Bone Bruise: Symptoms, Treatment, and Outlook

Most people are familiar with the bruising, discoloration, and swelling that occurs with a blow to muscles and soft tissue. However, what people may not realize is that bones can also become bruised.
Bruises can last from days to months and vary from mild to severe. Bone bruises are among the most serious and most painful. Bone bruises usually heal in a couple of months, although larger bone bruises may take longer.
Contents of this article:
What is a bone bruise?
Types of bone bruise
Causes of bone bruise
Diagnosing a bone bruise
Treatments for a bone bruise
What is a bone bruise?
Bruises form when a blood vessel breaks close to the surface of the skin following a blow. The broken blood vessels leak a small amount of blood into the tissues under the skin. The area will appear red in color at first, changing to blue or purple, green, yellow-brown, and finally normal skin color as the bruise heals.
[knee pain]
A traumatic blow can lead to a bone bruise.
Bruises can happen not only under the skin, but also deeper in tissues, organs, and bones. While these deeper bruises may not show visible signs of bleeding, the bruise can cause pain.
In 1988, a study discovered a condition that the researchers called bone marrow edema. People with hip and knee pain were found to have altered bone marrow density on a magnetic resonance imaging (MRI) scan that was not visible when examined by X-ray.
Bone marrow edema is now usually referred to as “bone bruise” to reflect the traumatic nature of the condition. A bone bruise is also sometimes called bone contusion.
The bone marrow changes in a bone bruise could be caused by:
Increased blood pooling: Dilated capillaries result in stagnant blood flow, which leads to severe inflammation.
Fluid within the bone: With muscle injuries, fluid collects in the muscles and makes them swell. This is known as edema. Bones are unable to swell as they are hard. Instead, fluid in the bones creates pressure, leading to pain.
Reactive hyperemia: This happens when blood flow increases after a temporary interruption.
Fracture: There may be a small fracture in the layer of bone, just below the cartilage in a joint.
Trabeculae are the meshwork of supporting fibrous tissues in a bone. A complete fracture of a bone means that all of the bone trabeculae in that particular area of the bone are damaged, which causes a break. A bone bruise is often described as the stage before a fracture. In this case, only some of the trabeculae are broken.
Symptoms of bone bruise
In the area affected by a bone bruise, symptoms may include:
Pain or tenderness that continues after a skin bruise has disappeared
A change of skin color
Joint pain near impact zone
Joint inflammation
Joint stiffness.
The pain associated with a bone bruise lasts longer than a soft tissue injury.
Types of bone bruise
There are three kinds of bone bruise:
Subperiosteal hematoma, when blood builds up beneath the fibrous membrane that covers the bone’s surface
Interosseous bruise, involving bleeding and swelling in the central cavity of the bone where red and yellow bone marrow is stored
Subchondral lesion, in which bleeding and swelling occurs between cartilage and the bone underneath.
The type of bone bruise a person has depends on where the injury occurs on the bone.
Subperiosteal hematoma mostly happens after a traumatic blow to the bone. It is common in the lower regions of the body.
Interosseous bruising may result if extreme pressure is applied to a bone on a regular basis. This type of bruise mainly affects football and basketball players and runners.
Subchondral lesions are triggered by either a compressive force that crushes the cells and separates the cartilage and underlying bone, or a rotational twisting force. Again, this type of bone bruise is seen most often in football and basketball players.
Jumping or impact from running on hard surfaces can cause all three types of bone bruise.
Causes of bone bruise
Any bone in the body can become bruised. Bone bruises are frequently reported in the knee, wrist, heel bone, foot, ankle, and hip. They often follow a single traumatic event, such as a sports injury, a fall, a car accident, or a strike from a person or object.
[ice hockey injury]
Participating in sports increases the risk of bruising a bone.
Twisting injuries that can cause joint sprains can also cause bone bruising.
Bone bruises occur by the following forms of trauma:
A direct blow to the bone
The forces associated with the skin or the muscle being torn away from the bone
Two bones striking each other after ligament injuries
Damage to neighboring bones.
Each of these forms of trauma has a unique associated pattern of bone bruise.
Bone bruises can also be caused by medical conditions such as arthritis, where the bone surfaces may grind against each other.
Risk factors for a bone bruise
A person may be more at risk of bone bruising if they:
Take part in high-impact sports-related activities
Have a physically demanding job
Do not wear protective equipment for sports or their job
Have osteoarthritis.
Bone bruises are common in people who play soccer, football, hockey, and basketball, those who practice martial arts, and in road runners.
Anterior cruciate ligament injuries in youth sports
Sports participation is growing significantly in high schools in the United States. Over the past few decades, male participation has increased by around 3 percent, while female participation has doubled every 10 years.
With this rise in sports participation, there has been an increase in anterior cruciate ligament (ACL) injuries in male and female athletes.
The ACL runs diagonally in the middle of the knee and provides rotational stability to the knee. Athletes who take part in high-demand sports like soccer, football, and basketball are most likely to injure their ACL.
MRI studies of acute ACL injury have found bone bruising, contusions, or edema in greater than 80 percent of study participants. The violent impact of the shin bone and thigh bone cartilage that is transferred to the bone is thought to cause bone bruises.
Diagnosing a bone bruise
It is important to get a doctor’s opinion if a bone bruise is suspected as the condition may be part of a more serious issue. Medical assistance should be sought if the swelling gets worse, if it does not go down, or if the pain has increased and is not relieved by pain relievers.
The doctor will often take details of medical history and symptoms, and ask how the injury occurred. The doctor may conduct a physical examination and check the injured area for pain, bruising, and swelling. A bone bruise may be suspected and diagnosed from this examination. An MRI might be suggested if the symptoms do not improve.
Bone bruises do not show up on X-rays, although an X-ray may be given to rule out a bone fracture. They appear on MRI scans as poorly-defined regions in the marrow.
Treatments for a bone bruise
A bone bruise can be treated with rest, ice, compression, elevation, precaution, and pain relief.
[ice on knee]
Applying ice may help to relieve the symptoms of a bone bruise.
A doctor may suggest:
Resting the affected bone or joint
Reducing swelling by raising the injured area above heart level
Applying ice to the injury several times a day
Drugs to reduce pain and inflammation
Wearing a brace to limit movement.
It is important to avoid constant or intense pressure or heavy weight on the affected area to prevent aggravating the problem. If the bone or joint does not have enough rest, the healing process can slow down, and more damage can occur.
A healthcare provider may also give advice about diet. Eating a diet rich in calcium, vitamin D, and protein can help the healing process. Smoking can delay bone healing.
Most bone bruises heal within a couple of months. However, it may be weeks or even months before a person can return to their sport.
In rare cases, the body may struggle to get blood flow to return to the injured area, causing avascular necrosis of the bone. Avascular necrosis is the death of bone tissue due to lack of blood supply. If the bone dies, the resulting damage is irreversible.
The time a bone bruise takes to heal depends on its severity. Bone bruises heal from as early as 3 weeks to 2 years.
While bone bruises are not always preventable, eating a balanced diet, getting regular exercise, quitting smoking, limiting alcohol intake, and wearing recommended protective equipment while playing sport can help keep bones healthy.

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