Managing a Persistent Lump After a Car Accident: Expert Advice Needed

There is a small lump in the superficial muscles of the upper posterior calf after a car accident. What should I do?

Hello Dr.
Wang, I have a small lump under the skin on the upper back of my calf muscle, approximately 1 cm in diameter.
This lump is likely a result of a minor car accident I had on September 20th of last month.
At the time of the accident, I went to the emergency room for bandaging my knee and elbow abrasions, and I informed the doctor about the impact on the upper back of my calf, which was somewhat painful.
However, since there was no redness, swelling, or visible bruising at that moment, the doctor advised that it would heal on its own, and I went home.

The next day, I noticed that the skin on the upper back of my calf, about the size of a palm, had turned a light yellow, and I could feel a hard lump (about 2 cm) under the skin, with some bruising nearby.
I did not seek further medical attention at that time, thinking it would resolve as the doctor suggested.
Approximately four weeks later, the pain and the yellow discoloration improved, but the hard lump remained at about 1 cm in size (it does not hurt when pressed), and it feels like it has not decreased in size since then.

I would like to ask Dr.
Wang: 1) What could this lump possibly be? If I want to address the issue of the lump, should I see a rehabilitation specialist, a dermatologist, or another type of doctor? 2) I am more concerned about the possibility of surgery; based on the description above, do you think I need to undergo surgery to resolve the lump? 3) Can this type of lump be resolved with rehabilitation treatments (such as heat therapy, electrical stimulation, or ultrasound)? 4) I am a patient with ankylosing spondylitis and take two Salazopyrin and three fish oil capsules (total omega-3 of 1200 mg) daily.
Since starting Salazopyrin, my platelet count has decreased from between 260,000 to 290,000 to around 230,000.
Is the reason I cannot heal as the doctor suggested, leaving me with a lump, due to the Salazopyrin and fish oil lowering my platelet count and coagulation function, making me more prone to developing lumps from impacts compared to others? Thank you, Dr.
Wang.

Xiao En, 20~29 year old female. Ask Date: 2023/10/31

Dr. Wang Zhaomin reply Rehabilitation

This consultation platform cannot provide a diagnosis or treatment.
Based on the description, it may be related to post-injury subcutaneous bleeding or fibrosis.
The platelet count is still within the normal range and may not necessarily be related to the mass.
Heat therapy and electrical stimulation may be helpful, but please visit a surgeon or a rehabilitation specialist for an accurate diagnosis and to arrange appropriate treatment.

Reply Date: 2023/10/31

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the persistent lump on your calf following your car accident. I understand that this situation can be quite distressing, and I will do my best to address your questions comprehensively.

1. Nature of the Lump: Based on your description, the lump you are experiencing could be a hematoma, which is a localized collection of blood outside of blood vessels, often resulting from trauma. Initially, the injury may not have presented with significant symptoms, but as time passed, the body’s response to the injury could have led to the formation of this lump. Other possibilities include a seroma (a pocket of clear fluid) or a fibrous tissue formation as part of the healing process. Given that the lump is not painful and has remained stable in size, it may not be an immediate cause for concern, but it is essential to have it evaluated by a healthcare professional.

2. Consulting the Right Specialist: For your situation, I recommend seeing an orthopedic specialist or a physical medicine and rehabilitation (PM&R) physician. They can assess the lump in the context of your recent trauma and determine whether it requires further investigation, such as imaging studies (like an ultrasound or MRI) to understand its nature better. A dermatologist may also be consulted if there are concerns about the skin or underlying tissue.

3. Surgical Intervention: The necessity for surgery depends on the characteristics of the lump. If it is indeed a hematoma or seroma that is not resolving, surgical intervention may be considered to drain the fluid or remove the mass if it is causing discomfort or functional impairment. However, if the lump is stable and asymptomatic, many healthcare providers may recommend a conservative approach, including observation and possibly physical therapy.

4. Rehabilitation Options: Physical therapy can be beneficial in managing the lump, especially if it is related to muscle tension or scar tissue formation. Techniques such as heat therapy, ultrasound, and gentle mobilization can help promote healing and reduce any residual tightness. However, the effectiveness of these treatments will depend on the underlying cause of the lump.

5. Impact of Medications on Healing: Regarding your concerns about the medications you are taking, such as Salazopyrin (sulfasalazine) and fish oil, it is essential to understand that these medications can influence your body’s inflammatory response. Salazopyrin is often used in the treatment of inflammatory conditions like ankylosing spondylitis, and while it can affect blood cell counts, the degree to which it impacts your healing process can vary. Fish oil, known for its anti-inflammatory properties, may also influence bleeding and bruising tendencies. However, it is unlikely that these medications alone are the sole reason for the persistence of the lump. It is crucial to discuss any concerns about your medications with your prescribing physician, who can provide personalized advice based on your medical history.

In summary, I recommend that you seek an evaluation from an orthopedic or rehabilitation specialist to assess the lump and determine the best course of action. They will be able to provide you with a tailored treatment plan that considers your overall health, including your condition of ankylosing spondylitis and the medications you are taking.

Please take care, and I wish you a smooth recovery.

Best regards,
Doctor Q&A Teams

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