A contusion is a blunt compressive injury that does not involve a break in the skin but cause damage to the underlying soft tissue. Blood seeps out of damaged blood vessels (known as capillaries) and collects in the surrounding tissue, thus forming ecchymosis – blue or black marks underneath the skin . Contusions of the trunk may involve the ches and chest wall, breast, ribs, abdominal wall and also the back, hip, buttocks, pelvis, genitals, or pelvic floor (perineum).
After the injury, the ecchymosis may extend some distance from the contusion site since the gravity may move (pull) the blood downward. Over a period of a fewdays, the black and blue will change to green and yellow color and eventually will fade. The affected is often swollen and painful.
Contusions of the trunk are usually a result of a fall from height or a direct blow from a blunt object. Contusions also occur as a result of road accidents and trauma from a motor vehicle failures.
Contusions are classified as:
• severe
• mild
• moderate
The chest wall is particularly vulnerable to contusions. The reason for this is because the bones (like ribs and clavicles) are found close to the surface of the skin. Clavicle (collar bone) contusions are often associated with an injury to the sternum (breastbone) or the shoulder joint. These can cause restricted movement in the chest area and the shoulder. A breast contusion involves the breast area, nipple as well as the underlying tissues. The back is also vulnerable to contusions. Contusions to the shoulder blade can cause restricted movement of the shoulder. Back contusions occur following a fall or blow by a blunt object. The scapula (shoulder blade) protrudes slightly with little muscle and fat between the bone and skin.
Risk factors:
Individuals bearing the highest risk for trunk contusions (esp. back, chest and abdominal wall injuries) incl. construction workers and physically active people who do manual labor, as well as those who participate in contact and high-impact sports like softball, baseball, soccer, wrestling, football, ice hockey, basketball, and boxing).
Treatment
Sometimes mild contusions do not need specialized medical attention. However, the affected muscle should be rested for a couple of days. Ice could be applied to the site of injury for the first 24 to 48 hours. In specific cases a compression bandage may help reduce swelling during the first 2 days. Physical activity should be avoided at least for the first 48 hours. Application of heat – as in hot packs, hot showers, heating pads, hot bath - may help speed reabsorption by increasing the blood circulation to the site of injury after the first 24 to 48 hours. Specialized heat liniments and/or ointments could work in a similar manner (they cause local vasodilatation).
Analgesics and OTC painkillers may be applied to relieve the sighnificant amount of pain. Aspirin, non-steroid and anti-inflammatory drugs are usually avoided. They may contribute to excessive bleeding. Healing times vary with the severity of the injury. Most trunk contusions resolve without any disability. Chest and abdominal contusions generally heal < 2 weeks. Breast contusions could take up to 6 weeks and back contusions – up to 2 weeks.
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