What is a bone bruise?

Medically reviewed by Angela M. Bell, MD, FACP on May 10, 2023

A bone bruise, also known as a bone contusion, appears when you have a small injury on the surface of a bone. This is a stage before a bone fracture, which involves damage to the bone at a closer level.

Someone with a bone bruise will have pain, tenderness, and swelling in the area that may resemble a hard lump. The skin over the area may also appear red or purple.

Read on to learn more about the symptoms, causes, and treatment available for a bone bruise.

What are the symptoms of a bone bruise?

The symptoms of a bone bruise include:

• pain and tenderness in the injured area
• swelling in the area and soft tissue located around it
• a hard lump
• change in skin color located in and around the injured area
• swelling and stiffness of an injured joint

At first, the area may appear red or purple. Bruising on darker skin may start off red and generally look darker than the surrounding area. It may then change to blue, green, then yellow-brown until the area returns to its usual color as the bruise heals.

When you have a bone bruise, the pain you experience can be more severe and last longer than a typical bruise. The severity of the symptoms depends on how severe the bone bruise is.

What can cause a bone bruise?

Bone bruises often occur in the knee, wrist, foot, ankle, and hip and may happen following a fall. The blow from the fall can cause the blood vessels that are close to the skin’s surface to break. This results in a small amount of blood leaking into the tissues under the skin.

There are various events that can cause a bone bruise, such as:

• jumping or running on hard surfaces
• being in a car accident
• twisting injuries, such as joint sprains
• experiencing a blow to the bone
• having two bones strike each other after ligament injuries
• experiencing damage to structures neighboring the bones

Conditions such as arthritis, where the bone surfaces grind against each other, may also cause a bone bruise.

There are three types of bone bruise:

Sub-periosteal hematoma

A subperiosteal hematoma occurs when there is bleeding under the outer surface of the bone. It is common in the lower regions of the body and can often affect people with a history of recent falls or sports-related injuries.

Interosseous bruising

Interosseous bruising is caused when bleeding and swelling occur in the bone’s medulla (where the bone marrow is located). It often results from a person regularly applying extreme pressure to a particular bone, such as the knee. This injury commonly affects footballers, basketball players, and runners.

Chondral lesion

A chondral lesion can be caused by bruising under the joint surface of the cartilage. It often results from pivoting or twisting on a bent knee, a direct blow to the knee, or general wear and tear. This type of injury can also occur from a series of minor injuries that have taken place over time. It commonly affects football and basketball players.

What are the risks of a bone bruise?

Anyone can get a bone bruise. However, you may be more prone to one if you:

• play high impact sports
• have a physically demanding job that involves lifting and carrying
• have osteoarthritis
• do not wear the correct protective equipment when playing sports or working

A 2020 study reported that subperiosteal hematomas might become hardened and resemble a bone cyst on rare occasions, which may lead to surgery.

Another 2022 study concluded that severe bone bruising that happens when the ligament inside your knee ruptures could mean there’s a risk of repeated joint inflammation and post-traumatic osteoarthritis.

How is a bone bruise diagnosed?

Consider speaking to a healthcare professional if you think you may have a bone bruise, since this could be part of a more serious condition. Symptoms to look out for include increased swelling or pain that does not respond to over-the-counter pain relief medication.

A healthcare professional will take your medical history into consideration to rule out any underlying health conditions. They may also carry out a physical examination and check the injured area.

If your symptoms do not improve, a healthcare professional may request that you undergo an MRI scan. A bone bruise will not show on an X-ray, although you may be offered one to rule out any fractures to the injured area.

What treatment options are available for a bone bruise?

A healthcare professional may suggest treating bone bruising through methods such as:

• resting the bone or joint
• keeping the injured area elevated above heart level to increase blood flow
• applying ice to the area several times a day
• taking nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) to help with pain and inflammation

Depending on the bone bruise’s severity, a healthcare professional may advise wearing a brace to limit movement. They may also advise you to eat a diet high in calcium, vitamin D, and protein to help the healing process.

Additionally, you should avoid participating in physical activities and sports until the injury is fully healed.

Minor bruises may start to get better within a few weeks, according to experts. More severe bruising may take several months or longer to heal.

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How can osteoarthritis affect your chances of getting a bone bruise?

Osteoarthritis is the most common form of arthritis, where the joint cartilage between the bones becomes damaged or breaks down. This leaves the joint unprotected from friction and impacts.

This loss of cartilage changes the joint’s function and leads the bones to grind against one another, causing a bone bruise, pain, stiffness, and swelling.

Summary

A bone bruise is an injury to the bone’s surface area that can result from a fall, repetitive joint movements, and ligament injuries. You can also get a bone bruise if you have osteoarthritis.

Symptoms of bone bruising include:

• pain
• swelling
• a change in color to the injured area

You can treat a bone bruise with:

• plenty of rest
• placing ice on the injured area
• over-the-counter pain medication
• keeping the injured area elevated

If you are concerned about symptoms of a bone bruise, consider speaking with a healthcare professional who can help you to determine the best treatment option.

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