A bruise or hematoma is a swelling underneath the skin that is caused by damage to blood vessels that leads to a contained bleed. A bruise can occur anywhere in your body where there are blood vessels. This section describes bruises underneath the skin that is visible as a swelling with discolouration.
The blood vessels are located in the sub-cutis, underneath the dermis layer of the skin. When these blood vessels are damaged, a localised bleed occurs in the muscles or within ligaments. The result is a palpabel swelling that resolves after a few days to weeks.
Bruises can occur in two ways
- From the outside for instance a punch to the upper arm or chest. The size of the hematoma depends on the force and localisation of the punch.
- From the inside for instance a rupture of tendon such as in a sprained ankle or during high-intense sport activities.
It is important for the GP to assess the following factors
- Location of the bruise
- Nature of the bruise
- Any visible bleeding
- Size of the bruise
- Does the bruise displace or move due to gravity
- Use of medication such as anti-coagulants or platelet-inhibitors
- Co-morbidities such as platelet disorders or Immune thrombocytopenia purpura
If a trauma occurs (punch, fall or sprain) then the next step a GP takes is to determine the 3 following conditions
- Muscle rupture
Management of most bruises can be done at home under advice and involve
- Cool packs; typically effective in the first 24 hours of the bruise.
- Pressure bandage
- Physiotherapy; a GP will consider this if there is functional limitation
Referral to surgeon will be considered in the event of internal bleeding
Bruises typically heal well and within 2 to 4 weeks. Management can be done at home and referrals are rarely indicated.