A Hodgepodge of Contusions

Looking at what consists of a contusion, the various types, and severity associated with the injury.

Today’s post will consist of several remaining terms that come up often but aren’t well defined. My goal is to identify the rest of the terms and continue to further the knowledge base. There are many terms for the same problem or based on location, which define how it is described.

First up is the common contusion. A contusion is defined as a blow to an area that damages the small blood vessels and connective tissue in the area. This can be caused by getting hit hard or falling the ground which if severe enough can impact function. While everyone has dealt with a bruise at some point or another, not everyone gets hit by a 250 lb linebacker going at full speed.

When the contusion occurs, the blood vessels do burst and the discoloration is the result of the burst blood vessels releasing blood, rising up to the surface, then slowly reabsorbed by the body. This is why a bruise fades over time. The more severe the contusion, the more impact it can have. While nothing has been torn, the connective tissue of the muscles and other tissues including fat and skin are still impacted. The tissues of the body are quite pliable and if damaged, will respond to pain as any other portion of the body, except brain tissue. Contusions, if severe enough can cause compartment syndrome in the area. This occurs when swelling becomes excessive and pushes on the connective tissues surrounding the muscles. If not managed quickly, the excessive pressure can begin to kill the muscle, leading to permanent damage.

Various types of contusions include hip pointer, nerve contusion, stingers, and bone bruises. Hip pointer injuries are to the bony portion of the hip known as the iliac crest. This is right above the waist line and are common due to the location players fall to the ground or are tackled in the area. This area is also where the abdominal wall attaches to which limits trunk motion and the hip abductors connect right below the area, which allow for a player to run and perform lateral movements.

Nerve contusions, such as what Shaq Lawson dealt with, is when bruising occurs to a nerve. In most cases in the body, the nerve is well insulated and protected from injury. However, in certain cases, these nerves sometimes exit the body temporarily and are exposed. Cases include the ulnar nerve that exits temporarily near the elbow and the peroneal nerve which is on the outside portion of the knee near the fibula. If you’ve ever hit your funny bone, that’s your ulnar nerve screaming at you. In Lawson’s case, he hit the peroneal nerve which causes pain and weakness to the area. These injuries can resolve relatively quickly, but are quite painful and may take some time to rehab from to ensure proper movement.

Stingers are another type of nerve injury that can be incredibly painful, but can quickly resolved if managed correctly. Stingers occur when a player gets tackled violently and the shoulder is pushed in one direction and the head in the opposite, leading to traction on cervical or neck nerves. Compressive forces can also cause similar symptoms, such as a direct head blow during a poor tackle or when driven into the ground. Pain is typically felt in the neck and shoulder region, with pain also produced sometimes all the way down the arm causing pain, weakness, and numbness. Due to how the nerves connect all back to the spinal cord and brain, this is why pain can travel down the arm despite the injury occurring in a different area. These injuries can resolve with rest and proper stretching, but is not something that can be rushed.

Finally, bone bruises complete this article. Bone bruises are actually a type of fracture that is less severe than a true bone fracture that we all think of. Keeping it brief, there are 3 types of bone bruises: Sub-periosteal hematoma, inter-osseous bruising, and sub-chondral lesion.

Sub-periosteal hematoma occurs when a direct high force trauma occurs and blood forms under the periosteum, which is a membrane that covers the outside of the bone. Inter-osseous bruising occurs when the bone marrow of the bone becomes damaged, specifically the blood supply. This occurs as the result of a repetitive high compressive forces on the bone, such as excessive running or jumping. These are seen more common in the knees and ankles.

Sub-chondral lesions occur when the cartilage layer of the bone becomes damaged. This area is found at the end of the bone and is the part that articulates with another bone. An extreme crushing force or rotational/shearing force may also cause this, commonly seen in injuries such as ACL tears. ACL tears typically not isolated, but MCL damage, meniscus damage, and even a sub-chondral lesion due to the forces that occur on the joint during the injury also occur.

This wraps up the breakdown of injuries that are commonly reported, but are not fully known. These injuries happen far too often and are a part of football. While padding, playing surfaces, and proper tackling can reduce incidence of injury; these are the types of injuries that come with playing football. Most of these injuries can be managed conservatively with rest, icing, stretching, and padding. These are injuries that do not keep players out for extended time, but can be injuries that knock out players during key games.

What is most important is that the Bills continue to keep injuries to a minimum. They have suffered injuries just as any other team in the NFL, but have avoided the season ending, season altering injuries thus far. Continue to check back for regular updates and further in depth analysis of the latest Bills injuries. Thank you and GO BILLS!!

Author: Dr. Trimble

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!! When I am not cheering on the Buffalo Bills, I am a Physical Therapist. To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D'Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduated in 2013 with my Doctorate in Physical Therapy and moved home for several years. Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care. Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. 
I am currently an injury spotter working with Dr. David Chao, Orthopedic Surgeon based out of San Diego. In this role, I provide real time updates regarding injuries during the game. I also currently write for Grandstand Sports Network and all content is published on both Banged Up Bills and Grandstandsportsnetwork.com. I hope you enjoy what I publish and I welcome any comments or questions you may have.
Disclaimer: My opinions are my own.  Any thoughts I have on the injuries is based on media reports, my knowledge of the injury, and speculation based on the information currently available.


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