Managing a Persistent Lump After a Car Accident: What You Need to Know

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

Hello Dr.
Chen, I have a small lump under the skin in the upper back area of my calf, 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 also informed the doctor that I had hit 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 me that it would heal on its own, and I went home.

The next day, I noticed that the skin in the upper back of my calf, roughly 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.
At that time, I did not seek further medical attention, thinking it would heal naturally as the doctor suggested.
About four weeks later, the pain and the light yellow discoloration resolved, but the hard lump remained at about 1 cm in size (it does not hurt when pressed), and it seems to have stabilized at that size without further reduction.
I would like to ask Dr.
Chen:
1) What could this lump possibly be? If I want to address the issue of the lump, should I see a surgeon, a rehabilitation specialist, or another type of doctor?
2) I am particularly concerned about the possibility of surgery.
Based on the brief description above, do you think I need to undergo surgery to resolve this lump?
3) Can this type of lump be resolved through 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 260,000-290,000 to around 230,000.
Is the reason I have not been able to 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.
Chen.

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

Dr. Chen Bingze reply Surgery

Hello, I actually recommend that you see a surgeon directly.
It seems there may be a blood clot, but it should be quite superficial.
Even if surgery is needed, it would be a very minor outpatient procedure, so you can rest assured.
Your platelet count is also still within a good range.

Reply Date: 2023/10/31

More Info

After a car accident, it is not uncommon to experience lingering symptoms such as lumps or swelling in the affected areas. In your case, the persistent lump in your calf could be a result of soft tissue injury, such as a hematoma or a localized collection of blood that has not fully resolved. Here’s a detailed breakdown of your concerns and recommendations for managing this situation.

1. Nature of the Lump: The lump you are feeling in your calf could be a few different things. It might be a hematoma, which is a localized collection of blood outside of blood vessels, often caused by trauma. Hematomas can sometimes feel firm or hard as they organize and heal. Alternatively, it could be a scar tissue formation or a benign soft tissue mass. Given that it has not changed in size or caused pain, it is likely not an acute issue, but it is still important to have it evaluated.

2. Next Steps for Evaluation: To address the lump, it would be advisable to consult with a healthcare professional. Depending on the characteristics of the lump and your overall health, you may want to see either an orthopedic surgeon or a physical medicine and rehabilitation specialist (physiatrist). An orthopedic surgeon can assess whether the lump is related to any underlying structural issues, while a physiatrist can help with rehabilitation strategies. If there is any concern about the nature of the lump, imaging studies such as an ultrasound or MRI may be warranted to provide more information.

3. Surgical Intervention: Regarding your concern about surgery, it is difficult to determine without a thorough examination and possibly imaging studies. Many lumps can resolve on their own or with conservative treatment, such as physical therapy. Surgery is typically reserved for cases where there is significant pain, functional impairment, or if the lump is suspected to be something more serious. If the lump is simply a residual hematoma or scar tissue, it may not require surgical intervention.

4. Rehabilitation Options: Physical therapy can be beneficial in managing soft tissue injuries. Techniques such as heat therapy, ultrasound, and electrical stimulation can help reduce discomfort and promote healing. However, the effectiveness of these treatments can vary based on the individual and the specific nature of the lump. It is important to discuss these options with your healthcare provider to determine the best course of action.

5. Impact of Medications: You mentioned that you are taking Salazopyrin (sulfasalazine) and fish oil supplements. Salazopyrin is often used to manage inflammatory conditions like ankylosing spondylitis, and while it can affect blood cell counts, the degree to which it impacts your coagulation and healing processes can vary. It is possible that your medications may influence your body’s response to injury, but this would need to be discussed with your prescribing physician. They can provide insights into how your medications might be affecting your healing and whether any adjustments are necessary.

In summary, while the lump you are experiencing may not be a cause for immediate concern, it is important to have it evaluated by a healthcare professional to rule out any serious underlying issues. Monitoring the lump and seeking appropriate medical advice will help ensure that you receive the best care possible. Remember to communicate openly with your healthcare provider about all your symptoms and concerns, including the impact of your current medications on your recovery.

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