Bone bruise: Difference between revisions

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Force causes separation of the cartilage (or ligament) and the underlying bone, plus bleeding when the energy of the impact extends into the bone.
Force causes separation of the cartilage (or ligament) and the underlying bone, plus bleeding when the energy of the impact extends into the bone.


Seen in sport players who run/jump on hard surfaces
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<br>For the all bone injuries, incidence rates tend to be higher amongst professional athletes and those that run and jump frequently on hard surfaces, for example football and basketball players. <sub><ref name="p3" /><ref name="p6" /></sub>  
<br>For the all bone injuries, incidence rates tend to be higher amongst professional athletes and those that run and jump frequently on hard surfaces, for example football and basketball players. <sub><ref name="p3" /><ref name="p6" /></sub>  
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== Physical Therapy Management    ==
== Physical Therapy Management    ==


The treatment of a bone bruise consists of rest and precaution.<br>The affected area should be avoided to bear repetitive or strong loads.<br>This is to avoid aggravation of the problem. Usually only painkillers<br>(such as a small dosage of ibuprofen) are given to lighten the pain.<br>The patient should receive advise about how he could reduce the load on<br>the affected area and be made clear that if he does not rest enough the <br>healing process will slow down or the structure can be damaged even more. <sub><ref name="p0">The Basics of Bone Bruises;                                                                                  Grades of recommendation F
The treatment of a bone bruise consists of [[RICE]], pain relief and/or anti-inflammatories as prescribed by a medical practitioner and load restriction dependant on the circumstances of the injury. <sub><ref name="p0">The Basics of Bone Bruises;                                                                                  Grades of recommendation F
http://bruises.knowingfirstaid.com/permalink.php?article=Bone%20Bruises.txt</ref></sub><br>The time for the resolution of a bone bruise is variable. At its earliest the bruise will be gone 3 weeks after the acute trauma. In all cases the bone bruises disappeared at 2 years after the trauma.<sub><ref name="p3">V. Mandalia, A.J.B. Fogg, R. Chari, J. Murray, A. Beale, J.H.L. Henson. Bone bruising of the knee. Clinical Radiology 2005; 60, 627–636                                                                                                        Grades of recommendation:A</ref><ref name="p6" /></sub><br><br>
http://bruises.knowingfirstaid.com/permalink.php?article=Bone%20Bruises.txt</ref></sub> The time for the resolution of a bone bruise is variable. Literature suggests that the healing time to completely resolve this injury can take anywhere between three weeks to up to two years after the trauma.<sub><ref name="p3">V. Mandalia, A.J.B. Fogg, R. Chari, J. Murray, A. Beale, J.H.L. Henson. Bone bruising of the knee. Clinical Radiology 2005; 60, 627–636                                                                                                        Grades of recommendation:A</ref><ref name="p6" /></sub><br><br>





Revision as of 13:38, 12 November 2018

Original Editors - Laurien Henau as part of the Vrije Universiteit Brussel's Evidence-based Practice project.

Top Contributors - Laurien Henau, Claire Knott, Admin, Rik Van der Hoeven, Kim Jackson, Wanda van Niekerk, Lucinda hampton, 127.0.0.1 and WikiSysop - . 

What is a bone bruise?[edit | edit source]

A bone bruise is one of the four types of fractures that can occur in the human body. Other fracture types include stress fractures, osteochondral fractures and bone fractures.[1] A bone bruise can be described as one or a combination of the three different kinds of bone injuries including: sub-periosteal hematoma, inter-osseous bruising and a sub-chondral lesion. [2] A bone bruise is differentiated from the alternative fracture types in that only a few of the trabeculae are broken.[3]

Clinically Relevant Physiology[edit | edit source]

Bone tissue is a specialised form of connective tissue that is made up of an organic matrix (collagen and glycosaminoglycans) and inorganic minerals (calcium and phosphate). [4] An adult human skeleton contains 80% cortical bone and 20% trabecular bone. Both types of bone are composed of osteons. Cortical bone is the solid type of bone and trabecular bone resembles honeycomb which is comprised of a network of trabecular plates and rods. Read more about the histology and physiology of bone here.

