Pelvic Pain After Car Accident: Causes and Next Steps

Right abdominal injury including pelvic involvement from a car accident?

Hello doctor, I was in a car accident in mid-June where I hit the ground on my right side and rolled over twice.
After getting up, I felt a significant internal jolt, as if my organs were shaken.
I had an abdominal ultrasound in the emergency room, and they said everything was fine.
However, in mid-July, I still felt uncomfortable and visited a gastroenterology clinic, but they found nothing wrong.
I noticed that pressing on the bone in my pelvis was painful.
In mid-August, I saw an orthopedic specialist who took X-rays and also said my pelvis was fine.
Later, in September, I went to a rehabilitation clinic, where they mentioned that the pain could be due to a hematoma, and I continued with rehabilitation.
On the 10th of this month, I still experienced pain when pressing on the bone and the surrounding tissue.
I also visited a general practice clinic, where another ultrasound was performed, and they said there was nothing significant.
Could the pain be due to the hematoma, or could it be caused by something else? Which specialty should I consult for this situation?

Yujie, 20~29 year old female. Ask Date: 2018/10/23

Dr. Chen Jiaming reply Surgery

Trauma can cause contusions to the skeletal muscles.
If fractures and other issues are ruled out, after the acute pain phase in the initial stage of the injury, if chronic pain persists, it is primarily advisable to consult an orthopedic specialist or a rehabilitation physician.
In many cases of contusions that lead to chronic tenderness, it is recommended to minimize excessive self-testing of the painful areas and to use some analgesics to allow for proper healing of the injured site.

Reply Date: 2018/10/23

More Info

After a car accident, experiencing pelvic pain can be quite concerning, especially when multiple medical evaluations have not revealed any significant injuries. Based on your description, it seems that you have undergone various examinations, including ultrasound and X-rays, which have indicated no major issues with your pelvic bones. However, the persistent pain you are experiencing, especially upon pressure, suggests that there may be underlying factors that need to be addressed.

Possible Causes of Pelvic Pain After a Car Accident
1. Soft Tissue Injury: Even if the bones appear intact, soft tissue injuries such as muscle strains, ligament sprains, or contusions can cause significant pain. The trauma from the accident could have resulted in damage to the muscles or connective tissues around the pelvis, which may not be visible on X-rays or ultrasounds.

2. Hematoma Formation: You mentioned that the rehabilitation team indicated the presence of a hematoma. A hematoma is a localized collection of blood outside of blood vessels, often resulting from trauma. This can lead to swelling and pain in the affected area, and it may take time to resolve. The pressure from the hematoma can irritate surrounding tissues, contributing to your discomfort.

3. Referred Pain: Sometimes, pain in one area can be referred from another part of the body. For instance, injuries to the lower back or abdominal organs can manifest as pelvic pain. Given that you felt a significant jolt during the accident, it is possible that your lower back or abdominal muscles are also affected.

4. Nerve Injury: Trauma can also lead to nerve irritation or injury, which may cause pain in the pelvic region. Conditions such as sciatica, where the sciatic nerve is compressed or irritated, can lead to pain that radiates down the leg or into the pelvic area.

Next Steps
Given your ongoing symptoms, here are some recommendations for further evaluation and management:
1. Consult a Specialist: Since you have already seen various specialists, it may be beneficial to consult a pain management specialist or a physical medicine and rehabilitation (PM&R) physician. They can provide a comprehensive evaluation and may suggest advanced imaging techniques, such as MRI, to assess soft tissue injuries that X-rays cannot detect.

2. Physical Therapy: Engaging in physical therapy can be very beneficial. A physical therapist can develop a tailored rehabilitation program focusing on strengthening the pelvic and core muscles, improving flexibility, and addressing any movement patterns that may contribute to your pain.

3. Pain Management: If the pain persists, discussing pain management options with your healthcare provider is essential. This may include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or even nerve blocks if indicated.

4. Monitoring and Follow-Up: Keep track of your symptoms and any changes. If the pain worsens or new symptoms develop, it is crucial to seek immediate medical attention. Regular follow-ups with your healthcare provider will help monitor your recovery and adjust your treatment plan as necessary.

5. Lifestyle Modifications: Incorporating gentle exercises, maintaining a healthy diet, and ensuring adequate hydration can support your recovery. Avoiding activities that exacerbate the pain is also essential.

In conclusion, while the absence of visible injuries on imaging studies is reassuring, the persistence of pain indicates that further evaluation is warranted. Engaging with specialists who can provide a multidisciplinary approach to your care will be crucial in managing your symptoms effectively and ensuring a full recovery.

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