What to Know About a Bone Bruise

Medically Reviewed by Carmelita Swiner, MD on July 07, 2023
4 min read

Our bones can bruise, just like our skin, and a bone bruise is similar to the skin bruise you might see following some kind of trauma. A bone bruise, also called a bone contusion, leaves you sore and may be painful, although it is less serious than a bone fracture.

Bruises to your bone don’t always leave a visible black-and-blue mark like you see with a bruise to your skin. Still, bruises that happen to your muscle and bone are very similar, because they involve damage to the small blood vessels in the area of the injury. Your blood leaks into the nearby tissue, causing inflammation and irritation.

Each bone in your body has three layers:

  • Periosteum – This is the hard outer part of the bone that acts as protection for the inside structures.
  • Compact bone – The second layer acts as the structure and support for your body. It is hard, white, and smooth.‌
  • Spongy bone – The center of your bone is soft and has pores that store bone marrow.

When you fracture a bone, you sustain significant damage to the tissue in your bones, resulting in a crack that is visible on an x-ray. A bone bruise often results in a microfracture, where so little of the tissue is damaged that it doesn’t appear on an x-ray.

Still, the injury causes blood to pool around the compact bone beneath the periosteum, called a subperiosteal hematoma. This may lead to swelling around your bones, cartilage, ligaments, and tendons. If bleeding occurs in the center, softer part of your bone, it’s an intraosseous bone bruise.

Injury of any kind can cause a bone bruise. Common reasons for a bone bruise include:

  • Sports injuries
  • Car accidents
  • Falls, especially from height
  • Arthritis‌
  • Child abuse

If you regularly engage in risky behavior, play sports, or are particularly clumsy, then you may be at a greater risk for a bone bruise.

If you suspect you injured one of your bones, seek emergency medical attention right away. Early detection is often the key to ensuring any bone damage heals properly. Signs of a bone bruise include:

  • Pain and tenderness under your skin
  • Swelling around the area of the injury, including the soft tissue
  • A hard lump under your skin
  • Visible bruising on the outside of your skin‌
  • Swelling and stiffness in a nearby joint

Soft tissue injuries don’t hurt for as long as a bone injury does. The severity of the bone bruise contributes to the length of time that you experience symptoms.

Bone bruises are often accompanied by other damage to surrounding tissue. Because bone bruises do not show up on x-rays, diagnosing them is a relatively new practice. Before MRIs, it was difficult to diagnose a bone bruise without proof of the damage. Still, they’re very common and can happen to anyone at any age. ‌

Your doctor will ask you about your symptoms and may ask for details about the events that led to the injury. They will conduct a physical exam and an x-ray. If a fracture doesn’t appear on the x-ray, your doctor may request an MRI for a more detailed image of the bone and surrounding tissue.

If you have a bone bruise, your doctor may suggest:

  • Resting the affected bone or joint, avoiding pressure to the area and unnecessary movement
  • Applying an ice pack throughout the day to reduce swelling
  • Resting with the injured area up higher than your heart
  • Taking medication to address symptoms of pain and inflammation‌
  • Wearing a brace or cast that helps you limit movement for faster healing

Your doctor may talk to you about your diet and lifestyle during your appointment to address any nutrient deficiencies that might have contributed to the bone bruise. They may also advise you to stop smoking if you’re a smoker because it extends your healing time.

After determining the severity of your bone bruise, your doctor provides a timeline for healing. Bone damage may take two to four months to heal. Sports and other physically demanding activities may be on hold until your bruise heals completely.

It is possible, in the case of a severe bone bruise, for the bone to be permanently damaged. If the area is very large, your body may struggle to heal the area completely. A lack of proper blood flow for too long may lead to avascular necrosis of the bone, which means that part of the bone dies. 

That’s why, if you suspect that you’ve bruised your bone, you seek medical attention right away. Early detection leads to effective treatment.