Bruises: When to Worry About Persistent Hard Lumps After an Injury

The lump at the site of the bruise has not resolved after the car accident?

Hello Doctor, I was involved in a car accident on September 27th, which resulted in an impact to my left calf.
I was taken to the emergency room where the doctor diagnosed it as a contusion and confirmed with an X-ray that there were no fractures.
I applied ice for the first two days, but on the third day, I switched to heat therapy and experienced swelling and discomfort, so I stopped the heat application.
As of October 1st, the swelling had not subsided, and I began to feel sharp pain and numbness in my left calf.
After consulting a general surgeon, I was informed that there is a hematoma trapped in the muscle tissue causing a lump.
My family suggested I see a Traditional Chinese Medicine (TCM) specialist for acupuncture.
I have had two follow-up visits for acupuncture and have been using patches; the swelling has improved, but the hematoma lump has not resolved.
It appears as a long, firm mass that does not protrude significantly or increase in size.
There is pain upon palpation, but it does not move.
Occasionally, I experience pain while walking, and standing for more than five minutes leads to noticeable swelling.

I would like to ask the doctor:
1.
How long does it typically take for a normal hematoma lump to resolve? How long should I wait before considering surgical intervention? Which specialty should I consult for surgical intervention?
2.
Does the swelling while standing indicate any nerve involvement?
3.
Currently, no doctor has recommended an ultrasound.
Would it be appropriate for me to request one proactively? Thank you.

Lin, 20~29 year old female. Ask Date: 2021/10/13

Dr. Li Zhonghuai reply Surgery

Hello! The general principles for managing bruises and contusions are as follows: if there is no open wound or only a superficial abrasion, conservative treatment is recommended, and at most, aspiration with a fine needle may be performed.
If the overlying skin is necrotic, debridement is necessary.
Accumulated blood can compress nerves, and swelling from the contusion can also exert pressure on nerves, potentially causing nerve damage.
Vitamin B12 supplementation is advised.
Therefore, it is important to elevate the affected limb during rest or sleep.
Ultrasound is typically available in outpatient clinics, and sometimes, if fluid is aspirated, it may reaccumulate by the next visit, which also requires ultrasound evaluation.
General surgery departments are more likely to utilize ultrasound.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2021/10/13

More Info

When it comes to bruises and the persistence of hard lumps after an injury, it's essential to understand the body's healing process and when to seek further medical evaluation. Based on your description, it seems you sustained a contusion (bruise) on your left calf from a car accident, and while initial assessments ruled out fractures, you are experiencing ongoing symptoms that warrant attention.

1. Duration of Bruises and Hard Lumps: Typically, a bruise can take anywhere from a few days to several weeks to heal, depending on the severity of the injury and individual healing factors. The hard lump you are feeling is likely a hematoma, which is a localized collection of blood outside of blood vessels, often resulting from trauma. Hematomas can take longer to resolve than the discoloration associated with bruising. If a hematoma persists for more than two to three weeks without significant improvement, it may be advisable to consult a physician about the possibility of drainage or further intervention. This would typically be done by a general surgeon or an orthopedic specialist, depending on the location and nature of the hematoma.

2. Swelling and Nerve Impact: The swelling you experience when standing could indicate that the hematoma is putting pressure on surrounding tissues, including nerves. If the swelling is significant, it could potentially lead to nerve compression, which might explain the pain and numbness you are feeling. It's crucial to monitor these symptoms closely. If you notice increasing numbness, weakness, or changes in skin color or temperature, you should seek immediate medical attention.

3. Ultrasound Imaging: If your symptoms persist, requesting an ultrasound is a reasonable step. An ultrasound can help visualize the hematoma's size and location, assess any potential complications, and guide treatment decisions. It is perfectly acceptable to advocate for this imaging if you feel it is necessary, especially given the ongoing pain and swelling you are experiencing.

In addition to these points, it’s important to continue following up with your healthcare providers. If you are seeing improvement with acupuncture and other treatments, that is a positive sign, but do not hesitate to seek further evaluation if your symptoms do not improve or worsen.
Moreover, consider the following general care tips for managing bruises and hematomas:
- Rest: Avoid putting weight on the injured leg as much as possible to allow healing.

- Ice Therapy: Continue using ice packs for the first 48 hours post-injury to reduce swelling. After that, heat can be applied to promote blood flow and healing, but be cautious if it causes discomfort.

- Elevation: Keep the injured leg elevated to help reduce swelling.

- Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation, but consult your doctor before taking any medication.

In summary, while bruises and hematomas can take time to heal, persistent symptoms like hard lumps, swelling, and pain should not be ignored. Regular follow-up with your healthcare provider and open communication about your symptoms will be key to ensuring proper recovery. If you feel that your concerns are not being adequately addressed, seeking a second opinion is always a valid option.

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