Feeling a hard lump under a recent bad bruise can be worrying. The good news is that in most cases of bruising, these lumps are not a cause for concern. However, there are possible complications from bruises. When bruising is severe or if the injury occurs on the head, it is important to be aware and take action.
What Is a Bruise?
Medical experts define a bruise as an area of skin discoloration that occurs when small blood vessels break and leak their contents beneath the skin. Bruising is common after a fall or bump against a hard surface.
Typically, bruises occur when there has been an injury to soft tissues under the skin. Blood collects at the location of the injury and causes distinctive red, purple, or blue coloring to appear. As the bruise heals, it may turn yellow, until it finally resolves after a few weeks.
What Is a Hematoma?
In cases where the bruise is especially bad, a hematoma may form. A hematoma is defined as a collection of blood that occurs outside of the blood vessels in an organ, tissue, or other body space. A hematoma can feel like a hard lump that develops at the site of the bruise.
If you are unsure of whether you have a hemotoma, consider the following. Hematomas may feel:
When you push on a hematoma, it may move around under the skin. It may also feel uncomfortable or even painful. While these signs and symptoms may be disconcerting, they are not usually a cause for alarm. Usually, the body will eventually reabsorb the blood that formed the hematoma without treatment.
Treatment for a Bruise or Hematoma
Bruises will generally heal on their own, but treatment may help a hematoma heal faster and in some cases, offer relief from any pain or discomfort. Medical experts suggest different ways to care for a hematoma.
- Apply a cold pack to the site of the bruise during the first 24-hours to reduce bleeding. Ice the area in 10-20 minute increments, 4 to 8 times per day.
- Whenever you sit or lie down for the next three days, elevate the bruised limb to reduce swelling. Resting is also important as it can prevent you from making the injury worse.
- Take an over-the-counter medication like acetaminophen to reduce the pain associated with a hematoma but be sure to follow label instructions and guidelines from your healthcare provider.
- Consult your doctor if necessary. They may advise draining the hematoma if it is not healing properly.
When a Hematoma Occurs on the Head
There are some instances when the development of a hematoma may require special care. When a severe accident occurs (for instance, a car accident, sports injury, or a serious fall), the injuries may lead to subdural hematoma, an epidural hematoma, or an intraparenchymal hematoma. Each can have life-threatening consequences if left unchecked.
According to the National Library of Medicine, a subdural hematoma happens when blood vessels rupture between the covering of the brain (called the "dura") and the surface of the brain.
This type of bleeding occurs rapidly and compresses the brain tissue, leading to issues like dizziness, headaches, confusion, and even death. These symptoms may appear right away, a few days after an injury, or over a period of weeks. When the injury occurs slowly it is called a chronic subdural hematoma.
Medical experts define an epidural hematoma as bleeding between the inside of the skull and the dura, or the outer covering of the brain. This injury often occurs after a skull fracture during childhood or adolescence. It can also occur after the rupture of a blood vessel, such as an artery.
Rapid bleeding from an epidural hematoma can put pressure on the brain. Symptoms may include a loss of consciousness (often followed by regaining consciousness before losing it again), difficulty breathing, headache, vomiting, seizure, and even death.
Intracerebral or intraparenchymal hematoma occurs when blood begins to pool in the brain. According to the Mayo Clinic, potential causes include the rupture of a bulging blood vessel, poorly connected arteries and veins, high blood pressure, or tumors.
The injury can also happen after a major trauma to the head. With an injury like this, there can be more than one intraparenchymal hematoma affecting the brain at a time.
Treatment for Hematoma
When it comes to treating hematomas on or around the head, a medical professional will need to be consulted. Most often, they will use imaging techniques like a CT scan or MRI scan in order to determine the size and placement. From there, they can determine the best course of action.
Studies suggest that effective treatments for hematomas of the head generally include:
- Surgery: This is a fairly common way to treat a hematoma on the head. In some cases, drainage of the affected area is required. More severe cases may need a craniotomy where a section of the skull is opened.
- Monitoring and medication: In some instances, the hematoma may be minor. In those cases, a doctor may choose to monitor the area closely over a period of weeks or months. In addition, they may prescribe medication.
How to Monitor a Bruise or Hematoma
Unless it involves a head injury, a hematoma that forms after severe bruising does not normally require any treatment. However, it is important to pay attention to any and all symptoms that appear. If the bruised area is causing significant pain, it continues to be swollen, or the hematoma does not appear to be healing, it may be time to consult with a medical professional.
Experts advise that in the case of a head injury, medical attention may be necessary. This is especially important if the following symptoms occur:
- Dilated pupils
- Mood changes
The healing time for a hematoma is different for each person. It can vary dramatically depending on the size and placement of the hematoma as well as the cause of the bruise.
Generally speaking, smaller hematomas heal within five to ten days. Larger hematomas will start to look better after ten days but may last for several weeks. If you see no signs of progress or feel the hematoma is taking longer than it should heal, make an appointment with your healthcare provider.
Other Possible Causes of Hard Lumps Under Bruises
Although a hematoma is the most common cause of a hard lump under the skin after a serious bruise, there are occasional other instances in which a hard lump forms after a fall, sports injury, or other trauma that causes bruising.
A bone bruise occurs when there is deep trauma to bone tissue that is not severe enough to cause a bone fracture. According to medical sources, there are different types of bone bruises that are distinguished by the area where blood pooling occurs.
- Subperiosteal hematomas occur when there is blood build-up beneath the periosteum.
- Subchondral bone bruises happen when there is bleeding and swelling in the area between your cartilage and the bone beneath it.
- Intraosseous bone bruises occur when bleeding and swelling happens in the medulla of your bone.
Most bone bruises take one to two months or more to heal. In addition to standard bruise treatment, a bone bruise might require the use of wearing a brace to limit movement and allow the area to heal.
Myositis ossificans is another possible complication of bruising that can cause a hard lump or hardened area. Most commonly associated with serious sports injuries, the condition is caused by abnormal bone tissue growth inside muscle tissue after the area is badly injured or after repetitive sports injuries.
While a hematoma often appears relatively soon after a bad bruise, this abnormal bone tissue growth within the muscle may not occur until two to three weeks following an injury. It is characterized by hardness and pain and can limit the range of motion and mobility of the injured person.
The Cleveland Clinic suggests that you can treat myositis ossificans at home with these remedies:
- Icing the area regularly
- Gentle stretching
- Limited activity and rest
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
- Using an elastic bandage to decrease swelling
Check With Your Doctor
Whether you have a minor bruise or mild hematoma, in many cases, there's no need to worry about a hard lump under a bruise. Usually, the lump will resolve without any treatment. You need to give it time to heal and focus on minimizing the symptoms. In any circumstance where you are concerned, however, seeking the care of your doctor can help ensure there are no complications from your bruise.