What Is A Contusion
Bruising isnt like most injuries where your skin breaks and starts to bleed. When you bruise, the force that hit you was not powerful enough to break your skin. Instead, it was powerful enough to break the tiny blood vessels beneath your skin and cause them to bleed.;
Contusions can range in severity. They can be small and harmless. They can also be larger and lead to serious complications.;
You can get a bruise from knocking your knee against a table or by sustaining a heavy blow to the head. A head injury can even bruise a part of your brain. This is called a cerebral contusion.
Anyone can get a bruise, but children, athletes who play sports, and people who are older are more likely to get contusions.;Contusions can happen on the:
While all types of contusions will cause at least some discomfort, bone contusions are the most painful. They also take the longest to heal. Its common for other injuries to happen alongside a bone bruise, such as a ligament sprain.;
The typical signs and symptoms of a contusion involve:;
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Diagnosing A Bone Bruise
Your healthcare provider will ask you about your medical history and symptoms. He or she will ask how you got your injury. Your provider will examine the injured area to check for pain, bruising, and swelling. After the exam, your healthcare provider may be able to tell if you have a bone bruise.
A bone bruise doesnt show up on an X-ray. But you may be given an X-ray to rule out a bone fracture. A fracture may need a different kind of treatment. An MRI can confirm a bone bruise. But your healthcare provider will likely only give you an MRI if your symptoms dont get better.
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Causes Of Knee Bruises
Bruises to the knee generally occur from direct and blows to the body involving something blunt. This may occur due to a fall or when a person bangs their knee into something hard.
Bruising can also develop alongside other types of injury, such as fractures, broken bones, torn tendons, or dislocated joints.
Older adults are more likely to bruise than younger adults. Additionally, people may bruise more easily than others.
What Are The Symptoms Of A Knee Contusion
The most common symptom of a knee contusion is the pain at the moment of an injury. The following day you may also experience bruising, tenderness and swelling in the area of the knee.
You should know that the knee is vulnerable to contusions, so if you fall onto the knee, you will also have a knee contusion. Also, the bruising may occur if your tissue is damaged, for example if you have a sprain of a knee ligament.
The bruising is actually a result of blood vessels damage within the tissue. In this case the blood will leak into surrounding tissues, so you will notice blue and black color under your skin. It is proved that it takes about 24 hours for the bruising to develop. After a couple of days, you will notice that the bruising will fade, so your skin will turn yellow or green.
You may also experience a feeling of tightness in the area of a knee. You should have in mind that not only the tissue may be injured, but also the bone of the knee, which will increase the severity of the injury.
In most cases a knee contusion is not a serious problem. But, when the impact on a knee is too hard, the pain will also be more intense and it will be difficult to move the leg. In this case a medical help will be necessary.
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Bone Bruise Vs Real Stress And Occult Fracture
In a;real bone fracture,;both the cortical bone and the medullary bone are completely broken, and the bone parts are separated, which can be seen on an X-ray.
In a;stress fracture;due to repeated trauma, both the cortical and medullary bone are broken, but the bone parts on the both sides of the fracture do not split. A stress fracture can sometimes be detected by an X-ray, and if not, by an MRI;15.
In an;occult bone fracture,;both the cortical and medullary bone are broken, but the fracture line is so thin that it is not detected by an X-ray;3. The occult bone fracture that involves the bone and the cartilage and makes communication between a bone bruise and the joint is called;osteochondral fracture;6.
In a;bone bruise,;only the medullary bone is broken, and the cortical bone remains intact. A bone bruise cannot be detected by an X-ray or CT but only by an MRI;3.
Recovery And Healing Time
The healing time is measured as the time taken for the bone bruise to completely disappear. In most cases, it can take a few months for the bruise to go away. In knee joint bone bruises, this time is upto two months whereas ankle bruises may take even twelve months to completely go away. Reticular bruises tend to heal the fastest. Impaction and geographic bruises take moderate amount of time. The time taken to heal gets more in older individuals or those people who already have osteoarthritis of the joint.
The time taken by the individual to get back to normal activities is called as recovery time. This time is usually shorter than healing time. Once the injury heals, the person can resume his normal activities. This takes only a few months. The presence of underlying joint damage and degeneration can make the healing time longer. For knee joint bruises it is six months and only three months for ankle bruises.
The known complications that are associated with intraosseous bleed are joint stiffness, post trauma osteoarthritis. This is more common after a geographic bruise. In some cases, there is avascular necrosis of the bone as the blood supply to the bone is affected. It leads to chronic pain and the only treatment is surgery.
