What is the treatment for a bone bruise?

Treatment of Bone Bruises

The recommended treatment for bone bruises includes localized cold therapy with or without pressure, rest, and gradual return to weight-bearing activities based on symptom resolution. 1

Understanding Bone Bruises

Bone bruises are traumatic injuries to the bone that don't appear on standard radiographs but can be visualized on MRI as areas of edema within the bone. They typically occur from direct trauma or axial overloading of the bone.

First-Line Treatment Approach

Immediate Management

• Cold therapy: Apply localized cold with or without pressure to the affected area to help with hemostasis 1
  • Use ice packs for 15-20 minutes several times daily, especially during the first 48-72 hours
  • Avoid direct application of ice to skin (use a thin cloth barrier)

Pain Management

• NSAIDs: Can be used for pain control 1
  • Consider topical NSAIDs like diclofenac gel or patch for localized pain with minimal systemic effects 1
• Acetaminophen: Alternative for those who cannot tolerate NSAIDs

Activity Modification

• Protected weight-bearing: Gradually increase weight-bearing based on symptom resolution 2
• Rest: Reduce activities that cause pain to the affected area
• Assistive devices: Consider crutches, walking boots, or braces depending on location and severity

Monitoring and Follow-Up

Expected Recovery Timeline

• Pain typically begins to resolve within 2-4 weeks for minor bone bruises 3, 4
• Complete resolution of MRI findings may take 4-12 months 3
• More severe bone bruises may require protected weight-bearing for up to 4 months 2

Warning Signs

• Persistent pain beyond expected recovery timeframe
• Worsening symptoms despite appropriate treatment
• Development of new symptoms

Special Considerations

Location-Specific Recommendations

• Weight-bearing bones (calcaneus, talus, tibial plateau):

  • More conservative approach to weight-bearing progression 2, 5
  • May require longer periods of protected weight-bearing

• Non-weight-bearing bones:

  • Generally faster recovery
  • Focus on protecting the area from further trauma

Rehabilitation

• Begin gentle range-of-motion exercises as pain allows
• Progress to strengthening exercises as symptoms improve
• Return to sports/activities should be gradual and based on symptom resolution

Potential Complications

• Delayed healing in weight-bearing bones 2
• Potential risk for chondrolysis if the bone bruise is near articular surfaces 2
• Possible development of stress fractures if weight-bearing is increased too rapidly 2

When to Consider Advanced Imaging

• When radiographs are normal but pain persists beyond expected timeframe
• When symptoms are disproportionate to visible injury
• To rule out associated injuries (especially with knee injuries, where soft tissue injuries are present in up to 94% of cases with bone bruises) 3

Remember that bone bruises should be managed with appropriate rest and gradual return to activities to prevent potential complications such as stress fractures or prolonged symptoms.