Post-Car Accident: Severe Numbness in Calf After Hematoma

After a car accident, there is a hematoma in the calf, and one week later, there is severe numbness in the calf?

Hello Doctor: After my car accident, I developed a hematoma in my left calf, but it wasn't severe enough to require surgery.
I applied ice for the first 1-3 days and then switched to heat therapy from days 4-6.
During my follow-up appointment on the third day, the orthopedic doctor advised that I could rest for about two weeks and gradually recover.
On the night of the fourth day, I suddenly experienced numbness in my calf, which persisted on the fifth day.
On the sixth day, due to work requirements, I sat down and within three minutes, the numbness returned.
Prolonged sitting even caused numbness to extend to my thigh.
Standing alleviates the numbness somewhat, but I am currently unable to stand for long periods.
Should I return to the original hospital for a follow-up, or which specialty should I consult for this issue?

Endia, 40~49 year old female. Ask Date: 2024/02/05

Dr. Shen Boquan reply Orthopedics

Hello, due to a car accident, you have a hematoma in your calf.
If the swelling is severe enough to compress the distal circulation, known as compartment syndrome, orthopedic or plastic surgeons typically recommend a fasciotomy for decompression.
If your orthopedic surgeon determines that it hasn't reached that stage, conservative treatment is usually advised until the hematoma resolves.
However, sometimes the swelling can be so significant that it takes longer to subside, potentially several months.
If you are feeling very uncomfortable, anti-inflammatory and pain relief medications can help alleviate your symptoms.
Both orthopedic and plastic surgeons can assist you.
Wishing you good health, Shen Bo-Chuan.

Reply Date: 2024/02/05

More Info

After a car accident, experiencing severe numbness in the calf, especially following a hematoma, can be concerning and warrants careful evaluation. The symptoms you describe—numbness that worsens with sitting and improves with standing—suggest that there may be underlying issues that need to be addressed.
Firstly, it is important to understand that a hematoma, which is a localized collection of blood outside of blood vessels, can cause pressure on surrounding tissues, including nerves. If the hematoma is large enough, it can compress nerves in the area, leading to symptoms such as numbness, tingling, or weakness. In your case, the numbness in your left calf could be a result of nerve compression due to the hematoma or swelling in the area.

The timeline of your symptoms is also significant. The fact that you experienced numbness starting on the fourth day after the accident, and that it has persisted, suggests that the issue may not be resolving as expected. While some degree of numbness can be normal following an injury, especially with a hematoma, persistent or worsening symptoms should be evaluated further.

Given your current symptoms, it would be advisable to return to the hospital for a follow-up appointment. You should consider seeing either an orthopedic specialist or a neurologist. An orthopedic doctor can assess the hematoma and determine if it is causing any complications, while a neurologist can evaluate the nerve function and determine if there is any nerve damage or compression that needs to be addressed.

During your follow-up, the physician may recommend imaging studies, such as an ultrasound or MRI, to assess the hematoma and any potential nerve involvement. They may also perform a physical examination to evaluate your range of motion, strength, and sensory function in the affected leg. Depending on the findings, treatment options may include physical therapy to improve mobility and strength, pain management strategies, or, in some cases, surgical intervention if there is significant nerve compression or if the hematoma does not resolve.

In the meantime, it is important to continue to monitor your symptoms. If you experience any new symptoms, such as increased pain, swelling, or changes in color in your leg, or if you have difficulty moving your foot or toes, seek medical attention immediately.
In summary, while some numbness can be expected after a hematoma, persistent or worsening symptoms should not be ignored. A follow-up with the appropriate specialist is essential to ensure that any underlying issues are addressed and to facilitate your recovery. Remember to take care of yourself and avoid activities that may exacerbate your symptoms until you have been evaluated by a healthcare professional.

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