Muscle Bruise - Soft-Tissue Contusion

Injury during workout
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Muscle contusions are very common sports injuries, second in frequency in athletes only to muscle strains.  Most frequently seen in participants in contact sports such as football, rugby, and lacrosse, muscle contusions also occur in non-contact sports such as soccer, baseball, and basketball.  The most common areas of injury are the thigh, followed by the arm.  Almost all muscle contusions can be treated without surgery, but there is often debate about what the ideal treatment of a muscle contusion should be.

  

Symptoms of a Muscle Contusion

Making a diagnosis of a muscle contusion is relatively straightforward if there is an obvious injury the athlete or patient remembers, but can be more difficult if the particular injury is not recalled.  Typically, the issue is to exclude other, often more serious injuries.  These injuries may include fractures (broken bones), dislocations, and complete muscle ruptures.

Common symptoms of muscle contusion injuries include:

  • Pain directly over the contused area
  • Swelling, bruising, and redness
  • Painful range or motion

Muscle Contusion Injuries

When a muscle contusion injury occurs, a portion of the muscle ruptures.  This causes a disruption of the small blood vessels called capillaries, and bleeding into the muscle tissue.  At that point, the bleeding forms a collection of blood within and around the muscle tissue called a hematoma.  After the initial injury, there is a gradual increase in inflammation over the next several days.

  While much of the focus of treatment of muscle injuries has been to control this inflammation, we also know the inflammation is important to the healing response.  This causes disagreement among some doctors and scientists about the optimal treatment of muscle contusion injuries. 

As the muscle tissue heals, many athletes fear the formation of scar tissue.

  Early movement seems to help prevent scar formation.  In addition, the amount of scar is very closely related to the severity of the initial injury, where more severe muscle tearing causes more significant scar formation.

Optimal Treatment of Muscle Contusions

As stated, there is controversy about the optimal treatment of muscle contusion injuries.  If you have sustained a contusion, and you have been evaluated to ensure there was not a more serious injury, some of the common treatments include:

Ice: Ice application is often performed, and does help reduce the earliest stages of inflammation.  Recent studies have demonstrated effects of icing are probably only significant in the first minutes and hours after the injury, but ice may help with pain control thereafter.

Early Movement: Immobilization has been shown to be detrimental to healing muscle leading to joint stiffness and muscle atrophy.  Gentle range-of-motion activity is recommended, and splinting or immobilization should be avoided.

 If weight bearing contributes to pain, crutches can help alleviate pain while allowing for some mobility.

Anti-Inflammatory Medications: Both nonsteroidal anti-inflammatory medications (NSAIDs) and corticosteroids (cortisone) have been used to treat muscle contusions.  The idea is they will decrease inflammation, and move healing into the repair phase.  Studies have shown minimal effects, and conflicting results.  There is no conclusive evidence that these treatments change the result of a muscle contusion healing, but they may help to control symptoms.

Surgery: Almost all muscle contusion injuries are treated non-surgically.  In very rare circumstances, where the injury causes a ledge defect in the muscle, some surgeons may recommend repair.  Again, there is little scientific data to support this method of treatment.

Complications of Contusions

One of the unusual complications of a muscle contusion is called myositis ossificans. This unusual complication tends to occur in more severe contusion injuries, but it is unclear why it occurs in some patients and not others.  Patients who develop myositis ossificans develop bone formation within the muscle tissue.  Ultimately, the bone may have to be surgically removed, but this removal has to be delayed otherwise the myositis ossificans is likely to recur.  Typically, surgery is delayed for about a year before surgical removal.

Sources:

Beiner JM and Jokl JM. "Muscle Contusion Injuries: Current Treatment Options" J Am Acad Orthop Surg July/August 2001; 9:227-237.

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