In medicine, a bone contusion is an injury to the bone that is not a broken bone (fracture) can be designated.
This leads to edema, i.e. accumulations of fluid in the bone itself or between the bone and periosteum, and so-called microfractures. Microfractures are the smallest fractures in the bones. Bone bruises are also known as bone bruise.
Difference between broken bone and bruised bone
The bruise has in common with a fracture that it does not necessarily have to be accompanied by externally visible skin injuries.
However, the smallest fractures and the accumulation of fluid in the bones and the surrounding tissue often damage the small blood vessels running there, causing blood to leak out and a bruise (bruise) that is visible from the outside.
Read more on the topic: Bone Bruise - How Dangerous Is It?
Bone bruises are always caused by an injury. Mostly it is a clearly definable event, typically a fall event or the bumping of a bone (e.g. shin or hip) against a hard object (e.g. table).
On the other hand, a bone contusion can also result from recurring minor injuries to the bone. These are usually not noticed acutely, but only late, when these smallest injuries add up and ultimately lead to bone contusion. Such a chronic bone contusion often arises from excessive strain during sport or from incorrect posture or misalignment of joints, which lead to an inappropriately high load in individual bone areas and in this way promote the occurrence of the smallest injuries.
The acute or chronic injury can tear small blood and lymph vessels within the bone and in the surrounding tissue. The resulting accumulations of fluid irritate the periosteum surrounding the bone, which is very sensitive to pain.
Read more on the topic Bruised tibia
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The main symptom of bone contusion is pain in the affected area. This can lead to pressure and movement pain, but also pain at rest. The latter typically occur at night.
In addition to the pain, swelling and a bruise can often be observed. The latter is caused by damage to small blood vessels in the area of the bone and the surrounding tissue.
However, since other injuries, such as broken bones, joint or muscle injuries, can lead to pain and swelling and the pain localization cannot normally be confined to the bone with certainty, bone contusion is a diagnosis of exclusion. This means that other injuries that could be the cause of pain must first be ruled out using imaging diagnostics (e.g. X-rays or ultrasound) in order to be able to make the diagnosis of bone contusion.
Experienced examiners can, however, use the severity and type of pain indicated by the patient as well as the described mechanism of injury to determine whether it is just a bruised bone or a more serious injury. In this way, potentially superfluous imaging examinations and their disadvantages (e.g. X-ray: radiation exposure) can be avoided.
Also read: Bone pain
The pain caused by the bruised bones can last for days to weeks.
If they persist for another 4-6 weeks after consulting a specialist, the possibility of an MRI examination should be considered. On the one hand, this is suitable for excluding other possible causes of pain, especially joint and soft tissue injuries and is, on the other hand, the only way to actually see a bruised bone in a targeted manner. Due to the high expenditure of time and money, this option should be used sparingly.
If the examiner suspects a bruised bone as the most likely cause of the pain, a wait-and-see approach and possibly an X-ray is therefore preferable to an MRI examination.
Read more on this topic:
- Procedure for an MRI examination
- Cost of an MRI examination
Different locations on bones and joints
A Bruised bone can occur on all bones and joints and cause different symptoms or pain depending on the location.
A bruise on the knee can result from an acute injury as well as from chronic overload. The former particularly include bumping the knee against a hard object, e.g. a table edge, as well as sports injuries in the knee area, e.g. Cruciate ligament tears or meniscus injuries. A chronic bone bruise on the knee is mostly due to a misalignment of a joint or inadequate stress (e.g. due to incorrect movement sequences or inappropriately increased training).
Osteochondrosis dissecans is an important differential diagnosis for bone contusion on the knee. For reasons that are not yet fully understood (however, reasons similar to those of chronic bone contusion seem to be decisive), there is a circulatory disorder in the area of the bone under the joint surfaces and, as a result, symptoms similar to those of chronic bone contusion.
If a bone contusion is suspected on the knee, the focus of the diagnosis is a physical examination and, if necessary, an X-ray examination. If the symptoms persist for a longer period of time after rest, an MRI examination can be carried out with regard to possible osteochondrosis dissecans or accompanying joint injuries.
More on the subject: Osteochondrosis dissecans in the knee
A bruised shin is very common, for example when you hit something violently.
In addition, shin contusions are more common in contact or speed sports. Bruises on the tibia can be very painful because there is almost no protective layer of soft tissue over the bone to protect the bone from the effects of violence.In the case of large forces, fractures of the tibia must also be considered.
A Bruised bone in the area of Foot can occur when, e.g. when playing football, an opponent steps on the patient's foot.
If the pain is severe, an X-ray examination can be a possible option Metatarsal fracture exclude.
Another common injury mechanism that leads to a Bruised bone kicks in certain martial arts like kickboxing or taekwondo.
This type of bone contusion also manifests itself on the foot acute painthat get stronger especially under stress or pressure. In addition, there is often swelling and possibly a bruise at the site of the injury.
Next to the metatarsus is that Ankle joint the most common of one Bruised bone affected part of the foot.
Injuries to the shoulder, mostly caused by falls, can lead to ligament, tendon and muscle injuries as well as bone contusions. This leads to swelling and pain in the shoulder area, which can persist even at rest and become worse under stress.
The most common mechanism of injury is a dislocation of the shoulder joint by falling on the outstretched arm. The dislocation of the joint and the resulting tearing of the muscle tendons and ligaments creates a forceful effect on the bone, which results in the microfractures described above.
