Deep bruising is bruising that lies below the superficial layers of the skin in a patient. Most bruises are subcutaneous, located just below the skin, and while they can be associated with minor pain and swelling, they typically resolve on their own without complications. In the case of deep bruising, the bruise is in the underlying muscle or bone, and can be accompanied with serious medical risks such as internal bleeding and organ damage. It also takes longer to heal and is much more painful than subcutaneous bruising.
Bruising at all levels is usually caused by trauma. In addition, people can develop bruising as a result of reactions to medications or coagulation disorders. In the case of deep or superficial bruising, people will experience tenderness at the site of the bruise and there may be some discoloration or swelling. Deep bruising can sometimes be a clinical sign in a patient who has not sustained physical trauma and may indicate the presence of leukemia or another blood disorder.
Intramuscular and periosteal bruises are both forms of deep bruising. A risk with this type of bruising is that trauma severe enough to cause damage at that depth can also potentially seriously injure bones and organs. People may have broken bones and other injuries, and could develop an internal hemorrhage caused by breakage of larger blood vessels than those involved in bruising. Patients with deep bruises must be carefully evaluated for signs of additional medical issues.
A deep bruise can be extremely painful. Contact with the bruise can cause a sharp pain and patients may also experience pain if they attempt to move the involved area of the body. Resting and elevating the region while icing it to cut down on swelling can help with deep bruising. Immobilization with a cast or sling can also be used in the early stages of treatment to help the patient avoid pain and tenderness associated with movement.
In some cases, the bruising will resolve on its own after weeks or months. If the pain persists or grows worse, however, it can be a sign that something else is occurring and the patient needs additional treatment. The treatment will not cure the bruise, but should address the related problem so the bruise can finally heal. Patients with a history of deep bruising may want to note it when meeting with a surgeon, as previously injured areas can be scarred or discolored and it is helpful for surgeons to know about old injuries ahead of time.