematoma may be needed to prevent further damage and to hasten the recovery process. During the procedure the large clot of blood that is present is removed through a small incision. The area is irrigated with saline. The incision is then closed. Antibiotics are usually necessary for a short period of time to either treat or prevent infection to the area.
Prognosis is excellent in almost all cases. Occasionally bone may develop within the muscle, which may affect the long-term prognosis.
Compartment Syndrome – The muscles in the leg are contained within small compartments. These compartments are surrounded by tight fascial structures that allow the muscles to expand during exercise and activity. Deep muscle bleeding occurs within the compartment. These tight fascial bands may not be able to expand and excess pressure develops within the compartment due to the bleeding. Usually signs and symptoms of a compartment syndrome include severe pain, numbness in the affected part or on the top or bottom of the foot. Extreme pain with attempts at passively stretching the muscle is also seen. Immediate attention to this problem is critical. Surgery to decompress the compartment and prevent nerve damage and allow a complete return to function.
Below are clinical pictures of a patient who was involved and a motor vehicle accident which luckily for the patient only resulted in a lot of soft tissue injury (contusions and abrasions). Note the significant bruising present from bleeding of damaged muscle and other soft tissue.