What Is a Bone Bruise?

Despite the name making it sound like a simple bruise, a bone bruise is a lot more painful and the pain lasts longer than the giant swelling of a bruise on the skin or in the muscle.

Bone bruises are only one step away from a fracture. (Image: Adobe Stock/ashtproductions)

In fact, it's one step before a bone fracture. Here's what you need to know about bone bruises.

How Does a Bone Bruise Happen?

Bones are composed of a network of fibers that help retain calcium, a mineral in the body that keeps bones healthy and strong. If a bone is damaged extensively enough, many of these tiny fibers will break, resulting in a fracture. A bone bruise occurs when only a few of the fibers break.

This condition, which is also called a periosteal hematoma, occurs when the outer layer of a bone, called the cortex, sustains small breaks following injury or trauma. If you're taking medication that thins your blood, you may be at greater risk for bone bruises.

Bone Bruise Symptoms

It's important to note that when it comes to looking out for bone bruise symptoms, that they may vary slightly depending on where your injury occurred. Additionally, not all of these symptoms will be present simultaneously. But here are some things to watch for:

  • Deep bone bruises can cause severe pain that lasts anywhere from several weeks to 2 years after an injury (see reference 3, section 1).
  • There's also swelling and discoloration with bone bruises since the muscle and tissue surrounding the affected bone are also damaged.
  • The skin around the injured bone can appear enlarged and puffy, tender to the touch and can appear blue or purple due to pooled blood beneath the skin.
  • As a bone bruise begins to heal, the injured skin may appear green or yellow in color, until it is completely healed and regains its normal coloring.
  • When the shoulder is affected, your range of motion can be limited and weakness may be present. This makes activities like bathing and dressing quite challenging.
  • Bone bruising in the knee or shin can lead to difficulty with walking and balance. Stiffness with bending or straightening the knee may also occur.
  • If the ankle or foot are affected, standing and walking are often extremely painful and crutches may be necessary to assist with your mobility. In addition, swelling may develop below the injured area in the forefoot or toes.
  • Bruising to the tailbone causes pain with sitting, particularly on hard surfaces, and can limit your ability to ride in a car.
While an x-ray may find a fracture, typically an MRI is used to diagnose a bone bruise. (Image: Adobe Stock/romaset)

How Do You Diagnose a Bone Bruise?

The most common way to diagnose a bone bruise is to get an MRI. This method of imaging enables you to assess the amount of damage to the bone and the layers that have been affected.

In addition, it allows your physician to see the bleeding and swelling that can occur in the area. While an x-ray can help to rule out a fracture, it is not useful when looking for a bone bruise (see reference 3, section 1).

Bone Bruise vs. Muscle or Skin Bruise

It can be tricky to differentiate between a run-of-the-mill bruise on your muscle or skin and a deeper bone bruise. Typically the symptoms of a bone bruise stick around much longer than one on your skin or muscle and are the result of a more significant trauma or injury.

In addition, bone bruises typically lead to significant swelling which in turn can cause stiffness in nearby joints. On the contrary, muscle or skin bruises heal more rapidly and usually don't affect your mobility as greatly.

Bone Bruise vs. Fracture

Since both bone bruises and fractures can result from similar trauma, it's important to know which one you're dealing with. The pain from fractures tends to be sharper in nature while bone bruises may cause a deeper, more achy type of pain.

In addition, feelings of instability and even visible deformities in the skin can accompany a fracture while these usually aren't seen with a bruise. Because these two serious conditions are commonly confused, it is important to see your doctor if you are experiencing any of the symptoms above so that you can be properly diagnosed and treated.

Bone Bruise Treatments

Immediately after injury, apply an ice pack to the area to reduce pain and swelling. An ice pack can be applied over a wet towel for 10 to 15 minutes every 3 to 4 hours. Ice is typically used for 2 to 3 days after injury or until swelling has subsided.

Thereafter, heat can be applied to decrease pain and promote healing. Heat is typically applied for 15 to 20 minutes at a time for 3 to 4 days. Place a towel between your skin and the heat source (heat pack or hot water bottle) to reduce the risk of burns.

Other important treatments are to rest and elevate the injured area as much as possible, as well as take an over the counter anti-inflammatory pain medication such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Resting allows the body to generate new bone tissue without stressing the injured area.

Depending on the severity, patients may continue light activity wearing a splint, elastic bandage or athletic tape, while more severe cases may need crutches or a sling to prevent any more damage and allow for healing.

When Should I Go to a Doctor for a Bone Bruise?

Patients who experience severe pain from a bone bruise should contact a doctor immediately after the injury to find out if they have a bone fracture, which is diagnosed with an X-ray.

Some researchers are linking bone bruises with other more serious conditions such as ACL injuries and arthritis, therefore you should see a doctor immediately if your pain is moderate but you also have one of the following symptoms:

  • You don't see improvement, or if swelling increases, after 3 or 4 days of icing, resting and anti-inflammatory pain medication.
  • If you have pain while stretching or bearing weight in either leg.
  • If the skin is pale and cool below the injury.

Bone bruises can be predecessors to larger problems, like the development of damage to the smooth articular cartilage that covers the end of your bones. In addition, this type of injury can speed up the formation of osteoarthritis in the involved area. So be sure to take this injury seriously and to address any symptoms with your physician to decrease the chances of developing these potential side effects.

What Do YOU Think?

Have you ever had a bone bruise? Or fractured a bone? What did you do? What did your doctor tell you? What kinds of treatments helped you heal? Share your stories and questions in the comments below!

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