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Bruising is a type of injury which is caused by rupturing of blood capillaries under the skin without breaking the epidermis. It is marked by the appearance of a blue-red patch on the skin, which does not fade when touched. Bruises mostly occur on the surface of the skin but in some cases, they can also be internal such as in bones or in muscles. Internal bruises are generally severe and can cause excessive pain and swelling. These bruises need special medical care and attention for quick recovery. On the other hand, topical bruises generally fade away on their own.

  1. Types of Bruises
  2. Symptoms of bruises
  3. Cause of Bruises
  4. Prevention of Bruises
  5. Diagnosis of Bruises
  6. Treatment of bruises
  7. Precautions for bruises
  8. Doctors for Bruises

Types of Bruises

Depending on the intensity and location of the injury, bruises can be of three types:

Subcutaneous Bruise
This is the most common type of bruise, which occurs due to a haemorrhage in the dermal layer of the body.
Apart from injuries, it may also occur due to allergies and autoimmune disorders.

Intramuscular Bruise
These bruises are usually associated with muscle sprain or injury. Depending on the severity, intramuscular bruises are of three types:

  • Mild Intramuscular Bruise: These are also known as grade 1 type of bruise and are not that severe. They occur due to a minor injury to muscle fibre and are associated with slight oedema. There is no loss of muscle strength or movement. Though it is still advised not to continue with heavy chores especially intense physical activities to prevent worsening of the injury.
  • Moderate Intramuscular Bruise: Grade 2 type of bruises are a bit more severe than grade 1 and are usually associated with difficulty in muscle contraction. They occur due to the formation of muscle defect or muscle gap. Moderate intramuscular bruises usually take 2-3 week to heal, rarely healing takes a month. 
  • Severe Intramuscular Bruise: This is also known as grade 3 type of intramuscular bruise and as the name suggests, is a serious case of muscle injury and bruise. Severe damage to muscle structure and intense ecchymosis (discolouration of the skin) is seen in this case along with excessive pain and loss of muscle function. It takes about six weeks to recover from this kind of bruise. 

Bone Bruise
Bone bruises occur due to a traumatic injury to a bone, which may be due to a fall, accident or a sports injury. Although a bone bruise is much less severe than a fracture, it can cause extreme swelling and pain in the affected area. Another reason for this kind of bruise can be arthritis.

Our bone is made of majorly three parts:

  • Periosteum: It is a thin layer that covers the bone
  • Subchondral bone: This bone is present right below the cartilage that connects two joints
  • Medulla: It is the part of the bone that contains the bone marrow and other fibrous tissue or trabeculae

In the case of a periosteal bruise, the injury damages some of the trabeculae (porous bone tissue present at the end of long bones). A bone bruise can be subdivided into three types majorly depending on the location of the bruise on the bone:

  • Subperiosteal hematoma: In this case, bleeding occurs in the area of the periosteum. This is a major bruise but still is less serious than other kinds of bone bruises as the injury only affects the upper layer of bone. 
  • Subchondral bone bruise: This type of bone bruise, bleeding and swelling occurs in the area between the cartilage and bone
  • Inter-osseous bone bruise: Inter-osseous bone bruise occurs when an injury affects the medulla of a bone. Damage of fibrous tissue or the trabeculae is quite severe in this case. An inter-osseous bone bruise can be considered the most serious kind of bruise and takes months to recover. Total rest is recommended for quick recovery

Symptoms of bruises

Some apparent symptoms of bruises are:

  • Pain: Depending on the type and location of injury bruises are usually associated with mild to severe pain. Internal bruises are much more painful than muscle or subcutaneous bruises 
  • Swelling:  Swelling in the bruised area occurs as a result of the collection of blood in the underlying tissue. Just like pain, swelling can range from minor to major depending on the cause and location of the bruise. In major injuries, the swelling spreads to surrounding areas, while inflammation associated with minor injuries might as well go unnoticed 
  • Discolouration: Skin discolouration is one of the most apparent symptoms of a bruise. This is actually the colour of the blood collected beneath the dermal layer. The colour may vary from light pink to dark brown. The difference in the shade of colour depends on the amount of blood leaked and the thickness of the surface of the affected part through which the bruise is visible
  • Impaired function: Bruising in muscle and bones may also cause partial or complete loss of function

Cause of Bruises

A bruise can occur due to various causes. Some of them are discussed below:

