History: The individual with a contusion may have a history of a recent injury, usually a blow or a fall. In general, the individual complains of skin discoloration, swelling, and pain. Depending on the location of the contusion, restricted movement or stiffness is a possibility. When questioned, the individual may report use of aspirin or anticoagulants or a history of a blood coagulation disorder such as hemophilia.
Physical exam: The contusion may appear dark blue or red or yellow-green, depending on how soon the physical exam was performed after the injury. If it is a superficial or muscle contusion of the extremities, then the discoloration may move distally, towards the hands or feet as it resolves. The site may feel firm and be tender to the touch. Swelling is usually apparent around the bruise. There may be limited range of motion (ROM) and/or loss of function of the proximal and/or distal joints. The extent of the contusion may not be obvious until 2 to 3 days after the incident. Contusions involving a larger area of discoloration in the lower legs may be associated with several weeks of general lower leg, foot and ankle swelling. Sometimes, there are no visible signs of internal contusions although pain may be reported by the individual on palpation of the chest or abdomen.
Abuse may be a factor in individuals with a history of contusion and physicians should consider this during examination. Specific to contusions in the extremities, pain out of proportion to the extent of injury can be a sign of compartment syndrome and compartment pressure should be measured.
Tests: Tests are usually not needed for this diagnosis unless fracture or internal injury is suspected. With severe contusions, plain x-rays may be needed to rule out a bone fracture. Magnetic resonance imaging (MRI) is the imaging technique of choice for soft tissue injury; CT scans may be used to diagnose deep organ contusions such as in the heart, lung, or abdomen. If the individual has a history of contusions caused by minor trauma, a complete blood count and blood-coagulation tests (prothrombin time or PT, partial thromboplastin time or PTT) may be done. Changes in blood pressure shortly after injury may indicate significant bleeding.
Source: Medical Disability Advisor