What is the treatment for a patient with a bruise or soft tissue injury on their arm?

Treatment for Bruises and Soft Tissue Injuries of the Arm

For a patient with a bruise or soft tissue injury on their arm, the recommended first-line treatment is rest, application of cold therapy for 20-30 minutes at a time, and limiting use of the injured extremity to avoid activities that cause pain. 1

Initial Management

• Apply cold therapy (ice and water surrounded by a damp cloth) to the injured area for 20-30 minutes, 3-4 times daily, to reduce pain and swelling 1
• Avoid direct ice contact with the skin to prevent cold injury 1
• Rest the injured extremity and avoid activities that cause pain 1
• Elevate the injured arm during the first few days to reduce inflammation and promote healing 2
• Clean any open wounds with water or saline solution to prevent infection 2

Compression Therapy

• A compression wrap may be applied to promote comfort after the injury 1
• Ensure the compression wrap is not too tight to avoid compromising circulation 1
• Note that while compression may provide comfort, evidence suggests it does not significantly reduce swelling, improve joint function, or accelerate recovery time 1

Wound Care (If Skin Is Broken)

• For open wounds, thoroughly clean with potable water or sterile saline solution 2
• Cover the wound with a clean, occlusive dressing to maintain a moist environment and prevent contamination 2
• Consider application of topical antibiotic ointment for superficial wounds if no allergies are present 2

When to Seek Medical Attention

• Seek medical attention if the injury limits use of the extremity or causes significant pain 1
• Medical evaluation is necessary if there are signs of infection such as:
  • Progressive redness extending beyond the initial injury
  • Increasing pain or tenderness
  • Warmth at the site
  • Purulent discharge or foul odor
  • Fever or general malaise
  • Increasing swelling 2
• Consider medical evaluation if there is uncertainty about whether the injury is a sprain, strain, or fracture 1

Follow-up Care

• Monitor the injury for improvement over the first 48-72 hours 1
• Gradually reintroduce normal activities as pain subsides 1
• Continue cold therapy as needed for pain management 1
• If symptoms worsen or do not improve within a few days, medical evaluation may be necessary 1

Common Pitfalls to Avoid

• Do not apply heat in the acute phase (first 48-72 hours) as it may increase swelling 1
• Avoid placing ice directly on the skin as this can cause cold injury 1
• Do not tighten compression wraps excessively as this can compromise circulation 1
• Avoid early return to activities that cause pain, which may worsen the injury 1
• Do not ignore persistent symptoms or signs of infection, as these require medical attention 2

By following these guidelines, most simple bruises and soft tissue injuries of the arm will resolve without complications. The mainstay of treatment remains rest, cold application, and limiting use of the injured extremity until healing occurs 1.