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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

  1. 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.
  2. 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

  1. Location of the bruise
  2. Nature of the bruise
  3. Any visible bleeding
  4. Size of the bruise
  5. Does the bruise displace or move due to gravity
  6. Use of medication such as anti-coagulants or platelet-inhibitors
  7. 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

  1. Fracture
  2. Contusion
  3. Muscle rupture

Management of most bruises can be done at home under advice and involve

  1. Rest
  2. Cool packs; typically effective in the first 24 hours of the bruise.
  3. Pressure bandage
  4. 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.