Management of Large Bruising to Forearm
The best management for large bruising to the forearm includes immediate application of localized cold therapy with or without compression, followed by rest and elevation of the affected limb. 1
Initial Management
- Apply localized cold therapy (ice pack) to the bruised area for at least 10 minutes to promote hemostasis and reduce swelling 1, 2
- Use compression along with cold therapy, as this combination is significantly more effective than ice alone for controlling bleeding and reducing pain 2
- Elevate the affected forearm above heart level to minimize swelling and further bleeding 2
- Rest the injured area and avoid activities that could worsen the injury 2, 3
Mechanism of Action
- Cold therapy causes vasoconstriction, which helps limit bleeding into surrounding tissues 1
- Compression helps prevent additional bleeding and reduces swelling by limiting fluid accumulation 2
- The combination of cold compression has been shown to reduce hematoma size by approximately 20 cm² over 180 minutes compared to compression alone (which reduced size by less than 10 cm²) 1
Ongoing Care
- After initial management, continue intermittent cold therapy for the first 24-48 hours 3, 4
- Avoid heat application in the acute phase (first 48-72 hours) as this may increase bleeding 4
- Protect the area from further injury during the healing process 4
- Gradually introduce gentle range of motion exercises after the acute phase to prevent stiffness 3
When to Seek Medical Attention
- If the bruise is expanding rapidly or continues to enlarge despite appropriate first aid measures 2
- If there is significant limitation in movement of the affected limb 2
- If there are signs of complications such as increased pain, numbness, or changes in skin color that might indicate vascular compromise 2
- If the bruise shows signs of infection (increasing redness, warmth, fever) 2
Common Pitfalls to Avoid
- Applying heat during the acute phase (first 48-72 hours), which can increase bleeding and swelling 4
- Excessive compression that may impair circulation 1
- Returning to full activity too soon, which may lead to reinjury 4
- Ignoring or inadequately treating deep muscle bruises, which can lead to complications such as muscle shortening 5
Special Considerations
- For elderly patients or those on anticoagulants, bruising may be more extensive and take longer to resolve 4
- In cases of significant trauma, consider the possibility of underlying fracture, especially if pain is severe or function is significantly impaired 6
- Monitor for signs of compartment syndrome in severe forearm bruising (increasing pain, pallor, paresthesia, pulselessness, paralysis) 6