Bone Bruise (Contusion)

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Bones provide the entire structure of our bodies. In fact, the adult human skeleton is made up of 206 bones! These include the bones of the skull, spine (vertebrae), ribs, arms, and legs. Bones are made of connective tissue reinforced with calcium and specialized bone cells. Most bones also contain bone marrow, where blood cells are made. All of our bones work with muscles and joints to hold our body together and support freedom of movement.

This is called the musculoskeletal system. Therefore, the skeleton supports and shapes the body and protects internal organs such as the brain, heart, and lungs. Bones also contain the majority of our body’s calcium. The body is frequently building up and breaking down bone tissue as required. So healthy bone requires a balanced diet, regular weight-bearing exercise, and the right levels of various hormones.

Bruises often form when a blood vessel breaks close to the surface of the skin following a blow. The broken blood vessels leak a small amount of blood into the tissues under the skin. The area then will appear red in color at first, changing to blue or purple, green, yellow-brown, and, lastly, a person’s regular skin color as the bruise heals. Bruises don’t only happen under the skin, but also in deeper tissues, organs, and bones. While these bruises may not show visible signs of bleeding, they can cause a high amount of pain.

A bone bruise (bone contusion or bone marrow edema) is a traumatic injury to a bone. It is less severe than a bone fracture; with a bone fracture, all the trabeculae regions of bone have broken in either a single or multiple fragments. However, with a bone bruise, an injury only damages some of these trabeculae (also called microfracture). Many of these bone bruises are classified into three types, which are:

  • Subperiosteal hematoma – This is caused by an impact on the periosteum, a thin tissue on the top of the bone that allows blood to flow beneath it. It is the most painful type of bone bruise.
  • Subchondral bruise – An injury that may cause bleeding and swelling in the area between your cartilage and the bone beneath it.
  • Interosseous bruising – This condition is caused by repeated, compressive impact to the area, resulting in bone marrow damage. Athletes often experience this type of bone bruising on the knees and elbows.

Furthermore, bone bruising is frequently caused by repeated wear and tear on the joints and bones, as well as high-contact sports.

Causes & Symptoms of a Bone Bruise (Contusion)

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A bone contusion can lead to many bone marrow changes during bone bruising, such as the following:

  • Increased blood pooling – Widened blood vessels stagnate the blood flow, which may lead to severe inflammation.
  • Reactive hyperemia – This occurs when blood flow increases after a temporary interruption.
  • Fracture – There may be a tiny fracture in the layer of bone right below the joint cartilage.
  • Fluid within the injured bone – With muscle injuries, fluid collects in the muscles and makes them swell. This is referred to as edema. Bones are unable to swell, as they are hard. Instead, fluid in the bones creates pressure, leading to pain.

Injury of any kind can cause a bone contusion. Sports injuries, motor vehicle accidents, or falls from a great height can cause them. Also, twisting injuries (such as those that cause joint sprains) can also cause a bone bruise. Medical conditions such as arthritis may lead to a bone bruise.

This is because where there is arthritis, bone surfaces aren’t well-protected and they grind against each other. In severe cases, child abuse is another cause of multiple bone bruises.

Many of these bone bruises may vary depending on the location of the bruise, such as:

  • The tailbone – You may experience pain when sitting, especially on hard surfaces, and it can impair your ability to drive.
  • The knee / shin – Walking and balance may be difficult to perform, and you may experience stiffness when bending or straightening the knee.
  • The shoulder – The range of motion may be limited, and you will most likely feel weakness in the injured shoulder that makes bathing and dressing difficult.
  • The ankle/foot – such as standing and walking can be very painful, and crutches may be required to help you move around. Swelling can also develop below the injured area.

Other symptoms linked to a bone bruise include:

  • Hard lump in the affected area.
  • Swelling of an injured joint.
  • Stiffness
  • Change in color of the injured area.
  • Swelling in the area and soft tissues around it.
  • Pain and tenderness.

Who gets a Bone Bruise?

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Bone bruises are very common within the population, meaning anyone can get one. The bones that you are most likely to bruise are the ones in your knees and heels. You may also be at a higher risk for a bone bruise if you do not use the correct safety gear for your sports activity. Another factor that can increase the chance of bone contusion includes vehicle collisions, such as not wearing a seatbelt while in a situation of a car accident.

How Does a Bone Bruise Affect You? How Serious is it?

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As mentioned earlier, a bone bruise can be referred to as another condition known as ‘bone marrow edema’. This is the build-up of fluid in the bone marrow. The edema is commonly linked to osteoarthritis where the cartilage breaks down and joints become extremely painful. The edema can also occur because of a fracture or joint injury. If you have osteoarthritis, bone marrow edema may be a sign that your condition has worsened. You may also develop subchondral cysts along with the fluid buildup (these are often spotted on an MRI).

