Bruises

Bruises and welts are the most common types of physical injuries. In distinguishing non-accidental
injuries from those that are abusive, a detailed history is crucial. Also, consider:

  • Location of the injury
  • Pattern of the injury
  • Date of the injury

When looking at the LOCATION of the bruise/mark, remember that unintentional or accidental
injuries of this nature generally occur to the front of the body and on areas of the skin over bony
prominence, with the knees and shins being the most common areas. Trauma to the soft,
unsupported tissue of the body such as the cheeks, may be due to intentional action, like slapping or
pinching.

The areas of a person’s body most likely to be injured accidentally, through falls or other accidents
are:

  • Knees
  • Elbows
  • Forehead
  • Hands
  • Chin
  • Nose

Suspicious injuries often occur on the posterior side of the body, in an area extending from the back
of the neck to the back of the knees.

From the PATTERN of a bruise injury, we can often determine what instrument/object was used to
create it.

Grab marks & Fingertip Bruises – most often found on the upper arms, shoulders and extremities.
The person may have been violently grabbed, shaken or pulled.
Slap Marks – generally linear, parallel bruises similar to outline of fingers. Slapping may also cause
loose teeth, abrasions inside the mouth, ruptured ear drums or eye injuries.
Wrap-around Marks – marks of objects that conformed to the shape of the skin. These are generally
caused by flexible objects such as straps, belts, ropes or cords.
Object-shaped Marks – object forces the skin to conform to the shape of the object. These are
generally caused by blows from rigid objects such as sticks, switches, rulers, boards or plastic coat
hangers.
Areas of Mass Bruising – deep muscular bleeding, severe bruises, bruises at different stages and
internal bruises. These are generally blows by hands or fists on soft tissue, use of both flexible and
rigid objects and several blows landing in the same approximate areas.
Tie Marks – abrasions, friction burns (rope burns), and blisters. These are caused by materials used
to tie a person up that rubs against their skin (as with gagging).
Bite Marks – pair of crescent-shaped bruises or lacerations often with individual teeth marks. The
bruising may appear wide and shallow or torn/punctured area that is long and narrow.

  • It is important to take photographs and describe the injuries thoroughly in your documentation.
    The description must include the shape, size, color and location, and be adequately detailed so
    that anyone reading the description can mentally picture the injury.

When attempting to determine the DATE an injury occurred, reports from others may be the most
reliable source of information. It is possible to estimate the age of a bruise based on its color but
complete accuracy is difficult. Several factors affect the color of a bruise, including the location on
the body, the force of the blow and the differences in healing patterns of individuals. Deep-seated
bruises (created by injury to vessels deep in the skin) can take days to show and may remain dark for
weeks.

The following is a description of bruising at various stages of resolution:

  • Swollen, tender………………..0 – 2 days
  • Red – blue………………………..0 – 5 days
  • Green……………………………….5 – 7 days
  • Yellow………………………………7 – 10 days
  • Brown……………………………..10 – 14 days
  • Clear………………………………..2 – 4 weeks
The above information is only a guide. The victim should always be examined by a physician when an injury occurs.