Hand bruise – the closed injury of the top extremity which is not followed by essential violation of structure of fabrics. Arises during the falling or blow. Damage of all segments of an extremity is possible: fingers, brush, forearm, elbow joint, shoulder and shoulder joint. It is shown by pain and a swelling, in the place of a bruise hematomas are quite often formed. The movements are usually kept, but limited. At injury of a joint can arise . For an exception of heavier damages carry out a X-ray analysis, KT and other researches. Treatment is conservative.
Hand bruise – traumatic damage of soft tissues of the top extremity. Skin at such damage remains whole, however in its thickness, and also in the thickness of muscles and hypodermic fatty cellulose, there are hemorrhages. Hand bruises, as a rule, are a consequence of a home or sports injury. Can come to light at persons of any age, are more often diagnosed for children that is caused by their high physical activity. Adult patients in winter time are usually injured when falling on the street. During the summer period the number of patients with the injuries got in operating time at the dacha increases.
In 70% of cases slight injuries, in 25% of cases – bruises of moderate severity and in 5% of cases – heavy bruises are diagnosed. Damage symptoms gradually accrue in the beginning, and then completely disappear within 1-3 weeks, the absolute recovery becomes an outcome. In some cases bruises are complicated by formation of the large not resolving hematomas or gemartrozy. The main objective of the traumatologist is the careful exception of more serious injuries (ruptures of sheaves, changes, dislocations) and prevention of development of complications.
Pathogenesis of a bruise of a hand
At bruises skin, muscles and hypodermic fatty cellulose are injured. Small vessels are broken off. If blood impregnates fabrics, hemorrhage is formed if "moves apart" - the hematoma (filled with blood a cavity) is formed. The following blood and the accruing hypostasis squeeze the nervous terminations therefore pain after a trauma gradually amplifies. If the bruise is in a joint zone, there are microscopic damages of intra articulate structures that can lead to development of a gemartroz.
The size of hematomas and hemorrhages depends on quantity and diameter of the damaged vessels, and also on a condition of the curtailing system of blood. Small vessels are corked within several minutes, large days and more can bleed. At the people having hemophilia, serious illnesses of a liver, some autoimmune diseases and diseases of vessels and also at the patients accepting trombolitik and heparin, extensive hemorrhages and hematomas can arise even at damage of a small amount of small vessels.
In the first 3-4 days of hemorrhage (bruises) have cyanotic or crimson coloring, in the subsequent begin to turn yellow. The blood which is in a cavity of superficially located hematoma appears through skin therefore the area of a hematoma looks dark-purple, dark and cyanotic or almost black. Deeply located hematomas represent volume formations of a myagkoelastichesky consistence, skin over them can be not changed or covered with bruises.
Bruise of a shoulder joint
Arises at sharp blow or falling on area of a shoulder joint. Pain syndrome usually moderate. Puffiness, restrictions of movements and hemorrhage comes to light (is more often on the external surface of a joint). At heavy bruises with an anguish of the capsule and damage of intra articulate structures of pain can be intensive, reminding a pain syndrome at a change. It is possible or post-traumatic sinovit. Sometimes at such bruise of a hand the cartilage is injured articulate – its small pieces break away and get into a joint cavity, forming freely lying intra articulate bodies.
The bruise of this area should be differentiated first of all from a fracture of a surgical neck of a shoulder (especially at elderly patients). At a bruise of a hand of the movement in a joint are limited slightly or moderately, at changes of the patient cannot raise a hand or take her aside. Pokolachivaniye on an elbow at a change causes pain in a shoulder joint, at a bruise is not followed by unpleasant feelings. Lack of a krepitation and pathological mobility allows to assume a hand bruise, but does not allow to exclude a change as at the driven damages these symptoms are absent. For statement of the final diagnosis appoint a X-ray analysis of a shoulder joint.
Treatment of bruises is performed by the doctors specializing in the field of traumatology and orthopedics. The hand is suspended on a kosynochny bandage, recommend to put cold for reduction of hypostasis and hemorrhages. At pains appoint analgetics. With the day before yesterday give the direction on UVCh. Houses are advised to put dry heat and to accurately rub a joint with rassasyvayushchy ointments. Joint punctures at bruises of a hand are required extremely seldom as the amount of liquid is usually small, and it resolves independently. The term of disability fluctuates of 1-2 weeks at slight injuries up to 3-4 weeks at heavy damages with violation of integrity of a cartilage.
