What is a bone bruise?

A bone bruise is a traumatic injury to a bone. It's less severe than a bone fracture.

You might think of a black and blue mark on your skin when you hear the word bruise, but bruises can also happen in muscle and bone. This happens when an injury damages small blood vessels and causes blood and fluid to leak into the nearby tissues and blood vessels.

Bone is made of different kinds of tissue. The periosteum is a thin layer of tissue that covers most of a bone. Where bones come together, there is usually a layer of cartilage at the edges. The bone here is called subchondral bone. Deep inside the bone is an area called the medulla. It contains the bone marrow and fibrous tissue called trabeculae.

With a bone fracture, all the trabeculae in a region of bone have broken. But with a bone bruise, an injury only damages some of these trabeculae. It's also called a microfracture. An injury might cause blood to build up in the area beneath the periosteum. This causes a subperiosteal hematoma, a type of bone bruise. An injury might also cause bleeding and swelling in the area between your cartilage and the bone beneath it. This causes a subchondral bone bruise. Or bleeding and swelling can happen in the medulla of your bone. This is called an intraosseous bone bruise.

The term bone bruise is fairly new. This is because healthcare providers only started diagnosing the injury when the use of magnetic resonance imaging (MRI) became more common in recent years. A bone bruise doesn’t show up on an X-ray.

Bone bruises are fairly common. They can happen to people of all ages. Any type of bone in your body can get a bone bruise. Other injuries often happen along with a bone bruise, such as damage to nearby ligaments.

What causes a bone bruise?

Injury of any kind can cause a bone bruise. Sports injuries, motor vehicle accidents, or falls from a height can cause them. Twisting injuries—such as those that cause joint sprains—can also cause a bone bruise. Medical conditions, such as arthritis, may also lead to a bone bruise. This is because where there’s arthritis, bone surfaces are not protected and they grind against each other. Child abuse is another cause of multiple bone bruises.

Who is at risk for a bone bruise?

You may be at higher risk for a bone bruise if you don’t use the correct safety gear for your sport. Other risky actions, such as not wearing a seatbelt, may also raise your risk for a bone bruise.

What are the symptoms of a bone bruise?

Symptoms of a bone bruise can include:

• Pain and tenderness in the injured area

• Swelling in the area and soft tissues around it

• Hard lump in the area

• Change in color of the injured area

• Swelling of an injured joint

• Stiffness of an injured joint

This pain is often more severe and lasts longer than a soft tissue injury. How severe your symptoms are and how long they last depend on how severe the bone bruise is.

How is a bone bruise diagnosed?

Your healthcare provider will ask you about your medical history and symptoms. They will ask how you got your injury. You’ll be given an exam of the injured area that checks for pain, bruising, and swelling.

After the exam, your healthcare provider may be able to tell if you have a bone bruise. A bone bruise doesn’t show up on an X-ray. But you may be given an X-ray to rule out a bone fracture. A fracture may need a different kind of treatment. An MRI can confirm a bone bruise. But your healthcare provider will likely only give you an MRI if your symptoms don’t get better.

How is a bone bruise treated?

Treatment for a bone bruise may include:

• Resting the bone or joint

• Applying ice to the area several times a day

• Raising the injury above the level of your heart to reduce swelling

• Taking medicine to reduce pain and swelling

• Wearing a brace or other device to limit movement, if needed

Your healthcare provider may give you advice about your diet. This is because eating a diet that is rich in calcium, vitamin D, and protein can help you heal. Your healthcare provider may ask you to not use certain over-the-counter medicines for pain. Some of these may delay normal bone healing. If you smoke, your healthcare provider will advise you to stop smoking. Smoking can also delay bone healing.

Some lower extremity bone bruises need restriction of weight-bearing. Your healthcare provider will tell you how long you should not put weight on your bone. Most bone bruises slowly heal over 1 to 2 months. A larger bone bruise may take longer to heal. You may not be able to return to sports activities for weeks or months. If your symptoms don’t go away, your healthcare provider may give you an MRI.

What are possible complications of a bone bruise?

Most bone bruises heal without any problems. If your bone bruise is very large, your body may have trouble getting blood flow back to the area. This can rarely cause avascular necrosis of the bone. This leads to death of that part of the bone.

When should I call my healthcare provider?

Call your healthcare provider if your symptoms don’t start to get better in a few days. Call your provider right away if you have any severe symptoms, such as a high fever.

Key points about bone bruise

A bone bruise is a type of traumatic injury. It's less severe than a bone fracture. It causes blood and fluid to build up in and around your injured bone:

• You may have symptoms such as pain, swelling, and a change in color of the injured area.

• Your healthcare provider will need to rule out other medical problems, such as a bone fracture.

• A bone bruise can be seen only on an MRI scan. But it can be diagnosed and treated without an MRI scan.

• Your healthcare provider may treat your bone bruise with rest, ice, pain medicines, and a brace to prevent the bone from moving.

• In rare cases, a bone bruise may cause a complication called avascular necrosis. This causes part of the bone to die.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.