How Painful Is a Bone Bruise? Types, Symptoms, & Treatment

Bone bruises are classified into three types based on where they occur on the bone:

1. Subperiosteal hematoma: Caused by an impact on the periosteum, a thin tissue on the top of the bone that allows blood to pool beneath it. It is the most painful type of bone bruise.
2. Interosseous bruising: Caused by repeated, compressive impact to the area, resulting in bone marrow damage. Athletes commonly experience this type of bone bruising on the knees and elbows.
3. Subchondral bruise: Occurs when the cartilage and bone separate, resulting in cartilage bleeding.

Bone bruising is frequently caused by repeated wear and tear on the joints and bones, as well as contact sports.

Bones are made up of a network of fibers (called trabeculae) that aid in the retention of calcium, a mineral that keeps bones healthy and strong. Many of these tiny fibers will break if a bone is severely damaged, resulting in a fracture. When only a few of the fibers in the bone break, it results in a bruise.

Signs and symptoms of a bone bruise include:

• Pain and tenderness in the affected area
• Swelling in the tissues around the impacted location
• Change in color on the surface of the skin
• Joint pain near the affected area
• Swelling of the joints around the bone
• Extreme pain or pain that is more severe than a typical bruise

Symptoms may vary depending on the location of the bruise:

• Shoulder: Range of motion may be limited, and you may feel weakness in the shoulder that makes bathing and dressing difficult.
• Tailbone: You may experience pain when sitting, especially on hard surfaces, and it can impair your ability to drive.
• Knee or shin: Walking and balance may be difficult, and you may experience stiffness when bending or straightening the knee.
• Ankle or foot: Standing and walking can be extremely painful, and crutches may be required to help you move around. Swelling may develop below the injured area.

MRI scans are used primarily to diagnose bone bruises.

A bone bruise often takes months to heal. The goal of treatment is to reduce the acute symptoms of pain, swelling, and limited range of motion:

• Apply an ice pack to the injured area right away to reduce pain and swelling. Every 3-4 hours, apply an ice pack over a wet towel for 10-15 minutes. Ice is usually applied for 2-3 days after an injury or until the swelling has subsided.
• Heat can be used to reduce pain and promote healing. Typically, heat is applied for 15-20 minutes at a time for 3-4 days. To reduce the risk of burns, place a towel between the skin and the heat source.
• Rest allows the body to regenerate new bone tissue without putting undue strain on the injured area.
• Elevate the injured area as much as possible and take an anti-inflammatory pain reliever, such as Advil and Motrin (ibuprofen) or Aleve (naproxen).
• Depending on the severity of the bruise, you may be able to continue light activities while wearing a splint, elastic bandage, or athletic tape. In other cases, you may require crutches or a sling to prevent further damage.

As soon as the acute symptoms are under control, you can begin a gradually progressing strengthening program. However, movements should be nearly normal with minimal pain. Exercises under the guidance of a physical therapist can promote healing, increase range of motion, and restore normal neuromuscular activity.