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11.14 Contusions (Bruises)


Presentation

The patient has fallen, has been thrown against an object or has been struck at a site where now there is point tenderness, swelling, ecchymosis, hematoma, or pain with use. On physical examination, there is no loss of function of muscles and tendons (beyond mild splinting because of pain), no instability of bones and ligaments, and no crepitus or tenderness produced by remote stress (such as weight-bearing on the leg or manual flexing of a rib).

What to do:

What not to do:

Discussion

The acute therapy of contusions concentrates upon reduction of the acute edema, and all other components of treatment are postponed for 3-4 days, until the inflammation and edema are reduced. Patients need to know this time course, and must understand that the more the swelling can be reduced, the sooner injuries can heal, function return and pain decrease. Edema of hands and feet is especially slow to resolve, because these structures usually hang in a dependent position, and require much modification of activity to rest.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD