Bone Bruise (Bone Contusion)

What is a bone bruise?

A bone bruise is a bone injury. It’s similar to a bruise you might get on the surface of your skin. But it’s more serious than a mark left over from roughhousing with your kids or playing pickup basketball.

Healthcare providers sometimes refer to bone bruises as bone contusions. Contusion is the medical name for a bruise.

Bone contusions are blood trapped under the surface of your bone after an injury. Your bones are living tissue that can get bruised in lots of the same ways your skin can. It takes much more force to bruise a bone than your skin, but the injury is very similar. If something hits your bones with enough force, they can bleed without being broken.

Visit a healthcare provider or go to the emergency room if you’ve experienced trauma like a fall or car accident. Especially if you feel sharp, intense pain that feels like it’s coming from a bone.

Types of bone contusions

A healthcare provider may classify a bone contusion based on where your bone is damaged:

• Periosteal contusion: The periosteum is a membrane of blood vessels and nerves that wraps around most of your bones.
• Subchondral lesions: A bone bruise in a joint, under the cartilage.
• Intraosseous contusion: Bruising inside your bone itself.

What is the most common bone bruise?

Bone bruises are common after traumas or other severe injuries. For example, experts estimate that around 80% of people who tear their ACL also bruise a bone in their knee joint.

Bone bruises can affect any bone in your body, but they’re more common in longer bones, especially in your legs, including your:

• Femur (thigh bone).
• Tibia (shin bone).
• Fibula (calf bone).

What are bone contusion symptoms?

The most common bone contusion symptoms include:

• Bone pain.
• Tenderness around the bone.
• Swelling.
• Skin bruising or discoloration.

What does a bone bruise feel like?

A bone bruise will feel like a more intense version of a typical surface bruise. A bruise on your skin or in a muscle will feel tender or painful, especially when you touch that spot. A bone bruise usually feels like a dull, throbbing ache that’s coming from deeper inside your body.

Depending on which bone is bruised, the pain might get worse when you move, stand or sit in certain positions.

What causes bone bruises?

Anything that hits your bones with enough force to damage them can cause a bone bruise.

Traumas and injuries are the most common causes, including:

• Sports injuries.
• Falls.
• Car accidents.

Injuries that twist your joints or body are more likely to cause bone contusions. Sprains (especially in your ankle and knee) can put enough pressure on your bones to bruise them.

What are the risk factors?

Anyone can bruise a bone, but some people have a higher risk, including:

• Athletes who play contact sports.
• People who have physically demanding jobs or hobbies.
• People who have blood disorders.
• People who have arthritis.

What are bone contusion complications?

Untreated bone contusions can weaken your bone enough to cause a bone fracture (broken bone). Many of the same injuries that cause bone bruises can also break your bones.

If trauma bruises your bone and you keep using it or putting stress on it, the damage can worsen to the point that your bone cracks or breaks.

How do healthcare providers diagnose bone bruises?

A healthcare provider will diagnose a bone bruise with a physical exam and some imaging tests.

Your provider will examine your injured bone and the area around it. Tell them what you were doing when you first noticed symptoms like pain and swelling and if you know what caused the injury (like a fall or sports injury). Tell your provider if certain activities, motions or physical positions make your symptoms worse (or better).

Bone bruise tests

Your provider might use a few different imaging tests to take pictures of your bones and the area around them, including:

• Magnetic resonance imaging (MRI).
• Ultrasound.
• Computed tomography (CT) scan.

X-rays can’t show bone bruises, but your provider might use one to check for a bone fracture.

What are bone bruise treatments?

Your provider will suggest treatments to take pressure off your injured bone and help it heal.

Most people can manage bone bruise symptoms at home with the RICE method:

• Rest: Avoid intense physical activity. Try not to use the injured part of your body while it heals.
• Ice: Apply a cold compress to your injury 15 minutes at a time, a few times a day. Wrap ice packs in a towel or thin cloth so they’re not directly touching your skin.
• Compression: Wrap an elastic bandage around your injured bone to help reduce swelling. Your provider can show you how to apply a compression wrap safely.
• Elevation: Keep your injured bone above the level of your heart as often as you can.

Other bone bruise treatments include:

• Medications: Over-the-counter (OTC) NSAIDs and acetaminophen reduce inflammation and relieve pain. Your provider will tell you how often it’s safe to take these kinds of anti-inflammatory medications. Don’t take pain relievers for more than 10 days in a row without talking to your provider.
• Physical therapy: A physical therapist will give you stretches and exercises to strengthen your muscles, increase your flexibility and restore your range of motion (how far you can move a body part). This can be especially helpful if the bone contusion is in or near a joint.
• Immobilization: Your provider may suggest that you wear a splint, brace or cast. These devices will hold your bone in a neutral position and reduce stress on it while it heals. Your provider will tell you how long you’ll need to keep your bone immobilized.

How soon after treatment will I feel better?

You should start feeling better as soon as you begin managing any symptoms. The pain, swelling and tenderness should improve gradually after you start taking anti-inflammatory medications and reduce how often you use your injured bone.

Don’t resume any physical activities until your provider says it’s safe. Your bone still needs time to heal completely before it has all its usual strength.

If you put too much stress on a bone bruise before it heals (by returning to sports, work or doing intense physical activity), the weak spot near the bruise has a higher risk of becoming a fracture.

How can I prevent bone bruises?

You might not be able to prevent a bone bruise because it’s usually caused by traumas you can’t plan for. But you can reduce your general injury risk with these safety tips:

• Always wear your seatbelt.
• Wear the right protective equipment for all sports, work or physical activities.
• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
• Use a cane or walker if you have difficulty walking or have an increased risk of falls.

What can I expect if I have a bone contusion?

You should expect a bone contusion to heal. But it might take time, and it can be a frustrating process.

It’s usually hard to make a typical skin bruise worse (even if it can hurt a lot when you forget it’s there and touch that spot). A bone bruise is different. Because it’s damaged bone, it’s important to give your body time to heal. Depending on where the bone contusion is, you might have to avoid certain activities. This can be extra annoying if you have to skip your favorite workout, sport or hobby for a while.

Talk to your provider about how long you’ll need to avoid intense physical activity or exercise. They’ll help you understand what to expect.

How long does a bone bruise last?

Bone bruises can take a while to heal. Most bone bruises last a few weeks. More severe bruises can take months (or longer) to heal completely.

How long a bone bruise lasts depends on which type it is, which bone it’s in and if you experienced any other injuries at the same time.

Should I go to the doctor for a bruised bone?

Yes, absolutely. You should always see a healthcare provider if you think you have a bone bruise. Most typical bruises don’t need to be diagnosed and treated by a provider, but bone bruises do.

Visit a provider 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.

Go to the emergency room if you experience trauma like a severe fall or car accident.

What questions should I ask my provider?

You may want to ask your provider:

• Do I have a bone contusion or another injury?
• Which bone is bruised, and which type of bruise is it?
• Which treatments will I need?
• When can I resume playing sports, exercising or doing other intense physical activities?

What are the healing stages of a bone bruise?

Bruises just under your skin usually change color as they heal. They may appear red or purplish at first. If you have a darker skin tone, you may notice purple, dark brown or black bruising. As the area heals, the bruise may turn a lighter shade of brown, green or yellow.

Bone bruises go through similar healing stages, but you might not be able to see any visible changes because the bruise is deep inside your body. Ask your provider when it’s safe to start putting stress on your injured bone before resuming all your usual activities.

How do you know if a bone is broken or bruised?

Bone fractures (broken bones) and bone bruises are both painful injuries caused by a strong force hitting your body — usually a fall, car accident or sports injury. The difference is how your bone is damaged.

Bone bruises (bone contusions) happen when something hits a bone hard enough to make it bleed, but not crack or break.

A bone fracture happens when something hits your bone with enough force to break it in at least one place. Fractures are more serious injuries and can take much longer to heal than bone bruises.

Go to the emergency room if you’ve experienced trauma and have pain on or near a bone. No matter which injury you have, it’s important to get your bone examined right away.

A note from Cleveland Clinic

You get a bruise when the coffee table jumps out to bang your shin or someone on the other team takes a game of pickup basketball a little too seriously. Bone bruises are very similar to black and blue marks on your skin, but they’re deeper inside your body and are a little more serious.

Your provider will help you understand where the bruise is on your injured bone, and what you can do to help it heal. Don’t rush your recovery. It might take time, but it’s worth it. Wait to resume intense physical activities until your provider says it’s safe.