These cysts happen in places where the cartilage has been damaged. The cartilage hardens and forms fluid-filled sacs (cysts) in the joint. As more and more cartilage is lost, nerves become exposed – this leads you to feel more pain and decrease your mobility. In other cases, bone marrow edema can happen with fractures and other serious bone or joint injuries, such as:

  • Stress fractures – of the foot, hip, ankle, or knee from repeated impact and strain on a weight-bearing joint.
  • Anterior cruciate ligament (ACL) tears – which involve a key ligament that gives the knee joint stability and can cause bruising and inflammation of connective tissue, known as synovitis.
  • Bone tumors – This is where fluid weakens the bone and raises the risk of a fracture.
  • Bone infection – also called osteomyelitis, is an infection caused by bacteria or fungi. It causes painful swelling of bone marrow. Without treatment, swelling from this bone infection can cut off blood supply to your bone, causing the bone to die (avascular necrosis).

Recommended Treatment & Rehabilitation for a Bone Bruise

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It is important to seek a diagnosis if you ever suspect a bone contusion, as this condition may be involved in a more serious issue. Therefore, your doctor will begin by taking a complete medical history and asking how the injury occurred.

He or she might also conduct a physical examination to check the injured area for pain, bruising, and swelling. If a physical examination fails to result in a clear diagnosis, your doctor will order additional imaging tests to rule the condition, such as:

 

X-ray

An image of the bones in your bones and joints. An X-ray can locate arthritic changes in the body, including the location and severity of bruises. Unfortunately, bone bruises may not appear on an X-ray, although your doctor may perform one to rule out a bone fracture.

Magnetic Resonance Imaging (MRI)

This is an imaging test that cannot be seen on an X-ray. This can also be used to locate tumors, damaged discs, and loose ligaments in the affected area.

Once a diagnosis has successfully confirmed a bone bruise, physiotherapy may be further advised to treat the injured bone. A physiotherapist will design a specific treatment program to fit your specific needs, which may include manual therapy, and gentle exercises to relieve your pain. A bone bruise often takes months to heal, therefore, physiotherapy is necessary to lessen the time needed for a complete recovery. Treatments are likely to include a combination of the following, depending on your condition and its location:

 

Manual therapy

Manual therapy consists of specific, hands-on techniques that may be used to manipulate or mobilize joints and muscles. Manual therapy is often used in conjunction with other activities to increase movement and has been shown to reduce pain in your affected area.

Movement and exercise

Bone bruise can lead to a limited range of motion. Therefore, slowly moving more and exercising your stiff muscles can often be a great strategy to lessen the pain. Your physiotherapist will help identify specific movements that will help reduce your symptoms.

Modalities

Your therapist will be able to determine whether the use of modalities such as ice, heat, or electrical stimulation applied to specific areas will benefit your bone contusion.

 

During your physiotherapy session, your therapist will help you develop a home program that is special to your specific needs and requirements. The ultimate goal of treatment is to reduce the acute symptoms of pain, swelling, and limited range of motion. Certain treatments your physiotherapist will teach you are:

  • Ice application – Apply an ice pack to the injured area right away to reduce pain and swelling. Every 3-4 hours, apply the ice pack over a wet towel for 10-15 minutes. Repeat this method 2-3 times a day until the swelling has subsided.
  • Heat application – Heat can be used to reduce pain and promote healing. Normally, heat is applied for 15-20 minutes at a time 3-4 times a day. To reduce the risk of burns, place a towel between the skin and the heat pack.
  • Rest – Resting your injured area allows the body to regenerate new bone tissue without adding undue strain on that area.
  • Elevation – Elevate your injured area as much as possible.

Supportive equipment

Depending on the severity and location of the bruise, you may be able to continue to perform lighter activities while wearing a splint, athletic tape, or elastic bandage.

Alternative & Homeopathic Treatment for a Bone Bruise

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Bone bruises are often treated with prescribed equipment and medical products such as non-steroidal anti-inflammatory drugs (NSAIDs), however, there are many natural ways you can heal your bone bruise. Similar to a sprained ankle treatment, bone bruises can be treated through diet, supplementation, and rest. The following below are recommendations for you to heal your injured area naturally:

 

Fruits

Fruits are essential for healing bruises since most contain vitamin C. This helps heal bruises and wounds. Certain vitamin C fruits include strawberries, papaya, kiwi, and guava.

Cultured dairy

Dairy has a rich level of calcium, which is an important key building block for healthy bones. Cultured dairy like yogurt, buttermilk, and certain cheeses are calcium-rich foods that are also easier to digest.

Boron

Boron is one of the most overlooked supplements that uses its ability to improve bone health. Boron is a trace mineral that works in conjunction with calcium to build bones and help treat and prevent osteoporosis and arthritis. It has also been found to help fight against blood clotting when the body is trying to heal from sprains, bruises, and fractures.

Arnica oil

Arnica is a powerful healer and helps bone bruises and the symptoms of bone bruising by reducing swelling and relieving pain.