What is a bone bruise? Symptoms, Causes & Treatment

We all know what it is like to knock into something and bruise ourselves. But whilst simple soft tissue bruises will usually improve over 1 to 2 weeks, bruising to the bone can often take a lot longer to recover from. 

Bone bruises are common across all ages and can affect any bone in your body. They typically heal on their own but they can occur alongside other injuries, such as fractures and ligament damage, and can also lead to serious complications. So, it’s important to see your doctor if you think you have a bone bruise. 

In this article we delve into what a bone bruise is, its causes, symptoms and diagnosis including how to tell if a bone is fractured or bruised. You’ll learn what to look out for if you think you have bruised the bone, gain an understanding of when this might happen and how to prevent bruising bones, as well as finding out about bone bruise treatments.

What is a bone bruise?

A bone bruise is a type of traumatic injury to a bone that is less severe than a bone fracture. It is also known as a bone contusion.

Your bones are living tissue and can get bruised just like your skin can but they take much more force to do so. 

Bone structure includes multiple layers:

• Periosteum - a dense fibrous membrane covering most of the bone surface.
• Subchondral bone - found beneath cartilage at joints.
• Medulla - contains bone marrow and fibrous tissue (trabeculae).

A bone bruise contusion results from partial damage to the bone's internal structure. Unlike a fracture, which breaks all the trabeculae in a bone region, a bone bruise damages only some of these trabeculae, often referred to as a microfracture. 

The term ‘bone bruise’ itself is often misleading. Whilst it is possible to cause bleeding under the thick layer of tissue covering bones (periosteum) it is also possible to cause microfractures to the internal structure of bones without causing an outer break or fracture.

Different types of bone bruises

Depending on the affected area, bone bruises are categorised as:

Sub-periosteal hematoma - blood collects underneath your periosteum. Typically caused by a direct high-force trauma to your bone. It is more common in knee, leg and hip injuries.

Intraosseous bruising - bleeding and swelling occur within the bone's medulla due to bone marrow damage. It is often caused by repetitive and extreme pressure on your bone.

Subchondral bruising - bleeding occurs beneath the cartilage layer in a joint. It can be caused by extreme compression that separates the cartilage and underlying bone, or rotational twisting that triggers subchondral lesions.

What causes bone bruises?

Bone bruises can be caused by an injury of any kind if they are hit with enough force to damage them.

Common causes include:

Sports injuries

Bone bruises, such as a bruised shin, are common in sports, especially among athletes in high-impact activities such as martial arts, football, hockey, and basketball. For martial artists, blocking incoming attacks with arms or legs often leads to this type of injury. Similarly, athletes who frequently run and jump on hard surfaces are at higher risk due to the repeated stress on their bones. 

Knee joint sports injuries are particularly prone to bone bruising. For instance, many athletes who tear their anterior cruciate ligament (ACL) also sustain a bone bruise in their knee. While bone bruises don’t usually require specific treatment, they can significantly impact rehabilitation and recovery and may need careful management to ensure complete healing.

Car accidents

Car accidents can cause bone bruises due to the forceful impacts involved. These injuries can occur when the body strikes a hard surface, such as the steering wheel, dashboard, or seatbelt, leading to trauma to the underlying bone. The most frequently affected areas include your ribs, pelvis, and legs, as they are often subjected to high pressure during a collision. 

Bone bruises from car injuries may be accompanied by soft tissue damage, swelling, and pain. Physiotherapy can help you to regain full function and mobility.

Falls

Falls can cause bone bruises, especially if you land directly on hard surfaces. The impact can damage the underlying bone tissue, often affecting areas like your knees, hips, elbows, or wrists, which instinctively absorb the brunt of the fall. A coccyx bruised bone is usually caused by a fall onto a hard surface, such as ice or a slippery floor.

This type of injury is prevalent in activities where falls are frequent, such as cycling, hiking, or ice skating, and among older adults with reduced bone density. Bone bruises from falls are typically accompanied by swelling, tenderness, and restricted movement in the affected area.

Overuse

Bone bruises can result from repetitive stress or overuse, especially in activities that place continual pressure on specific bones, such as long-distance running or weightlifting. Over time, this repetitive strain can damage the internal structure of the bone, leading to microfractures and localised bleeding. 

Medical conditions like arthritis can also contribute to bone bruising. In arthritic joints, the protective cartilage wears down, causing bones to grind against each other, which increases the risk of bruising in the subchondral bone.

What does a bone bruise feel like?

A bone bruise feels similar to a surface bruise, but more intense. While a typical bruise on your skin or muscle may feel tender or painful to the touch, a bone bruise often causes a deep, throbbing ache that comes from inside your body.

The pain may worsen depending on the location of the bruise, especially when you move, stand, or sit in certain positions.

What are the signs and symptoms of a bone bruise?

Bone bruise symptoms can include:

• Pain and tenderness in the injured area
• Swelling in the injured area and surrounding soft tissues
• A hard lump in the area
• Colour changes in the area
• Swelling and stiffness in an injured joint.

The severity and longevity of your symptoms will depend on how bad your bone bruise is. 

How to tell if a bone is fractured or bruised

Bone fractures (broken bones) and bone bruises are both painful. They differ in how your bone is damaged. This table shows the differences between a bone fracture and a bone bruise.

How are bone bruises diagnosed?

