Post-Accident Muscle Lumps: When to Seek Medical Help

Q: Post-Accident Muscle Lumps: When to Seek Medical Help

Q： There is a small lump on the upper back of my calf after a car accident, measuring about 1 cm in diameter. <br>This lump is likely a result of a minor car accident I had on September 20 of this year. <br>At the time of the accident, I went to the emergency room for bandaging m

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

Hello Dr.
Li, 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 20 of this year.
At the time of the accident, I went to the emergency room for bandaging my knee and elbow abrasions, and I 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 that it would heal naturally, 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) beneath the skin, with some bruising nearby.
I did not seek medical attention at that time, thinking it would heal as the doctor suggested.
About four weeks later, the pain and the yellow discoloration resolved, but the hard lump remained at approximately 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.
Li: 1) What could this lump be? If I want to address the issue of the lump, should I see a rehabilitation specialist, a surgeon, or another type of doctor? 2) I am particularly concerned about the possibility of surgery.
Based on this brief description, 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 260,000-290,000 to around 230,000.
Is the reason I cannot heal naturally and have left 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.
Li.

Zheng, 20~29 year old female. Ask Date: 2023/11/01

Dr. Li Weiqiang reply Rehabilitation

Q: There is a small lump on the upper back of my calf after a car accident, measuring about 1 cm in diameter.
This lump is likely a result of a minor car accident I had on September 20 of this year.
At the time of the accident, I went to the emergency room for bandaging my knee and elbow abrasions, and I informed the doctor that I had hit the upper back of my calf and felt some pain.
However, since there was no redness, swelling, or visible bruising at that time, the doctor said it was nothing to worry about and that it would heal on its own, so 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 medical attention at that time, thinking it would heal as the doctor said.
About four weeks later, the pain and yellow discoloration resolved, 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.
What could this lump be?
A: It may be a result of fibrosis following tissue injury.
Q: If I want to address the issue of the lump, should I see a rehabilitation specialist, a surgeon, or another specialist?
A: You could try ultrasound therapy to see if it helps reduce the size.
Q: I am more concerned about the possibility of surgery.
Based on the simple description above, do you think I would need surgery to resolve this lump?
A: I don't think surgery would be necessary unless you are very concerned about its presence.
Q: Can this type of lump be resolved with rehabilitation (heat therapy, electrical therapy, ultrasound)?
A: You can try ultrasound therapy to see if it is effective.
Q: 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 and 290,000 to around 230,000.
Is the reason I cannot heal naturally, leaving behind 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?
A: Not necessarily; it could also be related to individual constitution.

Reply Date: 2023/11/01

More Info

Dear Patient,
Thank you for your detailed inquiry regarding the lump in your calf muscle following your car accident. Based on the information you provided, let's address your concerns systematically.

1. Nature of the Lump: The lump you are feeling under the skin could be a hematoma, which is a localized collection of blood outside of blood vessels, often resulting from trauma. Given that you experienced a bruise and some discoloration following the accident, it is plausible that the initial injury caused bleeding into the muscle tissue, leading to the formation of this lump. Over time, as the body reabsorbs the blood, the lump may decrease in size, but it can sometimes remain as a fibrous tissue or scar tissue, which might explain why it has not resolved completely.

2. Next Steps for Treatment: To address the lump, it would be advisable to consult with a healthcare professional who specializes in musculoskeletal injuries. A physical medicine and rehabilitation specialist (physiatrist) would be a good choice, as they can assess the lump and determine if it is indeed a hematoma or if there is another underlying issue. If the lump is found to be a significant concern or if there are signs of complications, a referral to an orthopedic surgeon may be warranted.

3. Surgical Intervention: Based on your description, it does not seem that surgery would be immediately necessary. Many soft tissue lumps, especially those that are not painful and do not show signs of infection or significant growth, can often be managed conservatively. Surgery is typically reserved for cases where there is a risk of complications, significant pain, or functional impairment. Your healthcare provider will be able to evaluate whether surgical intervention is necessary based on a physical examination and possibly imaging studies.

4. Rehabilitation Options: Physical therapy can be beneficial in managing soft tissue injuries. Techniques such as heat therapy, ultrasound, and electrical stimulation can help promote healing and reduce any residual tightness or discomfort in the muscle. However, the effectiveness of these treatments can vary based on the nature of the lump and the underlying tissue condition. It is essential to have a tailored rehabilitation plan developed by a qualified therapist.

5. Impact of Medications on Healing: Regarding your concerns about the medications you are taking, such as Salazopyrin (sulfasalazine) and fish oil, these can influence your blood's clotting ability. Sulfasalazine is known to have some effects on blood cell counts, including platelets, and fish oil can also have a mild anticoagulant effect. While these medications can contribute to a tendency to bruise more easily, they are not typically the sole reason for the formation of a persistent lump. It is crucial to discuss any concerns about your medications with your prescribing physician, who can provide guidance on managing your condition while minimizing side effects.

In summary, I recommend that you seek an evaluation from a physical medicine specialist to assess the lump and determine the best course of action. They can provide you with a comprehensive treatment plan that may include physical therapy and monitoring of the lump. If necessary, they can refer you to an orthopedic surgeon for further evaluation.
Please take care, and I hope you find relief soon.

Best regards,
Doctor Q&A Teams

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