by Boyd W. Haynes III, MD
Nearly everyone has strained a muscle during the course of their life. A strain happens when a muscle is stretched beyond its tensile limits and tissue damage ensues. The second most common injury is a muscle contusion, which happens when a muscle sustains an injury from being compressed or crushed or from a direct blow or blunt force trauma. This injury causes damage to the muscle fibers and connective tissue under the skin. Bleeding ensues and as the skin is not broken, the bleeding remains trapped under the skin, causing bruising to occur.
As you can imagine, these injuries happen often to football players or other athletes who participate in contact sports. Everyone remembers seeing Rocky, battered and bruised after a boxing match against Apollo Creed. But contusions also happen to us during our everyday activities. Just hitting one’s thigh on the corner of a desk or falling on a hard floor can cause a muscle contusion.
After this type of injury occurs, I often see patients who are worried about healing, recovery time and permanent muscle damage. We all get bruises and thankfully, most will heal with time and not cause any issues or loss of function. However, the severity of the contusion matters and for those which are very traumatic, medical attention is required to avoid complications.
How do we ascertain which contusions are serious enough to warrant medical attention? Pay attention to these symptoms:
- Severe pain
- Large surface area of the skin exhibits bruising
- A raised lump with a collection of pooled blood (a hematoma)
- Significant loss of motion of that muscle
- Weakness or pronounced stiffness of the affected muscle
- Faintness, nausea or vomiting and/or unconsciousness indicate shock
- Broken bone or dislocated joint
- Bruising to the abdominal area
One or more of these can be very serious and immediate medical help should be sought.
It is important to learn about the injury and what caused it. A physical examination and X-Rays can help me to determine if bones have been broken or joints dislocated. Ultrasound, MRI or CT scan can assist in the determination and the extent of soft tissue and bony injury. If nerve injury is suspected, an EMG may be ordered which checks nerve function and response.
For most injuries, the PRICE protocol can be followed:
Protection – Immobilization with a sling, splint or air cast
Rest – Behavior modification, maybe the use of crutches to allow rest
Ice – used intermittently for the first 24-48 hours
Compression – light bandage or ACE wrap
Elevation – keeping injured body part above the heart
I may also prescribe Aleve or a more potent oral anti-inflammatory drug and pain medication. For those with large hematomas, the blood under the skin may be drained with a syringe, to speed healing.
When bones are broken or joints dislocated, the fracture will have to be reduced and the joint returned to its normal position. This might be done in my office, after numbing the location of the injury or surgery may be needed, depending on the severity and location of the injury.
Complications may develop if medical assistance is not sought quickly for severe cases, such as:
- Compartment Syndrome happens when too much bleeding under the skin causes rapid and very painful swelling within a muscle group. This swelling can compromise blood flow to other areas, causing tissue death. Emergency surgery may be required to drain the excess fluids causing the swelling and release the muscle pressure.
- Myositis Ossificans can happen if an injured athlete returns to a high level of activity before the muscle has healed. The bruised muscle begins growing bone cells instead of muscle cells. Returning to the above PRICE protocol allows the muscle to rest and regenerate, usually without surgery.
Most contusions heal well with time. Some patients will need Physical Therapy to help them build strength and increase range of motion in the recovering muscle. Although patience is necessary, the body remarkably heals itself, usually without much intervention from physicians.