LEG HEMATOMA, LOWER LEG
DEFINITION--A collection of pooled blood in a small area of the lower leg. Hematoma in the lower leg can be quite disabling. A large hematoma in the enclosed space over the tibia (the "shin bone") can be a surgical emergency.
BODY PARTS INVOLVED
Soft tissue surrounding the hematoma, including nerves, tendons, ligaments, muscles and blood vessels.
SIGNS & SYMPTOMS
Swelling over the injury site.
Fluctuance (feeling of tenseness to the touch, like pushing on an overinflated balloon).
Redness that progresses through several color changes--purple, green-yellow, yellow--before it completely heals.
CAUSESDirect injury, usually with a blunt object. Bleeding into tissue causes the surrounding tissue to be pushed away.
RISK INCREASES WITH
Contact sports, especially if the lower leg is not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective gear and equipment, such as shin pads, during competition or other athletic activity if there is risk of a lower-leg injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the hematoma is very small.
Needle aspiration of blood from the hematoma if the hematoma is accessible. At the same time hyaluronidase (an enzyme) can be injected into the hematoma space. Hyaluronidase hastens absorption of blood.
Self-care for minor hematomas, or for serious hematomas during the rehabilitation phase.
Physical therapy following serious hematomas.
Your own observation of symptoms.
Physical exam and medical history by a doctor for all except minor injuries.
X-rays of the injured area to assess total injury to the lower leg and to rule out the possibility of underlying bone fractures. Total extent of the injury may not be apparent for 48 to 72 hours.
Permanent damage to muscles and nerves, causing muscle atrophy and a weak foot, if treatment is delayed.
Infection introduced through a break in the skin at the time of injury or during aspiration of the hematoma by a doctor.
Prolonged healing time if activity is resumed too soon.
Calcification of the blood remaining in the hematoma, if the blood is not completely removed or absorbed.
PROBABLE OUTCOMEAverage healing time is 2 weeks to 2 months unless blood is removed with aspiration. Healing time is much less with this treatment.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, heat ointments and liniments, or whirlpools.
Don't massage the leg. You may trigger bleeding again.
For minor discomfort, you may use:
Non-prescription medicines such as acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses. To prevent healing delay, protect the hematoma area against excessive motion soon after injury. Motion breaks down the clot and causes irritation throughout the lower leg, leading to possible scar formation, calcification and restricted movement after healing.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use gentle ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a lower-leg hematoma that doesn't begin to improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.