What is Periosteal Hematoma

Periosteal hematoma is a bone bruise that can cause tenderness and swelling close to the bone. It can result from a small, hidden break (fracture) in the bone, other injury to the bone area, or surgery.

It typically occurs in bones that are close to the surface of the skin, such as shin, knee, or heel bones. It may take several weeks to heal completely.

What are the causes?

This condition is usually caused by:

• Bone injury (trauma), such as:
  • A hard, direct hit (blow).
  • A fracture.
  • A sports injury, such as tearing the anterior cruciate ligament (ACL) in the knee.
• Landing improperly after a jump.
• Running too hard or too much without stretching.
• Twisting injuries.

What are the signs or symptoms?

Symptoms of this condition include:

• Severe pain around the injured area that usually lasts longer than a normal bruise.
• Difficulty using the bruised area.
• Tender, swollen area close to the bone.
• Discoloration of the bruised area.

How is this diagnosed?

This condition may be diagnosed based on:

• A physical exam.
• MRI.
• X-rays.

How is this treated?

Treatment for this condition depends on the severity of the injury. Your health care provider may recommend that you:

• Rest and put ice on the injured area.
• Take over-the-counter medicine for pain as needed.
• Use crutches to help you walk, if needed.
• Wear splints or braces around the injured area.
• Do physical therapy.

Follow these instructions at home:

If you have a plaster splint:

• Wear the splint as told by your health care provider.
• For the first 24 hours, rest the splint on a soft surface, such as a pillow.
• Do not put weight on the splint.
• Do not get the splint wet. Cover the splint with a watertight plastic covering when you take a bath or shower.
• Do not stick anything inside the splint to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the splint every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the splint. Do not put lotion on the skin underneath the splint.

If you have an air splint or a brace:

• Wear it as told by your health care provider. You may change the amount of air in the air splint as needed for comfort.
• You may remove your air splint or brace before bathing, before applying ice, and at night. Do not let it get wet.

Managing pain, stiffness, and swelling

• If possible, raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
• Wiggle your toes often.
• Use an elastic wrap as directed by your health care provider. Loosen the wrap if the area around the wrap tingles, becomes numb, or turns cold and blue.
• If directed, put ice on the injured area:
  • If you have a removable splint or brace, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your plaster splint and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicines.
• Ask your health care provider when it is safe for you to drive if you have a splint on part of your arm or leg.

Activity

• Do not participate in any activities that involve the injured area until your health care provider approves or you are fully healed. Your health care provider may recommend low-impact activities, such as swimming or cycling, instead of your normal activities.
• If physical therapy was prescribed, do exercises as told by your health care provider.
• Follow instructions from your health care provider about whether walking with crutches or a cane is required. This depends on the severity and location of your injury.
  • Use crutches or a cane until you can stand without pain, or for as long as told by your health care provider. Gradually, start using or bearing weight on the injured body part.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider or physical therapist. This is important.

Contact a health care provider if:

• You have any of the following symptoms that get worse:
  • Bruising.
  • Swelling.
  • Tenderness.
  • Warmth in the injured area.
  • Difficulty bearing weight on the injured body part.
• Your toes feel unusually cold, especially if this does not improve after removing a splint or wrap.
• You have pain that gets worse or does not improve with medicine.
• You have problems with your splint, such as:
  • Itching under your splint that will not go away.
  • Red or irritated skin around the splint.
  • Cracks or breaks in the splint.
  • A feeling that the splint is too tight.

Get help right away if:

• You have severe pain near the injured area or severe pain with stretching.
• You have increased swelling that results in a tense, hard area or a loss of feeling in the area of the injury.
• You have pale, cool skin below the area of the injury (in an arm or leg), and this does not go away after removing a splint or wrap.
• You cannot move your toes or fingers, even after removing the splint or wrap.

Summary

• Periosteal hematoma is a bone bruise that can cause tenderness and swelling close to the bone.
• Symptoms of this condition include pain that lasts longer than a normal bruise, difficulty using the bruised area, a tender and swollen area close to the bone, and discoloration near the bruised area.
• You may be given a plaster splint, an air splint, or a brace, depending on the location and severity of your injury.
• Treatment usually includes resting and icing the injured area, physical therapy, and pain medicine as needed.