Bone 1.jpgBone 2.jpg

Epidemiology[edit | edit source]

The most common cause of bone bruise is acute trauma however this condition can also be associated with normal stress loading and haemophilia A and B.[5]

The most commonly affected area is the lower limb. [6]

Patients with a bone bruise tend to have protracted clinical recovery, with more effusions and pain at matched time intervals and a slower return of motion. [1]

In patients with ACL rupture there is an 80% probability of concurrent associated bone bruising at the femoral condyle or tibial plateau.[1][4] According to Boks et al. 2007, the presence of bone bruising in these zones is the most important secondary sign in the diagnosis of ACL injury.

Bone 3.jpg

MRI with white arrow indicating presence of bone bruising in the (a) post-lateral talus area and (b) the caudal tibia epiphysis.

Clinical Presentation[edit | edit source]

Bone Injury Type Characteristics Typical Injury Mechanism
Sub-periosteal hematoma A concentrated collection of blood underneath the periosteal of the bone. Direct high-force trauma to the bone
Inter-osseous bruising Damage of the bone marrow. The blood supply within the bone is damaged, and this causes internal bleeding. Repetitive compressive force on the bone (extreme pressure on regular base).
Sub-chondral lesion Lesion occurs beneath the cartilage layer of a joint. Extreme compressive force or rotational mechanism such as testing (shearing force) that literally crushes the cells

Force causes separation of the cartilage (or ligament) and the underlying bone, plus bleeding when the energy of the impact extends into the bone.


For the all bone injuries, incidence rates tend to be higher amongst professional athletes and those that run and jump frequently on hard surfaces, for example football and basketball players. [1][2]

Diagnostic Procedures[edit | edit source]

Although an x-ray should identify whether or not there is a complete fracture, bone bruises are not able to be diagnosed using x-ray images. The best, current "gold standard" diagnostic imaging method for bone bruises is the MRI, in particular T2-weighted fat-suppressed images or T1-weighted imaging.[4]

Bone 7.jpg
Bone 6.jpg
Bone 5.jpg



Bone 9.jpg








Bone 10.jpg

[1][2][7]

Physical Therapy Management[edit | edit source]

The treatment of a bone bruise consists of RICE, pain relief and/or anti-inflammatories as prescribed by a medical practitioner and load restriction dependant on the circumstances of the injury. [8] The time for the resolution of a bone bruise is variable. Literature suggests that the healing time to completely resolve this injury can take anywhere between three weeks to up to two years after the trauma.[1][2]


References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 V. Mandalia, A.J.B. Fogg, R. Chari, J. Murray, A. Beale, J.H.L. Henson. Bone bruising of the knee. Clinical Radiology 2005; 60, 627–636 Grades of recommendation:A
  2. 2.0 2.1 2.2 2.3 V. Mandalia, J.H.L. Henson. Traumatic bone bruising – A review article, European Journal of Radiology 2008; 67; 54–61 Grades of recommendation A
  3. Janice Polandit, 5 Things You Need to Know About a Bone Bruise, 2011; http://www.livestrong.com/article/5521-need-bone-bruise/ Grades of recommendation F
  4. 4.0 4.1 4.2 L.C. Jungueira and J. Carneiro, “Functional Histology” 2010; 167
  5. Prof. Dr. S. Van Creveld and Dr. M. Kingma Subperiostal haemorrhage in haemophilia A and B. Ned. T. Geneesk. 105. I. 22. 1961; 1095-1098 Grades of recommendation F
  6. Christoph Rangger, Anton Kathrein, Martin C Freund, et al. Bone Bruise of the Knee. Acta Orthop Scand 1998; 69(3) : 291-294. Grades of recommendation B
  7. Simone S. Boks, Dammis Vroegindeweij, Bart W. Koes, et al. MRI Follow-Up of posttraumatic Bone Bruises of the knee in General Practice. AJR 2007; 189:556–562 Grades of recommendation B
  8. The Basics of Bone Bruises; Grades of recommendation F http://bruises.knowingfirstaid.com/permalink.php?article=Bone%20Bruises.txt