Bruises can occur in bones as well as soft tissue. Symptoms of a bone bruise may include swelling, skin discoloration, joint pain, and stiffness.

Most people are familiar with the bruising, discoloration, and swelling that is characteristic after a blow to the muscles and soft tissue. Bone bruises are similar, but they can be more painful and take longer to heal.

Most bone bruises usually heal within 3 months, although some may take up to a year to completely go away.

Read on to learn more about bone bruises, including the symptoms, types, and treatments.

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Bone bruises are a result of injury or trauma. When something strikes a bone, blood and fluid can build up inside the bone marrow, causing pain and swelling.

Previously, scientists referred to bone bruises as bone marrow edema. The authors of a 1988 study of 10 people with debilitating pain in the hips and knees discovered the condition. The participants had altered bone marrow density on a MRI scan that was not visible on an X-ray.

Today, doctors may use the terms “bone bruise”, “bone contusion”, or “osseous contusion”. People can have bone bruises on their own, but they can also indicate a person has a fracture, ligament tear, or other injury.

Trabeculae are the network 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 the stage before a fracture. In this case, only some of the trabeculae are broken.

The symptoms of a bone bruise may include:

  • swelling
  • pain or tenderness that continues after a skin bruise has disappeared
  • a change of skin color

If the injury is near a joint, a person may also have:

  • joint pain near the impact zone
  • joint inflammation
  • stiffness or difficulty moving the joint

There are several ways of sorting bone bruises into categories. One way is by describing which part of the bone tissue the bleed has affected. For example, a bone bruise may be a:

  • Subperiosteal hematoma: This occurs when blood builds up beneath the fibrous membrane that covers the surface of the bone.
  • Intraosseous bruise: This involves bleeding and swelling beneath the outer surface of the bone, in the cavity that contains red and yellow bone marrow.
  • Subchondral lesion: This is bruising that occurs under cartilage that is covering a joint. Either a compressive force that crushes the cells and separates the cartilage and underlying bone, or a rotational twisting force triggers subchondral lesions.

Doctors can also categorize bone bruises by the location on the body or the severity.

Bone bruises can follow a single traumatic event, such as an injury, fall, or car accident. They can also be the result of a series of events that place extreme pressure on a bone or joint over time, such as repetitive motions during a sport.

The types of injury that can result in a bone bruise include:

  • a direct blow to the bone, such as from a person or object
  • the skin or the muscle being torn away from the bone
  • twisting or rotation that pulls cartilage away from the bone
  • two bones striking each other
  • damage to neighboring bones
  • too much pressure on the joints, such as from running or jumping on hard surfaces

Each of these forms of trauma leads to a unique pattern of bruising the bone.

Bone bruises and ACL tears

Anterior cruciate ligament (ACL) injuries are an especially common type of sports injury that can cause bone bruising. The ACL runs diagonally across the middle of the knee and provides rotational stability.

A 2020 study of 207 adults with acute ACL injury found bone bruising in 81.6% of study participants. The most common sport that resulted in the ACL tear was basketball, followed by soccer and skiing.

Risk factors for bone bruising

People who work in physically demanding jobs, or who often participate in contact sports, may be more likely to experience the types of injury that causes bone bruises.

However, anyone could get a bone bruise as a result of an accident. Wearing protective equipment when doing physical labor or sports is important.

A doctor may diagnose a bone bruise by asking about a person’s symptoms, such as when they began and whether they have changed over time.

They may examine the affected area for signs of swelling and color changes in the skin. If the pain is around a joint, they may move it, or ask the person to move it, to determine if there are any mobility problems.

If they suspect a bone bruise or other injury, they may recommend medical imaging. This could include an X-ray, but to diagnose a bone bruise, a person will also need to undergo an MRI. Bone bruises do not show up on X-rays, although the doctor may perform one to rule out a fracture.

No treatments are proven to speed up the healing of bone bruises. Most will heal on their own with time. Until then, people may be able to do things to ease the symptoms, such as:

  • resting the affected bone or joint
  • raising the injured area above heart level to reduce swelling
  • applying a cold pack to the injury several times a day
  • taking pain medications, such as acetaminophen, to reduce pain and inflammation
  • wearing a brace to limit movement

For bone bruises and injuries affecting weight-bearing bones, such as the legs or feet, a person may have to avoid certain activities for a while. A doctor can advise on when it is safe to resume them.

If a person usually participates in contact sports or does a lot of physical labor, they should wear appropriate protective equipment to prevent further damage to the bones.

It is generally advisable to get enough calcium and vitamin D every day to support bone health.

The healing time for a bone bruise depends on its severity. The United Kingdom’s National Health Service (NHS) says most heal within 3 months. Some may take up to a year.

In rare cases, the body may struggle to return blood flow to the injured area, causing avascular necrosis of the bone, or osteonecrosis. This is the death of bone tissue due to lack of blood supply.

Osteonecrosis is more common in fractures and joint dislocation, but it could occur due to other types of trauma. Once bone tissue dies, the damage can be irreversible.

It is important to get the opinion of a medical professional if a person suspects a bone bruise. In some cases, the condition may be part of a more serious injury.

The symptoms of a bone bruise can also be similar to that of other conditions, such as arthritis. A doctor can perform tests to rule this out.

Seek medical assistance if the swelling gets worse, does not reduce in size, or if the pain has increased without responding to pain relief medication.

Bone bruises occur when an injury or force impacts the bone, causing fluid or blood to build up in the bone marrow. This can lead to pain and swelling, and may cause stiffness or difficulty moving, if the injury affected a joint.

Most bone bruises heal in several months, but some may take more or less time. No treatments can speed up the healing, but rest, pain medications, and cold therapy may help to alleviate symptoms.

Protecting the bones from further injury by wearing protective equipment during any high-risk activity is also advisable.