The Science of Bruising Part 2

Part 2: Contusions vs. Ecchymosis – The Different Types of Bruises

In our part 1 of 5 series on Bruising we discussed the basics of bruises – what they are, how they form, and how the body reacts to bruises. In this post we will be discussing the different types and levels of bruises. Although Bruise Relief® brand products work better on some bruise-types than others (and, remember it is not designed to work on all bruises) – knowing the types of bruises helps to know how to best treat them.

Bruises generally fall into two broad types: (1) Contusions and (2) Ecchymosis. Contusions are simply another name for a “typical” bruise – caused when blood vessels or capillaries are damaged or broken as the result of an impact to the skin. Ecchymosis is the skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels. The purple-hued, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis if it is larger than 1 centimeter. Ecchymosis can also occur in other areas of the body, such as under the nails, or in mucus membranes in the nose or mouth, especially when experiencing a cold or sinus infection.

Bruising can occur at 3 levels:

  • Subcutaneous — Bruising beneath the skin. These are the most common bruises and ecchymosis. They are also the kind that Bruise Relief® brand products work really well on, especially when applied soon after the impact or injury and enough gel or serum is applied and allowed to absorb into the area before it is rubbed off.
  • Intramuscular –These are often known as “deep bruises” and typically form in the belly of underlying muscles, for example the hamstrings or calves.
  • Periosteal –These are bone bruise, often the most painful and the one that may often require medical treatment. They can take months to heal.

The severity of bruises is determined by medical professionals by gauging the size of the bruise, but the type of bruise, the number of bruises and other factors — such as how the bruise occurred, where it is located, the person’s age, and the size and duration of the bruises all play an important part in the equation.

Bigger does not necessarily mean “worse”. For example, when a muscle is contracted (such as a muscle cramp caused by sports) it will bruise more easily because the surrounding tissues are located closer to bone.  Thus, a small ankle bruise could be more severe than a large impact on the upper leg that looks worse. As we age, blood vessels and capillaries change over time and become less pliant, expandable and resilient, thus one reason that older people are more prone to bruising.

In order to codify bruises and find the best treatment, medicine uses something called the Harm Scale that rates the severity and medical risks of specific bruising in a specific individual on a scale of 0-5, with 0 being a light bruise and 5 being at risk of death. The score is determine by the injuries caused to organs and tissues, other patient conditions (such as age and medical history), and associated injuries.

While most bruises simply require basic home care, some, such as bone bruises may require a visit to the ER or doctor, especially if the bruise causes extreme pain, swelling or internal pressure.

Light Bruises are generally the most common and are the kind that Bruise Relief brand products provide the best results for in most cases.  However, moderate to severe bruises can be dangerous! Why?

If the bruise is severe, bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma, which can lead to compartment syndrome where blood is cut off from the tissues leading to weakness, numbness and/or intense pressure – surgery is often the required method for treatment. Bruising trauma can also harm internal organs. For example, blunt trauma to the head can lead to traumatic brain injury, a concussion, coma or even death. Once again, surgery is often the required method for treatment of this sever situation.

The effects of bruising can also cause or increase other damage to the body including strained muscles or tendons. What at first might initially appear as simply bruising may turn more severe, especially if not initially treated. If you experience difficulty in moving, numbness, deep internal pressure or feel liquid under the skin of your bruise, it is a good idea to seek medical help.

Coming next in Part 3 of our series: Some causes of bruising and why some are more predisposed to bruising.