Bone Bruises-Symptoms, Causes, Treatment & Healing Time
Ever wondered what a bone bruise is all about? Here is a detailed discussion of what it is, signs, how it comes about, how long it lasts, types, treatment and more.
What is a Bone Bruise/Contusion?
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When you get a traumatic injury to the bone, and is found to be less severe than a bone fracture, then you are talking of a bone bruise. What people commonly know much about is the normal bruise that occurs on the skin that is characterized by a black and blue tinge to the skin.
However, there is more to just the skin when the bone is bruised after trauma. The change in color of the skin or occurrence of a bone bruise follows a breach to the small blood vessels, the capillaries. This is followed by a leakage of blood into the adjacent tissues and into the interstitial space (interstitium).
It would be worthwhile understanding how the bone is physiologically so that you can understand the pathology of a bone bruise going forward. See, the bone is composed of different types of tissue.
You have the periosteum which is what covers the bone and the subchondral bone which is a layer of bone formed when two bones come together. Deeper inside the bone is the medulla that has the bone marrow and the trabecular. The latter is a fibrous tissue.
Since the whole bone tissue is a specialized connective tissue, it contains collagen fibers, proteoglycans and blood vessels. These can be divided into the organic and the inorganic part whereby these are the glycosaminoglycans and the calcium and phosphate respectively.
A large part of the bone tissue is accounted for by Calcium ions while collagen fibers make up about 30% of the total surface.
Types of Bone Contusions
There are 3 kinds of bone bruises: interosseous bruising, sub-chondral lesions and the sub-periosteal hematomas (V. Mandalia, J.H.L. Henson.)[1]. When there is trauma on your bone, whichever part of the body this is, there will be a leakage of blood in the periosteum which results in a subperiostal hematoma.
The sub-periostal hematoma commonly occurs after a direct high-force trauma mostly occurring in the lower extremities.
Swelling occurs between the area with the layer of cartilage and the bone that is just under it and a clinical presentation of subchondral bone bruise occurs. This lesion leads to separation of the cartilage or the ligament and the underlying bone.
When there is a profound damage to the bone during bone bruise to an extent that the bone marrow is damaged, you will have inter-osseous bruising characterized by a jeopardy of internal bleeding. As this condition is rather more serious that the others, it should be caused by a high compressive trauma on the bone occurring repetitively. The knee and the ankles are most affected and thus so are athletes and football and basketball players.
There are types of bone bruises classified on the basis of a Magnetic Resonance Imaging (MRI) findings. Note that bone bruises do not appear on an X-ray.
One is the reticular bone bruise which occurs in the medulla of the bone tissue. It also can occur in the spongy deeper layer of the bone. Fortunately, the bruise is not that extensive and does not affect the cortical area of the bone hence regarded as mild in intensity.
The second type of bone bruise based on MRI findings is geographic bone bruise that is relatively larger in size and density as compare to the reticular bone bruise. It is in fact diagnosed as a fracture, more precisely, the osteochondral fracture.
Impaction bone bruise is the last type based on such imaging findings arising from friction between two bones on the articular surface to an extent that the bone is eroded and a bone bruise occurs.
The lay term used to refer to it is the kissing contusion as this is a characteristic finding seen on the MRI images as a white layer separating the bruised areas of the bones.
According to Christoph Rangger, Anton Kathrein, Martin C Freund, et al. (1998)[2], bone bruises are most frequently reported in the knee and the wrist. Other areas that follow in prevalence and incidence include the foot, hip bone and the ankle.
In the knee, the most common type of bone bruise is the Anterior Cruciate Ligament (ACL) injury and is rarely partial. It is usually severe requiring surgery. L.C. Jungueira and J. Carneiro, mention that in 80% of those with the RCL rupture, a bone bruise is eminent commonly in the femur condyles.
It may also be present in the tibia plateau. Ankle bruises occur after a supination injury located in the post-lateral talus area. They are also prominent in the caudal portion of the tibial epiphyses.
How can you bruise a bone
There are many ways in which you can injure a bone but they are limited to injuries accrued, accidents, falls and twisting injuries. There are also medical conditions that can predisposed to the injuries. Age can never be overestimated and can assault.
Here’s how you can bruise your bone:
- Being an athlete who runs on hard ground
- Being a fighter and receiving a blow to a joint. Martial arts personnel among others are affected.
- Road accidents and carnages
- If you are a sports-person in sports such as football, basketball and hockey. Hockey could induce excessive impact when the stick of ball hits one of your joints. Most common if you do not wear protective gear when playing your sport.
- Excessively falling perhaps due to ageing or comorbidity.
- Attempting suicide by jumping from high storeys of buildings.
Bone bruise symptoms-what does it feel like?
You will be able to know that you have a bone bruise when you have the following signs and symptoms:
- Pain and inflammation or soreness in the area on trauma. The pain in this case is different form the one experience after a soft tissue injury. It lasts longer and aches for longer at times in a throbbing manner.