To diagnose a bone bruise, your doctor will start with a physical exam and ask about your symptoms and medical history. Be prepared to share details about how the injury occurred (e.g., a fall or sports activity), when you first noticed pain and swelling, and whether certain activities or positions make the pain better or worse.

Diagnostic Tests

Your healthcare provider may use several imaging tests to examine the injured area, including:  

• Magnetic resonance imaging (MRI) - the most accurate way to confirm a bone bruise. Bone bruises seen on MRI indicate that quite a severe injury has been sustained. In the context of knee injuries, they often go with ligament damage such as anterior cruciate ligament (ACL) ruptures.
• Ultrasound - useful for assessing surrounding soft tissues.  
• Computed tomography (CT) scan - provides detailed images of the bone.  
• X-rays - while they don’t show bone bruises, they are often used to rule out fractures.

Bone bruise treatment options

Your doctor will recommend treatments to reduce pressure on your injured bone and promote healing. Most people can manage symptoms at home with the RICE method:  

• Rest - avoid intense physical activity and try not to use the injured area while it heals.  
• Ice - apply a cold compress for 15 minutes at a time, several times a day. 
• Compression - use an elastic bandage to gently wrap the injured area and reduce swelling. 
• Elevation - keep the injured area raised above your heart as much as possible to reduce swelling.  

Other treatments for a bone bruise:  

• Medications – use over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, to help reduce pain and inflammation. Follow your doctor’s instructions on how often to take these medications. 
• Physiotherapy - a physiotherapist can advise you on exercises to strengthen muscles, improve flexibility, and restore movement, especially if your injury is near a joint.  
• Immobilisation - a splint, brace, or cast may be recommended to keep your injured bone in place and reduce stress while it heals. 

Possible complications of a bone bruise

Most bone bruises heal without complications. However, if you keep using and putting stress on a bone that is bruised through trauma, the damage can worsen and crack or break your bone.

In rare cases, severe bruising of the bone can cause permanent damage. If the bruised area is very large, your body might struggle to fully heal it. A prolonged lack of proper blood flow to the bone can result in a condition called avascular necrosis, where part of the bone dies.  

It’s important to seek medical attention if you suspect a bone bruise. Early diagnosis and treatment can prevent serious issues and help ensure a full recovery.

How long does a bone bruise take to heal?

The healing time for a bone bruise depends on its severity, its location, and your overall health. 

In general:

• Mild bone bruises - heal within 2 to 4 weeks.  
• Moderate to severe bone bruises - can take several months, often 3 to 6 months or longer, to fully heal.  

Factors like age, activity level, and any underlying medical conditions (e.g., osteoporosis or poor circulation) can also affect healing time. You should follow your healthcare provider’s treatment plan and avoid activities that put stress on the injured area to help speed up recovery.

How to prevent bone bruises

You can’t prevent a bone bruise as it tends to be caused by an unplanned trauma. However, here are some safety tips to reduce your general injury risk:

• Always wear your seatbelt.
• Ensure your home is free of trip-hazards and clutter.
• Wear any advisory protective and supportive equipment for work, sports and other physical activities, DIY and gardening.
• Always use proper tools or equipment to reach things. 
• Use a walking aid if you have difficulty walking or have an increased risk of falls.
• Be mindful of the condition of walking and running routes and take care when navigating them.

About Ramsay Health Care

If you think you might have a bone bruise, you can access appointments quickly and conveniently for consultations and scans at your local Ramsay hospital.

Our experts are on-hand to diagnose your bone bruise and any other injuries you may have sustained. 

We have highly experienced radiographers who are fully trained in carrying out MRI and other imaging onsite or via mobile imaging units. If treatment is required, our physiotherapists are on-hand to give you personalised exercise advice to strengthen, improve flexibility, and restore movement. We also provide medical devices to aid immobilisation whilst your bruise heals.

FAQ about bone bruises

What is the difference between a bone bruise and a hematoma?

A bone bruise is a type of bruise that occurs within a bone, while a hematoma is a collection of blood outside of a blood vessel.

Can a bone bruise cause a blood clot?

No, a bone bruise does not cause a blood clot. However, a blood clot may form independently at an injury site after a large trauma.

Can a bone bruise heal on its own?

Yes, most bone bruises will heal on their own. They typically take 1 to 2 months to heal, but larger or more severe bruises can take months or longer to heal. 

Bone bruise healing time depends on your type of bone bruise, the bone it's in, and if you have other injuries.

Do I need to see a doctor for a bone bruise?

Yes, you should always see a doctor if you think you have a bone bruise. They can treat or rule out other injuries, diagnose your bruise, and treat it. 

Bone bruises can sometimes lead to serious complications, like a broken bone or bone death. Bone bruise symptoms may indicate a severe bone bruise that is only one part of your injury. For example, you could also have a fracture or a break or a ruptured ligament.

You should visit your doctor if you feel bone pain for more than a few days, or if you have other symptoms like swelling, a reduced range of motion, or pain when you use a body part.

Can you still walk with a bruised bone?

You can usually continue your daily activities when you bruise the bone. However, with some lower body bone bruises, such as your knee, shin, ankle or foot, walking may be painful and you should not put weight on them. Your doctor will advise you about whether you can walk with your bone bruise. 

How long should a bruised bone last?

A bruised bone can take a few weeks to a few months to heal. Factors that affect bone bruise recovery time include the severity of your bruise, where the bone is (weight bearing bones may need more recovery time), whether other injuries happened at the same time, your age and overall health, and whether you smoke or have diabetes.