The shoulder bruise usually is a consequence of direct stroke. There are all symptoms, characteristic of a bruise: swelling, hemorrhages and pain. The differentiation with a fracture of a shoulder is simple: changes of a diaphysis are followed by violation of an axis of a segment (sometimes – in combination with its shortening), rough deformation, pathological mobility, a bone crunch and almost full loss of an opportunity to make the active movements. At a hand bruise all listed signs are absent, the movements are kept, but a little limited. A shoulder X-ray analysis without changes.
Treatment is carried out in emergency station. Use a kosynochny bandage, cold, and then warmly. Appoint UVCh, if necessary write out analgetics. Usually all symptoms of a trauma disappear within 1-3 weeks. In some cases becomes an outcome of a bruise of a hand ossifitsiruyushchiya miozit – a muscle inflammation at which in its thickness small sites of ossification are formed. At the heavy bruises which are followed by a periosteum injury in the remote period ekzostoza are sometimes formed.
Bruise of an elbow joint
Bruises of an elbow joint can arise both at blow, and when falling. The victim complains of pain. Soft fabrics swell up a little, on skin hemorrhages develop. The movements usually remain, but their amplitude decreases. The differential diagnosis with dislocation of bones of a forearm is usually simple. At a hand bruise, unlike dislocation, there is no rough deformation, the active movements remain, there is no springing resistance at the passive movements. The pain syndrome is expressed less brightly.
It is more difficult to differentiate heavy bruises of a joint with the isolated dislocations of one of bones of a forearm and a change of a head of an elbow bone. Less intensive pains and lack of the expressed restrictions at rotation of a forearm testify to a bruise of a hand. The X-ray analysis of an elbow joint confirms integrity of bones and preservation of congruence of articulate surfaces. At an indistinct radiological picture appoint comparative pictures of both joints or KT of an elbow joint.
Treatment is carried out on an outpatient basis. As well as at other bruises of a hand, recommend rest, a kosynochny bandage and cold for the place of damage. Most of traumatologists belongs to thermal procedures with care as the elbow joint "is whimsical" and warming up can turn back various complications. At slight injuries choose waiting tactics, at heavy apply an electrophoresis. Gemartroz usually insignificant or is absent, punctures are not required. Restoration takes from 1 week to one month.
Bruise of a forearm and luchezapyastny joint
Arises at blows and falling, it is shown by pain, a swelling, hemorrhages and hematomas. It is simple to distinguish a bruise of a hand from a fracture of bones of a forearm – at a bruise there is no deformation, there is no pathological mobility, the extremity axis remains. The differentiation of a bruise and fracture of one bone of a forearm can represent some difficulties. Absence of pain at axial loading and a palpation of a bone testifies to a bruise. The X-ray analysis of a forearm is normal. Treatment – as at other bruises of a hand.
The bruise of a luchezapyastny joint is differentiated from a beam change in the typical place. At a bruise of a hand of the movement are limited slightly, hypostasis small or moderate, axial loading is painless. Lack of deformation is not a reason for a change exception as at beam changes shift is observed not always. A X-ray analysis of a luchezapyastny joint without changes. Treatment – as at bruises of a shoulder and shoulder joint.
Bruise of a brush and fingers
Local bruises of a brush and fingers usually arise at blow, extensive – at a sdavleniye. Distinctive features of such injuries are the expressed pain syndrome and considerable hypostasis of the back of a brush. Besides, heavy bruises of a hand are followed by a sleep, heavy feeling and the expressed malfunction. After a sdavleniye quite often there are necrosis centers. Hemorrhages in small joints are poorly expressed (an exception – joints of phalanxes of fingers).
At damage of proximal departments of a brush to the remote period there can be dystrophic changes of bones of a wrist. At hand bruises in a wrist and in a projection of pyastny bones because of considerable hypostasis blood supply of a brush is sometimes broken that leads to strengthening of a pain syndrome, emergence of developments of stagnation, injury of small nerves and formation of a kogteobrazny brush. Bruises of nail phalanxes with formation of a subnail hematoma in every third case are combined with difficult diagnosed regional fractures of fingers.
Complications in the remote period careful differential diagnostics and the thought-over treatment helps to warn. Patients are directed to a brush X-ray analysis, at doubtful result appoint brush KT. The hand is cooled with chlorethyl, a stream of cold water or a package of ice. At heavy bruises impose plaster. At the expressed tension of fabrics carry out poslablyayushchy cuts. Give the direction on UVCh or Ural federal district. In hard cases in the recovery period apply massage and LFK.