A condition where the blood collects inbetween the cortical bone and the periosteum is called as subperiosteal haematoma. The following are the common sites where this hematoma may occur:
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Symptoms Of A Bone Bruise
The symptoms of a bone bruise are similar to those of a regular bruise. Namely, you can expect to experience pain and tenderness in the affected area, swelling in the surrounding tissue, and a change in color. If a bone bruise happens in or near a joint, blood and other fluids can spill into the joint, causing swelling and stiffness. While bone bruises will vary in severity, on average they last longer and hurt more than a normal bruise.
Diagnosing a bone bruise requires consulting your doctor. If a bone injury is suspected, an X-ray is usually called for. While bone bruises dont appear on X-rays, fractures do and the test is important for ruling out more serious damage.
Who Is At Risk Of Bone Bruising
- People who run and jump regularly on hard surfaces
- People who are not conditioned for running or high impact sports/exercise and go from zero to hero very quickly .;
Note: Bone stress reactions that lead to bone bruising is due to an excessive amount of load going through that part of the bone that is unaccustomed!
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How To Treat A Bone Bruise
Bone bruises are painful and often make daily activities difficult. Bleeding inside a bone — damage to the bone marrow or the innermost layer of a bone — may be classified as a bone bruise. These injuries are typically caused by trauma and can take several weeks or even months to fully heal, depending on the area of the body affected. Treatments such as heat, cold, elevation and activity modification can decrease symptoms caused by the injury. Follow your doctor’s specific instructions to help your bone bruise heal.
How Do You Heal A Bruised Bone
One common bone bruise treatment consists of an ice massage, rest, and the administration of pain medication. As with many other bruises, a bone bruise will heal if given enough time. Certain exercises may also be required as part of treating a bone bruise in order to return the patient to his normal activities.
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Types Of Intraosseous Bleeding Based On Mri
Type 1: ;Reticular Bone Bruise
A reticular bone bruise is limited to the spongy part of the bone , is distant from the cortical bone and not connected to the joint surface; it is usually mild and scarce;25.
;;Picture 3.;Reticular bone bruise in the anklea) An MRI of a reticular bone bruise in the front of the talus bone b) Bone cracks in the medullary but not in cortical bonedark grey = medullary bone; light grey = cortical boneblue = cartilage; white = joint space
Type 2: Geographic Bone Bruise
A geographic bone bruise is bigger and denser than a reticular bruise and situated closer to the cortical bone; it can bulge into the joint space 25.
Picture 4.;Geographic bone bruiseDark grey = medullary bone; light grey = cortical boneblue = cartilage; white = joint space
Picture 5.;An MRI of a large geographic bone bruise in the knee
Type 2a: Osteochondral Fracture
When a geographic bone bruise communicates with a joint, it is called osteochondral fracture;6. The damaged cartilage may need up to 1-2 years to heal;6.
Type 3: Impaction Bone Bruise
After an impact of;the two bones in the joint, for example, the tibia and femur in the knee, a depression of the articular surface and bone bruises on the both bones can form; this is called a;kissing contusion9.
Picture 6. An MRI of a kissing contusion in the knee.The upper bone bruise is in the thighbone and the lower in the shinbone
What Causes Quadriceps Contusions
A quadriceps contusion happens when someone gets hit very hard in the thigh. The force makes the muscle tear and bleed. It also can tear the sheath that covers the quadriceps muscles.
Most quadriceps contusions happen from playing sports. For example, it can happen:
- when someone gets hit in the thigh with a ball, helmet, or another player during football or lacrosse
- in sports like skateboarding, skiing, and snowboarding, when someone falls and hits their thigh on a tree or other hard object
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How To Treat A Deep Bone Bruise Of The Knee
A bruise occurs when capillaries break and bleed into the surrounding tissue. According to the National Institutes of Health, a bruise can occur underneath the skin, within the belly of a muscle or within a bone. Most bruises heal on their own; however, a bruise can result in compartment syndrome. Compartment syndrome is an increase in pressure that can decrease the blood supply to tissues or organs around the bruise. You will notice excessive pain, swelling, numbness, tingling or weakness in your lower limb if compartment syndrome develops because of a deep bone bruise of the knee. This complication is life threatening, and you should seek immediate medical treatment. Use the following guidelines to promptly treat a deep bone bruise of the knee.
