What is a Bruise?

A bruise is an area of skin discoloration resulting from blood vessels breaking and leaking into the skin. The bruise can also be called a contusion or a hematoma. Most are familiar with the type of bruise that occurs when one has a blunt hit to the skin, such as might occur if one bangs one’s shin on the dishwasher door. Actually, there are three types of bruises that can occur. These are subcutaneous, intramuscular, and periosteal.

A subcutaneous bruise is usually the most minor, least painful, and shortest lasting. In fact some subcutaneous bruises do not hurt much at all, and people can’t remember injuring themselves. The subcutaneous bruise affects the blood vessels directly beneath the skin. It can range in color from dark purple, to brown. As the bruise fades, it becomes yellowish or light brown and ultimately disappears.

An intramuscular bruise affects blood vessels in the muscle, and occurs in muscles underlying the skin. Because it is deeper, it usually signifies a harder hit to the bruised area. Thus it can be more painful, and the bruise can be much larger as the blood vessels release blood to the skin. It can also be painful to the touch.

A periosteal bruise affects blood vessels and the outer layer of bone, called the cortex. If one breaks off enough of the cortex, one has a fracture. On the other hand, when only a few fibers break off, this is normally a bone bruise. It is the most painful of the bruises, and frequently requires an X-ray to rule out fracture. This is especially the case because fractures will also cause discoloration of the skin.

Generally the treatment for a periosteal bruise is icing the injury for 10-15 minutes every two hours for the first day. This can help with swelling and pain. It may also be necessary to rest the area, depending upon the extent of the injury. As well, taking acetaminophen can help. Doctors may recommend not taking ibuprofen or aspirin, since this can thin the blood and actually worsen bruising.

In fact, people who routinely use blood thinners like aspirin and warfarin will bruise much more easily. Blood vessels are slightly more vulnerable. People on blood thinners should be especially careful and seek treatment for any injuries to the head, since the risk of concussion is much higher.

Generally, however, the occasional bruise, especially of the subcutaneous type, is likely to cause a little discomfort, but will dissipate without significant pain. Should a person notice extreme pain or swelling around the site of an injury, a doctor should be consulted to rule out more extensive injury to the bones or muscles.