What Is a Bone Bruise (Bone Contusion)? And What Does It Mean If You Have One?
Key takeaways:
Bone bruises, also called bone contusions, are tiny injuries to your bone that don’t always show up on an X-ray.
Bone bruises can have similar symptoms to a broken bone or a sprained joint, including pain, swelling, or trouble moving a joint.
Bone bruises can take longer to heal than you’d expect. It’s important to rest the injured area to give your body the chance to recover.
Table of contents
After a serious fall or injury, many people will get an X-ray to check for broken bones. It can come as a surprise when the X-ray appears normal, especially if you have a lot of pain. This is especially true in areas like your knee, ankle, foot, or heel.
But there are a number of bone and joint injuries that don’t show up on an X-ray — including a bruised bone. Here’s a closer look at what a bone bruise is, how it feels, and how to treat it.
What is a bone bruise?
A bone bruise is an injury to your bone that doesn’t cause it to break or crack. But it can cause bone damage and bleeding that doesn’t show up on X-ray imaging.
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This can happen in a couple of different ways. To understand how, it helps to know that bones have several layers:
Cortical bone: The hard, outer layer of the bone.
Trabecular bone (or “spongy” bone): The inner layer of bone. It’s lighter than cortical bone but gives bone its strength.
Bone marrow: The innermost part of the bone, containing blood vessels and bone marrow, which help your body make different blood cells.
A bone bruise can be an injury to the outer cortical layer. It can also be a tiny “micro” break in the trabecular bone. When trabecular bone is injured, swelling can develop inside the bone as the body repairs it. Scientists think this swelling is what causes pain with bone bruises.
Bone bruises are a relatively new diagnosis. In the past, if an X-ray didn’t show a break, the bone wasn’t considered injured. But with advances in imaging — especially MRI — it’s easier to see smaller injuries to bone. Bone bruises were first discovered in the knee, a common site of injury.
What causes a bone bruise?
Bone bruises can happen whenever an increased force is applied to part of a bone. Common causes include:
Sports, especially contact sports: About one-third of bone bruises in kids and teens happen in football.
Falls: Even falling from standing can cause a bruise. The bone that hits the ground first — like a wrist, hip, or knee — can be easily bruised.
Motor vehicle collisions: Even in minor accidents, your knees or other body parts can collide against parts of the car and lead to bruising
Blunt trauma: Injuries from falling or swinging objects can bruised bones. Any injury that significantly bruises the skin also has the potential to bruise the bone below it.
Joint sprains and injuries: When a joint stretches beyond its normal range, it puts increased force on your bones. For example, a torn ACL in your knee is often associated with a bone bruise.
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Symptoms of a bone bruise
The symptoms of a bone bruise vary based on where it occurs in your body and which layers of the bone are affected. Common symptoms include:
Pain
Decreased range of motion in your joint
Swelling around your joint or over the injured area of bone
Visible bruising on your skin
A bone bruise can feel like a joint or muscle sprain. It can even feel like a bad bruise of your skin.
Bone bruises are commonly seen in the knee. But they can occur in many different areas, including:
Wrist
Hip
Knee
Shin (tibia)
Ankle
Foot
How do you diagnose a bone bruise?
When you’re injured, it’s common to get an X-ray of the hurt area. If the X-ray doesn’t show any obvious injuries, most people don’t need or get any additional imaging.
But if the injury doesn’t get better, or you’re experiencing a lot of pain, a healthcare professional may order an MRI. This allows them to look more closely for other injuries, like a torn ligament or a smaller break in the bone. An MRI may also pick up signs of a bone bruise.
It’s important to know that not everyone needs an MRI to diagnose a bone bruise. You might be able to tell if you have a bone bruise just based on your symptoms.
How do you treat a bone bruise?
Treatment for a bone bruise is similar to treating other injuries, like a sprained ankle. Here are some general treatment recommendations:
Rest: It’s important that you rest the affected body part to give your body a chance to heal itself.
Ice: Apply ice to the injury during the first 48 hours. This will help reduce pain and swelling. Use an ice pack for 15 minutes, with at least a 45-minute break between uses. This will help prevent cold injury to your skin.
Compression: Gentle compression on the injured area can help decrease pain and swelling. You can do this with an ace bandage or brace. Just be sure not to compress too much. Loosen it up if you feel numbness or tingling, or see your fingers or toes turning colors.
Elevation: Raise your injured arm or leg (usually higher than your heart level) to help keep the swelling down.
Pain relief: Over-the-counter (OTC) pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can ease discomfort. But not everyone will need these.
Physical therapy: Depending on the type and location of the injury, some people may benefit from physical therapy. This is more likely if the bone bruise is associated with other injuries at the same time, like a ligament tear.
How long does it take a bone bruise to heal?
Depending on how severe it is, bone bruises can take several weeks to several months to heal. A bone bruise may hurt for a similar amount of time, too. But the pain will gradually get better and likely go away before the bone is fully healed. It takes most people about 3 months to return to their pre-injury activity level. Most people have completely healed by 6 months.
When to see a healthcare professional for a bone bruise
If you think you may have a bone bruise, it’s important to see a healthcare professional. They can make sure you don’t have any broken bones or other injuries.
Even if you’ve already seen a healthcare professional (and maybe initially had X-rays), it’s worth another visit if you’re experiencing the following symptoms:
Pain that you can’t manage with rest and OTC medications
Pain that isn’t getting any better in the days following your injury
Decreased range of motion, stability, or strength in a joint
Increasing swelling, redness, or bruising
It’s also important to see your primary care provider if your injury is getting in the way of your ability to take care of yourself. For example, if you live alone and you’re having a hard time getting around your home safely.
Frequently asked questions
Complications from a bone bruise are rare. One possible complication is something called avascular necrosis. This is when a lack of blood flow to the bone causes your bone cells to die. But this is very unlikely.
Avoid massaging a bone bruise. This can lead to more trauma to the bruised area. This would also likely increase your pain as well.
Similar to other injuries, avoid using a heating pad in the first several days after your injury. Heat can increase bleeding and swelling around your bone as it begins to heal. But if you’re well into the recovery process, you can use a heating pad to help with pain or stiffness.
The bottom line
If you’re having a lot of pain and swelling associated with an injury, there may be a small injury to the bone — even if the X-ray is normal. But don’t worry, the treatment is the same for most injuries to the bone or surrounding areas. The best thing you can do is rest the affected area. It can be hard to slow down, but taking a break gives your body the time it needs to recover. And rest keeps you from further injuring yourself.
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References
Gómez, J. E., et al. (2018). Bone bruises in children and adolescents not associated with ligament ruptures. Orthopaedic Journal of Sports Medicine.
Mandalia, V., et al. (2008). Traumatic bone bruising — a review article. European Journal of Radiology.
Matthews, A. H., et al. (2023). Avascular necrosis. StatPearls.