  • Injury: Physical injury is one of the common causes of bruises. This injury can be because of various reasons ranging from minor to major accidents
  • Urticarial vasculitis: It is a rare condition marked by inflammation in blood vessels and the appearance of urticaria like rashes on the skin. Though urticaria vasculitis is much more severe and usually leaves bruises
  • Autoimmune disorders: It is an abnormal reaction of the immune system towards body cells or organs. Auto-immune conditions that cause destruction of platelets usually manifest in the form of internal bleeding and bruising
  • Bleeding disorder: Bleeding or blood clotting disorders such as haemophilia usually lead to internal bleeding and frequent bruising. These could either be genetic or acquired
  • Chemotherapy: Chemotherapy leads to a reduction in the number of platelets, the cells which are responsible for making blood clots and putting a stop to bleeding. Hence, bleeding can occur more easily in chemotherapy patients which can lead to the formation of tiny red dots or bruises
  • Old age:  With age, our body tissues tend to be more fragile and prone to damage. So, older people are at a much higher risk of developing bruises  
  • Medications: Medications such as blood thinners or anti-inflammatory drugs also increase the risk of bruises. The former leads to a reduction in blood clotting and later reduces the thickness of your skin and underlying tissues, making them prone to damage.

Prevention of Bruises

Bruises are mostly not severe but can lead to discomfort, pain and swelling. So, the best way is to take some safety measures and stay away from risky situations that can lead to injuries and bruises. Here are some tips you can consider to keep yourself safe from accidental and hazardous situations. 

  • Always wear safety equipment like helmets when you are playing contact sports 
  • Apart from this, maintain your surroundings in a way to reduce injuries. For example, do not spread things in the walkway or corridors. Also, arrange your furniture in a way that you do not bump into them while walking
  • Adjust the lighting in your room so that you get a clear sight of everything and do not bang into things 
  • Use a torch or a flashlight if you have to walk in a dim light area
  • Add vitamin C, Vitamin K and Vitamin B12 in your diet
  • Avoid blood thinners like aspirin, warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), or clopidogrel (Plavix). These blood thinners can make you more prone to get bruises

Diagnosis of Bruises

Subcutaneous bruises can be easily diagnosed by physical appearance.
Muscle and bone bruises require an X-ray or MRI scan for detection. Infrared bruising spectroscopy methods can also be used to diagnose muscle bruises

Treatment of bruises

In most cases, bruises don’t need specific treatment and get healed on their own. However, treatment of a bruise depends on its cause.

If the bruise is because of a specific disorder, it is important to tackle that disorder first. Treating just the bruise in such cases will not give any permanent result.
If the bruise is because of a physical injury, it can be treated with some general medication; depending on the intensity of bruise and injury. In case of severe bruising, your doctor may suggest you analgesics like acetaminophen to reduce the pain

Apart from this, you may be advised to wear a splint, brace or crutch or any other supporting device to reduce movements and pressure on the affected area. If the condition of the bruise is too alarming, your doctor may also recommend getting hospitalized for a few days for better treatment. Follow the instructions of your doctor carefully and give your body some rest for quick recovery.

Precautions for bruises

  • Do not drain the bruise on the skin using a needle. Give it some time and it will go away on its own
  • In case of severe bruise or injury, take as much rest as you can. Do not apply pressure on the affected tissue
  • While getting treatment for a bruise, do not miss your follow-up appointments with your doctor
Dr. U. Satyanarayana

Dr. U. Satyanarayana

आकस्मिक चिकित्सा

Dr. Sudhir Singh Pawaiya

Dr. Sudhir Singh Pawaiya

आकस्मिक चिकित्सा

Dr. Rumneek Sodhi

Dr. Rumneek Sodhi

आकस्मिक चिकित्सा

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References

  1. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Bruises
  2. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Bleeding into the skin
  3. MedlinePlus Medical Encyclopedia: US National Library of Medicine. Bleeding into the skin.
  4. University of Rochester Medical Center. Bone Bruise. Rochester, New York. [internet].
  5. Nidirect. Urticaria (hives). UK. [internet].
  6. S J Deacock. An approach to the patient with urticaria. Clin Exp Immunol. 2008 Aug; 153(2): 151–161. PMID: 18713139.
  7. Immune Deficiency Foundation. Autoimmunity. Maryland, US. [internet].
  8. Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; What is Hemophilia?
  9. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment
  10. Harvard Health publishing. Why do I bruise more easily as I age?. Harvard Medical school. [internet].
  11. United States Department of Agriculture. Innovative Fruit Production, Improvement, and Protection: Kearneysville, WV. National Nutrient Database for Standard Reference Legacy Release; Agricultural Research Service
  12. Cleveland Clinic. [Internet]. Cleveland, Ohio. Bruises: Prevention
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