Bone bruising

The term “bone bruising” is commonly used to refer to areas of localised bony tenderness after a traumatic injury, where there is no X-ray evidence of fracture. These painful injuries may be classified as “sub-periosteal haematomas”. While they can persist for several weeks, they usually resolve spontaneously with no further consequences.

“Bone bruising” is also used to describe traumatic bone lesions which are quite distinct from sub-periosteal haematomas. These injuries are usually not visible on X-ray or by observation (eg at arthroscopy), but they do show up on magnetic resonance imaging (MRI). They are a feature of certain common sports injuries and commonly associated with knee ligament tears such as anterior cruciate ligament ruptures. MRI shows bone bruises as localised abnormalities in the subchondral bone (just beneath the joint-lining cartilage) and marrow, because of the increased water content of the injured area. These areas of injury are thought to represent micro-trabecular fractures of cancellous (spongy) bone, haemorrhage and swelling of the marrow, without significant disruption to the adjacent bone or overlying articular cartilage.

Symptoms from bone bruising can sometimes take months to settle down. Treatment comprises rest and analgesic/antiinflammatory medication initially followed by a period of low impact exercise. It is thought that there may be an association of bone bruising with the subsequent development of osteoarthritis.

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