- There will be a change in color in the area. The skin may be bruised and a black or blue tinge may occur. There are chances that infiltration of blood into the area of normal physiologic extravasation of blood into the interstitial space may lead to hematomas. Hematomas may be purple-blue but can also be yellow or brown when the clot degrades and on resolution.
- Stiffness of the injured joint. This is caused by the swelling of the area making it had to move the bone along the joints.
You will not develop a diagnosis of the type of bone bruise you have based on the subjective symptoms or the objective signs alone.
You may have to go for some radiological investigations as they are very useful when it comes to determining the cause of the bone bruise.
An MRI can detect the bone bruise in the bone and changes in bone density not more than 30 hours after the injury. An X-ray and Computerized Tomography (CT) cannot pick up bleeding in the bone such as in intraosseous bone bruises.
How long do bone bruises last/take to heal
You will know whether the bone bruise has healed depending on whether the bruise has completely disappeared. It may take varying times or periods depending on the extent of damage of the bone.
Therefore, it may take between a period of 2 months and 2 years to have any severity of bone bruises healed. Another factor that determines the length of time is the joint affected.
For instance, in the case of a knee joint bone bruise, a period of 2 months is optima while it may take an ankle bruise longer, 12 months at least.
With regard to the type of bone bruise, reticular bruises have been shown to have the highest healing times. The other types of bone bruises picked up by MRI scans, impaction and geographic bone ruses take a slightly higher time but moderately significant.
However, healing time is not to say that you cannot resume your normal routine or sport. While healing time refers to the time it takes for the bruise to completely go away, recovery time is much shorter.
What factors will determine the duration
Healing will depend on a variety of factors. Some of these are:
Complications arising
There may arise complications such as infections, joint stiffness, post-trauma osteoarthritis and oedema. Some of these complications may require that you get a surgery so as to correct them.
Avascular necrosis occurring after such bone bruises could direly affect the rate of healing and hence the duration. Remember that surgery itself also requires its own healing time.
Age
Older people may not have a normal duration of healing time as seen in active young ones. This may be due to the slow replacement of worn out tissues alongside slow shutting of their organs.
Diet
Those that take a diet with nourishing food nutrients responsible for the replacement of bone tissue are most likely to have a faster recovery time. Fortifying food with some calcium supplements or bone soup could really help.
Joint
The type of joint affected determines the healing time. The healing of the ankle is different from healing of the knee and so will healing of the skull relative to that of the calcaneus.
Co-morbidities
There are disease conditions that prolong the healing time. Such includes menopause, hormonal imbalances, osteopenia, osteoporosis, cardiovascular diseases among others.
Parts of the body
Knee-patella bone
Athletes are most afflicted by bone bruises. They are at a high risk of hitting their knees on hard surfaces when they fall. The patella may be affected alongside the femur and the tibia in the process more precisely the epicondyle of the femur and the upper tibia.
Other parts of the knee that could be affected are the ligaments surrounding the knee. These are the anterior and the medial collateral ligaments.
The recovery time of a knee or patella bone bruise is about 6 months when there is ACL rupture. The bone will heal faster than the ligament.
Pelvic-Tail & Hip Bone
The hip bone can be injured and bruised. The neck of the femur is the most affected and is subsequently followed by oedema of the hip bone. There are risk factors that predispose you to bone bruises of the hip bone including osteoporosis that occurs in menopause and during the last trimester of pregnancy (transient osteoporosis).
The coccyx is a bony structure that is triangular and located at the lower end of the vertebral column. A coccyx injury is known as coccydynia and results in a bruise or fracture. The area is slow to heal and needs to be managed by cautious form of treatment. The bone injury is more prevalent in women since the female pelvis, being larger and broader, leaves the coccyx more exposed to risk factors of injury.
Ankle: Tibial & Talus
Injuries to the talus are caused by landing on the foot hard during an ankle injury as you spring. The talus lies just above the calcaneus bone and may bring about some injury to the latter bone. Ankle bone bruises are common in the area of the tibia and the talus specifically on the lower ends.
Injury to the tibia is synonymous to shin bone injuries. It is more common in athletes especially footballers and hockey players. Martial arts also predisposes to tibial bone bruises. It is the main cause of subperiostal hematoma too, of the tibial bone. This kind of injury lasts days to a few weeks but will depend on the extent of damage.
For the ankle, it may take about 3 months to heal but recovery may be achieved sooner. There may be a complication of subperiostal hematoma that may arise such as calcification of the blood clot. Around the clot, you may have bone tissue forming around it.
Bruised foot Bones
Bone bruises of the foot may take place in the talus, cuboid or the calcaneus bones. The cuboid bone is a tarsal bone that lies to the outer side of the foot towards the pinky toe. It is responsible for the articulation of the heel bone with the fourth and fifth metatarsals.
Much injuries to these bones occurs during hard landing on hard surfaces. Therefore, athletes are most affected especially if work outs or training sessions are ill-advised on how to properly land on the feet.
