A bruise develops when blood collects in tissues under the skin, often after damage to blood vessels. Bruises are usually black and bluish in color, but often turn purplish, bluish or green during the recovery process, which normally takes about 4 weeks. It is common for bruises to form lumps or knots at the center.
If the lump occurs in skin tissues, it is referred to as a hematoma. A painful lump in groin can, for example, develop after sudden pinching. Sometimes, a lump can form on bone or nearby structures such as ligaments. These are known as bone bruises. They are usually more serious than hematomas.
There are times that a hard lump under a bruise calls for medical help. In most cases, however, simple home treatments and time is all that is required. In this article, we will discuss both hematomas and bone bruises.
Hard lump under bruise; hematoma
A hematoma is a lump that develops under the skin due to blood clotting outside blood vessels. As mentioned earlier, injuries are the common causes. Babies can get bruises from simple acts such as being held or when learning how to walk. People with bleeding disorders sometimes develop hematomas even without injuries.
Signs and symptoms
Hematomas cause a dark coloration on a raised area on the skin. Color changes usually occur as the injury nears recovery. In most cases, hematomas are not painful or serious. Some may cause throbbing mild pain. Hematomas may have the following characteristics:
- Red, blue or purple
Bruises tend to spread with gravity, especially in lower legs. This is not a serious sign and should not worry you. You should only get concerned if a bruise develops immediately after an injury or causes swelling and pain. These are signs of a serious injury that may have involved bone fractures.
How to treat and prevent a hard lump under a bruise
A small lump under a bruise doesn’t require professional medical treatment. The following measures will help reduce pain and swelling as well as quicken recovery:
- Wrap some ice packs in a plastic bag and cover the bag with a piece of cloth. Compress the ice packs on the bruise for about 10 minutes. This is best done immediately after bruising to stop bleeding.
- Try pressing down on the bump some time after the injury. It may reduce the swelling. Be careful not to overdo the pressing.
- Soak a small towel in warm water and rinse to get rid of runaway water. Hold the cloth on the bruised area for about 5 minutes. This treatment is best done about 24 hours after the lump has formed. It is meant to encourage the regained flow of clotted blood.
When to see a doctor
As we have mentioned repeatedly, both bruises and hematomas are not serious. All the same, medical attention will be necessary in the following circumstances:
- If pain and swelling occur
- A massive lump on forehead develops or on your stomach and neck
- The bruise persists for more than 4 weeks
- You have recurring bruises and hematomas even without injuries being involved
Hard lump on bone after a bruise
As mentioned earlier, a hard lump on the bone after a bruise is known as a bone bruise or bone contusion. It develops when an injury causes small fractures on the surface of a bone or causes further injuries to surrounding tissues and joints. People who engage in sports such as martial arts often get these forms of injuries. The legs and arms are mostly affected. Often, the fractures that result in a hard lump on the bone after bruising are too small to be seen in X-ray images.
Intramuscular bone bruise (inter-osseus)
This is perhaps the most serious type of bone bruises. It develops inside bones, on the bone marrow. Pressure such as sustained when playing high intensity games or repetitive activities may compress bone marrow to an extent that blood cannot move normally. This results in internal bleeding inside bones. Lumps formed in this manner will usually cause swelling and pain. Difficulty walking or standing may also be experienced due to bone death, especially if the bone bruise occurs in the lower legs. Medical attention should be sought for this type of bone bruising.
Periosteal bone bruise (sub-periosteal hematoma)
Bones are surrounded by a dense membrane known as periosteum. It serves the role of nourishing bones and as a result contains many blood vessels. Injuries such as a blow on your shin can injure these blood vessels and cause blood leakage.
Since the periosteum is very close to the surface of bones, leaked blood will have little space to spread. It will as a result collect to form a painful, sore, hard lump. These types of bone bruises can take up to months before full recovery and are the most painful of all three types. You can for example develop a tender lump on shinbone after hitting yourself against a table.
Subcutaneous bone bruise (sub-chondral lesion)
Long bones such as the shinbone and thighbone interlock at the joints. To keep the bones from grating against each other, a smooth, elastic, resilient padding covers the ends of interlocking bones. Activities such as jumping or twisting a joint can crush the elastic cartilage or separate it from parent-bones. This leads to internal bleeding. A subcutaneous bone bruise in shoulder joint can cause a painful lump under chin due to swollen lymph nodes.
Causes and symptoms
Most bone bruises occur during sporting activities and accidents. Direct impact on a bone is likely to injure the periosteum and cause a periosteal bone bruise. Repetitive activities such as football are likely to cause repeated pressure and compression on bone marrow. As a result, intermuscular bone bruises will develop. Landing heavily on your feet or repetitive rotation movements at joints will most likely injure the cartilage and cause subcutaneous bone bruise.
Symptoms include swelling (edema), pain, tenderness and bone injury. Pain can make it difficult to walk or even stand. Even when the bone itself is not broken, hard blows can cause quite serious bone bruises that can even take months to heal.
Diagnosis and treatment for lump on bone after bruise
Like hematomas, bone bruises can heal without treatment. The better approach, however, is to go for medical diagnosis to rule out broken bones. Damaged cartilage may also lead to a lump on shoulder blade or knee due to osteoarthritis if not treated.
Treatment options include:
Pain killers are the most common medications used in treatment of bone bruises. Your doctor can prescribe them or you can just buy them over the counter. To reduce swelling, anti-inflammatory medications may be prescribed. Antibiotics will be necessary if a wound has formed on the skin such as after a blow.
Ice treatment is quite effective on swollen and painful lumps. This treatment doesn’t require a medical officer. All you need is to wrap ice packs in a plastic bag and compress on the lump for about 10 minutes. You can use a cold spoon in place of ice packs.
Close monitoring involves keeping an eye on the improvements the lump is showing. To encourage recovery, try keeping the affected bone elevated. This discourages accumulation of fluids in the affected area. During the recovery period, it will be helpful if you can stay away from activities that will strain the affected bone.
Self-diagnosis has its advantages. Sometimes, some home treatment techniques and over the counter medications are all you require to treat a certain conditions. The best thing is that there are many self-diagnostic tools such as lumps under bruise guides, testicular lump pictures and so on that you can easily access online. All the same, your doctor should be the one to decide if a lump is dangerous or not. Get medical help if no improvements are recorded after 24-48 hours.
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