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Patterned Bruises From Abusive Squeezing

Petska, Hillary W. MD, MPH*†; Frasier, Lori D. MD; Livingston, Nina MD§; Moles, Rebecca MD§; Sheets, Lynn K. MD*†

doi: 10.1097/PEC.0000000000001717
Illustrative Case: PDF Only

Bruising is the most common presentation of child physical abuse. Many patterns of abusive bruising result in positive or negative imprints of the implement used (eg, fingertips in “grab mark” contusions or hand in slap injury). However, bruising may also form along the lines of greatest anatomical stress (eg, gluteal cleft or pinna bruising). Bruising due to abusive squeezing also forms along lines of greatest anatomical stress, resulting in a negative imprint of the flexural folds of the hand. Four cases of children with this unique pattern of bruising due to abusive squeezing are presented. Recognition of these bruises as inflicted represents an opportunity for early identification and intervention in cases of child physical abuse.

From the *Medical College of Wisconsin and

Children's Hospital of Wisconsin, Milwaukee, WI;

Penn State Milton S. Hershey Children's Hospital, Hershey, PA; and

§University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT.

Disclosure: The authors declare no conflict of interest.

Reprints: Hillary W. Petska, MD, MPH, Child Advocacy and Protection Services, Children's Hospital of Wisconsin, PO Box 1997, C615, Milwaukee, WI 53201 (e-mail:

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