Elevate the injured knee above the level of your heart, advises the Mayo Clinic 1. Lie down and place your knee and foot on a pillow so that your entire lower leg is elevated to ease swelling.
Apply an ice pack to the bruised knee for 20 minutes. Remove the ice pack for 20 minutes. Repeat this cycle several times during the day to reduce pain and swelling in the knee.
Consider taking over-the-counter nonsteroidal anti-inflammatory drugs , such as Aleve, ibuprofen or Motrin, to reduce pain and swelling. Follow the instructions on the drug label and use as directed. Consult your doctor about taking these medications.
What Are The Risk Factors For Bone Bruises
Bone bruises are fairly common. Anyone can get one. The bones that youre most likely to bruise are the ones in your knees and heels.
A bone bruise is usually the result of a direct hit to the bone, which can occur during fall, accident, or bump during a sports event. You can also bruise your bone if you twist your ankle or wrist.
You might be more prone to bone bruises if one or more of the following applies to you:
- Youre active in sports, especially high-impact sports.
- You dont wear proper protective equipment.
- Your job is physically demanding.
- You take part in an activity thats physically demanding.
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Treatments For A Contusion
Most bruises heal quickly without the need for careful treatment. There are steps you can take to speed the healing process and make sure your bruise doesnt cause any complications.;
You might still see some discoloration of the skin after the pain goes away.
During the first 24 to 48 hours after the bruising, its important to follow the RICE method to speed healing:
- Rest: This means avoid moving the affected area. If the bruise affects your joints or ligaments, the doctor may prescribe crutches or a supportive sling to use while the injury heals.;
- Ice: Icing the bruised area will help any swelling go down. Apply an ice pack for 10 to 20 minute intervals, three or more times a day to reduce swelling.
- Compress: Using a compression bandage, especially on a joint like the knee, will reduce the swelling and provide support.;
- Elevate: Elevate the affected area above your heart level. This will reduce the blood flow to the area and also work to reduce swelling so the healing process can take place.;
You may need to wear a brace or walk with crutches to limit movement in the bruised area. This will help speed your healing and ease your pain.
Causes Of A Bone Bruise
A bone bruise is most often the result of an injury. Almost any blow strong enough to damage the bone but not fracture it can cause a bone bruise, but some forms of injury are more likely to result in a bruise than others.
- Direct force trauma: Any direct blow to the bone can cause a subperiosteal hematoma .
- Repetitive pressure: Subjecting the bone to regular high compressive forces is the most likely way to get an interosseous bruise. This is seen a lot in football players, basketball players and runners.
- Extreme compressive force: In cases where the bone is subject to a sudden, extreme form of compression, the cartilage can literally be crushed enough to separate and create a subchondral bruise. The impact from running on a hard surface or a blow to the sole of the foot can cause this type of injury, as can any high-velocity impact, such as a fall or a car accident.
- Twisting: Sudden twists, like those in a sprained ankle or knee, can cause a bone bruise. The shearing from such a twist is more likely to produce a subchondral bruise than other types since it can strip away cartilage.
- Medical conditions: Conditions like arthritis wear away at the protective cartilage between bones and causes them to grind against each other. This can create a subperiosteal hematoma or subchondral bruising.
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First See Your Doctor
You should always see a doctor if you have suffered a bone bruise to make sure you havent actually broken a bone. Your doctor will take an X-ray of the injury to make sure no fractures have occurred. This is extremely important, because if you do have a fracture and its not treated properly, several serious complications could occur.
If it is only a bruise, your doctor will very likely recommend you get plenty of rest in order to take pressure off of the injured area and reduce the chances that any complications will occur. He or she will also probably suggest you take an over-the-counter pain reliever. You can also try applying some ice to the area two or three times a day to help with pain. Just remember never to put ice directly on the skin, because that could lead to substantial damage to sensitive tissues. Wrap ice cubes in a cloth or a towel first.
In some cases, a doctor will recommend the use of a brace in order to provide support to the injured tissues as well as minimize pressure. This will help strengthen the injured area, reduce pain, and help hasten healing.
How Is A Bone Bruise Diagnosed
Your healthcare provider will ask about your symptoms and check the injured area. Tell your provider what happened when you were injured. Tell him or her when the pain started and how bad it is. Describe any other symptoms, such as stiffness or trouble moving the area.
- X-ray pictures may be used to check for a fracture.
- MRI pictures may show the bone bruise even if an x-ray is normal. Some bone bruises cannot be found for the first 30 hours after the injury. Other injuries may also show up in the pictures. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
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