For individuals and athletes with a gluteal contusion with severe bruising, can a healthcare provider determine if there are any other injuries to underlying structures, including muscle or tendon tears?

Gluteal Contusion

A gluteal contusion is an injury, in this case, a bruise to the buttocks’ gluteal muscles caused by damage to muscle fibers and blood vessels. A buttock bruise is caused by direct bodily impact, typically from falls, automobile collisions, accidents, bumping into something, or being struck by an object or person. Like all bruises, a gluteal bruise most often results in pain and visible discoloration of the skin at the injury site, varying in severity from grade I to grade III, with higher-graded bruises requiring more time to heal. Most butt bruises can heal on their own with time and rest, but if bruising is severe, individuals may require physical therapy to restore full muscle function.

Symptoms

A contusion is a muscle injury that can affect the body’s skeletal muscles. A gluteal contusion can be painful, with a black and blue mark that changes color over time. Other symptoms may include: (Mount Sinai, 2024)

• Tenderness to touch over the injury site
• Increased pain with contraction of the glutes
• Swelling
• Discomfort with sitting

Causes

A contusion occurs from direct trauma and forceful impact on the gluteal muscles, causing damage to underlying blood vessels, muscle fibers, and sometimes bone, resulting in bleeding under the skin. (MedlinePlus, 2016) Direct impacts to the gluteal muscles that can cause a contusion include:

• Falls
• Car accidents
• Direct hits to the buttocks from a piece of sports equipment or person.
• Bumping into furniture, a door, or a counter.
• Intramuscular injections into the gluteal muscles.
• Individuals who take blood thinners or anticoagulant medication have an increased risk of bruising from direct contact injuries.

Diagnosis

A gluteal contusion is usually diagnosed through a physical examination and is generally straightforward to diagnose based on physical appearance, symptoms, and type of injury. Contusions can be graded based on the severity according to the following criteria (Fernandes, T. L. et al., 2015)

Grade I

• An injury that affects only a small amount of muscle fibers, resulting in minimal pain, tenderness, and possible swelling.
• Causes minimal or no loss of strength in the affected muscle or range of motion limitations.
• Muscle use is typically unaffected.

Grade II

• An injury that causes significant damage to muscle fibers, resulting in increased pain and impaired muscle contraction.
• A small muscle defect can be felt to the touch.
• Discoloration increases over the first few days after injury.

Grade III

• An injury that involves extensive muscle fiber damage and bleeding across an entire area of a muscle that results in severe, and sometimes total, loss of muscle function.
• Causes severe pain and significant discoloration of the skin.

1. When contusions are larger, deeper, and involve significant blood pooling and swelling, they are called hematomas.
2. If the bruising is severe, a diagnostic ultrasound, CT scan, or MRI may be used to determine whether any underlying structures are damaged.

Treatment

Contusions are generally mild injuries. Treatment typically involves rest to allow the muscles to heal from the bleeding and the bruising to dissipate.

• Applying ice to the injury site can help relieve pain and inflammation.
• If the bruising is severe, significant physical activity like sports, dancing, running, jumping, and weight lifting should be avoided until the muscles heal. (Mount Sinai, 2024)
• With more severe bruising, contraction and stretching of the glutes are painful and can require longer healing and recovery time.
• Physical therapy rehabilitation may be needed for more significant injuries to restore muscle function.

Prognosis

A mild injury usually heals on its own with time and rest. More significant injuries take longer to heal and may require physical therapy to build strength and range of motion if muscle function is affected.

Healing Time and Recovery

Healing and recovery times for gluteal contusions vary depending on the severity of the injury (Fernandes T. L. et al., 2015)

Grade I

• Minor injuries that cause minimal discomfort typically heal fully in five days to two weeks.

Grade II

• During the first two to three days, contusions develop, increasing discoloration under the skin, and complete healing can take two to three weeks.
• Return to sport is typically resumed after a month.

Grade III

• Contusions can take up to four to six weeks to heal, often requiring rehabilitation to restore muscle strength and range of motion.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, we passionately focus on treating patients’ injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes. Our providers use an integrated approach to create personalized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If he feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide our community with the best clinical treatments.

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References

Mount Sinai. (2024). Bruise. www.mountsinai.org/health-library/injury/bruise

MedlinePlus. (2016). Bruises. Retrieved from medlineplus.gov/bruises.html

Fernandes, T. L., Pedrinelli, A., & Hernandez, A. J. (2015). MUSCLE INJURY – PHYSIOPATHOLOGY, DIAGNOSIS, TREATMENT AND CLINICAL PRESENTATION. Revista brasileira de ortopedia, 46(3), 247–255. doi.org/10.1016/S2255-4971(15)30190-7