In this case, however, shoulder dislocation therapy focuses on restoring the tendon, muscle, and ligament structures so that no specific treatment is given to the bruised bone. Less severe cases, in which the structures mentioned are only overstretched or torn, can be treated conservatively by sparing with the aid of a sling. More severe cases must be treated surgically. In both cases, however, the protection that should give the ligament and tendon structures the opportunity to heal is also the optimal therapy for the "incidental" bruises.
You might also be interested in these topics:
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Bruises on the elbow (olecranon) are often very uncomfortable, as various nerves run along exposed here and cause severe pain when subjected to violence.
Slight bruises on the elbow are colloquially referred to as "bumping the music or musician's bone". The ulnar nerve is irritated in its sensitive innervation area (nervous supply area) near the medial epicondyle (inner side of the elbow).
Read more on the topic: Elbow pain - what's behind it?
In the hand, bones can be bruised, especially in the metacarpal and wrist area. The former area is e.g. when boxing is affected, while a wrist bruise occurs especially when falling and trying to catch with the hands. A finger can also be affected.
If the bones are bruised, pain at rest and movement, as well as swelling may occur in the hand. An X-ray examination can rule out a broken bone as the cause of the pain.
Since the hand and wrist are practically constantly used in everyday life, it is particularly difficult to maintain the protective posture over a sufficiently long period of time in the case of a bone contusion in this area. This is why the process often takes a long time.
You might also be interested in these topics:
- Bruise of the finger
- Wrist pain
In the thigh area, bone contusions are rare due to the strong protective muscle sheath.
This means that the relatively thick thigh muscles that surround the thighbone cushion much of the force that is transferred to the leg when the leg hits a hard object. However, should a bone contusion on the thigh be suspected, an X-ray examination can rule out a possible bone fracture.
- Thigh contusion
- Pain in the thigh
The inner and outer ankles are parts of the upper ankle. The ankle joint itself is prone to bone contusions due to its high load and its weak muscular covering. Therefore, either both ankles or just the inner or outer ankle may be affected by the bruise. A bone contusion in the ankle is usually the result of fouls in so-called contact sports such as football or basketball.
In addition to severe stress pain, but also pain at rest, swelling and reddening of the ankle occur in particular. A peculiarity of the ankle joint, which it has in common with the wrist in particular, is its high levels of everyday stress. Patients with bruised bones in the ankle, especially at the beginning of therapy, usually complain of pain with practically every step or when standing, if not even pain at rest (i.e. when sitting or lying down).
Because a bruised ankle bone is often associated with ligament injuries in the ankle joint, in particular with tears in the outer or inner ligaments or syndesmosis. For this reason, it is necessary to consult a specialist in the event of severe pain and swelling. Based on a functional examination of the ankle, the doctor can decide whether there is a suspicion of accompanying ligament injuries. In this case, an MRI scan should be performed to confirm or rule out the suspicion. If such injuries are found during this examination, the therapy becomes more complicated.
Read more on the topic
- Torn ligament in the ankle
- Broken foot symptoms and causes
A bruise of the cheekbone occurs regularly in contact sports such as handball and soccer.
Physical disputes can also lead to bruises on the cheekbone. Those affected show swelling, redness and bruises on the face below the eyes at the level of the cheekbones. Bruises are treated conservatively here. A doctor should be consulted if sensitive disorders or fracture gaps appear.
Read more on the topic: Cheekbone fracture
As with all sports injuries, the basic therapy for bruised bones consists primarily of rest, cooling and compression.
With regard to cooling, it should be noted that the affected area should not be cooled continuously, but repeatedly for a few minutes at a time. In mild cases, these measures, supplemented by pain relievers and anti-inflammatory drugs such as diclofenac or ibuprofen, are sufficient as long as the period of rest is chosen for a sufficiently long period. Both drugs are available both as tablets and as an ointment.
If the medication has to be taken over a longer period of time, it should be discussed with a specialist whether measures to protect the stomach (proton pump inhibitors) should be taken, as stomach problems are one of the most common side effects of these active ingredients.
If the bone contusion is caused by other injuries, e.g. Ligament tears, accompanied, must be made a separate therapy decision for this.
If there is a large bruise in the area of the bruised bone that has not largely resolved after 10-14 days, a surgeon should consider removing it to prevent infection from developing.
Read more on the topic
- Therapy for a bruise
- Bone Bruise - what to do?
Can medication shorten healing times?
The healing of a bone contusion cannot be shortened by medication.
The symptoms such as pain, swelling and bruising can, however, be supported in their regression. Pain relievers, such as ibuprofen and diclofenac, relieve pain. For local treatment, ointments and gels can be used, e.g. Diclofenac gel.
- Diclofenac ointment
Regarding the duration of a bone contusion, no general statement can be made that would do justice to the great diversity of the diagnosis.
This versatility comes from the different locations where bone contusion can occur. In addition, the duration of a bone contusion depends on how consistently the therapy is followed by the patient and what accompanying injuries are present.
In the best case scenario, mild cases can regress to such an extent within days that you can start exercising again. This is especially the case when the affected bone is not stressed too much during sport, such as a shoulder bruise in a soccer player.
However, if it is a severe bruise or the affected bone is heavily stressed during the respective sport, it may take weeks to months before the sport can be resumed.
If the bone contusion is accompanied by ligament or tendon injuries, healing will take place (Convalescence period) accordingly longer.
In rare cases, however, bone contusion can cause discomfort months or years after it first appeared. This is especially the case with bone bruises that are not caused by an acute injury, but rather long-term due to excessive or incorrect loading. Inadequate compliance with the therapy guidelines, e.g. Too short or too lax protection can favor such a protracted course of the disease.
Read more on the topic Duration of a bruise