Shoulder bone
The clavicle, scapula and the humerus make up the shoulder bones. There are ligaments and tendons too. Bone bruises can occur in these bones in traumatic highly physical-contact sports such as American Football and rugby. The bruises can also result from carrying heavy objects on the shoulder. The prognosis is good for such bone bruises.
Rib (chest/Breast) bone
Bruising your sternum leads to pain in the chest due to a costochondritis. Bruised sternum or rib is due to traumatic blows to the area in car accidents during which you tend to hit your chest on the steering wheel. There are sports that could lead to this high impact contact such as rugby. There are cases of forceful coughs injuring your sternum too.
The bruise or injury is characterized by more to the cardinal signs mentioned before in this article and includes a pain that gets worse during breathing or coughing and on movement.
Elbow bone
Elbow bone bruises can arise from martial arts fighting techniques or from taking a hard backward fall when you try to support yourself. It is very painful and electrifying just as is the knee and the tibia.
Hand (wrist, Finger knuckle)
The hand may also experience some trauma and hence bone bruises in either of its many bones. The wrist is the biggest victim due to a twist on falling or carrying heavy objects.
The duration of healing depends on the heaviness of the fall among other factors aforementioned. Women who are in menopause and old may experience longer durations to the extent of 4 months before the bruise can heal.
Bone bruise vs. fracture
Both are very painful. Injuries to the bone may vary with the extent of damage on the tissues. Bone fractures are more extensive as all the trabecular in the bone tissue is damage. A significantly small proportion of the trabecular is damaged in a bone bruise (Simone S. Boks, Dammis Vroegindeweij, Bart W. Koes, ET al.2007)[3].
Bruised Bone treatment
When treating a bone bruise, there are pharmacological and non-pharmacological interventions. There are also conventional ways to manage the bruise and on the other hand, home remedies that you can opt for. When you get a bone bruise, you can do the following:
Make sure you rest the bone or the joint that is affected.
This will reduce the extent of damage until the injury is sustained. You may have to wear a brace or some device that will limit this movement until the injury is healed. Having enough rest and limited movement is the best method in recovery from a bone bruise.
To relive the pain, you can use a cold compress method.
Wrap some ice cubes in a towel then apply that to the site of injury. It will be able to cool things off for a while and ease the inflammation.
Get yourself on a better diet.
Having food that is rich in the appropriate minerals such as calcium and phosphates would do you some good. Getting some vitamin D supplement and boosting your protein will help replace the lost or damaged bone tissue.
Beef up the amount of leafy vegetables, fruits such as citrus foods (natural antioxidants, lemon, oranges, kiwi, guava and strawberries) and cultured dairy (to boost your calcium levels). You will also need to reduce on the amount of processed foods that you are having.
For instance, mass-produced snacks and fast foods have high sodium content and may delay the healing process.
Check your habits
Quitting some habits such as smoking and taking alcohol. There are links between smoking and slow bone healing. Smoking leads to vasoconstriction of blood vessels and an increased probability of blood clots.
You will therefore need to do some rehabilitation or get into one such programme so as to allow your bones to heal.
Supplements
Supplements could help you meet your recommended daily amounts of the nutrients that are requisite for bone development. These supplements may include:
- Bromelain: It is found in papaya and pineapples and helps modulate inflammation. In order to enjoy its benefits in bone healing, you will require does of about 500 – 2000 mgs in two divided doses daily.
- Lysine: this is an enzyme that doubles as a bone and wound healing promoter. It aids calcium absorption in the bones and promotes tissue regeneration. It is high in brewer’s yeast, parmesan cheese, eggs, cod and sardines.
Conventional analgesics.
You will get prescriptions of analgesics to relieve the pain and the inflammation. Some of the analgesics will be taken orally while others will have to be applied to the site of the bruising.
Diclofenac, ibuprofen, aspirin, tramadol and corticosteroids should work well. Poultices and analgesic foams are also effective for the reduction of pain. Supplements mentioned in this section will be prescribed too.
How to Treat a Bone Bruise – Manual Therapy You Can Do from Nancy Crooks on Vimeo.
Deep bone bruise not healing
A bone bruise may take longer than anticipated due to a variety of factors such as age, existing medical conditions, diet and lifestyle, the extent of damage and the type of joint affected.
It may be that the extent of the bruise is appreciably large and may have been underestimated in time. You will need to exercise some patience if non-complication is observable.
Therefore, with consideration of the factors, you may be able to explain why it is taking longer than usual to heal.
References
[1] V. Mandalia, J.H.L. Henson. Traumatic bone bruising – A review article, European Journal of Radiology 2008; 67; 54–61 Grades of recommendation A
[2] Christoph Rangger, Anton Kathrein, Martin C Freund, et al. Bone Bruise of the Knee. Acta Orthop Scand 1998; 69(3) : 291-294
[3] Simone S. Boks, Dammis Vroegindeweij, Bart W. Koes, et al. MRI Follow-Up of posttraumatic Bone Bruises of the knee in General Practice. AJR 2007; 189:556–562 Grades of recommendation B