Muscle Hardening and Indentation After Thigh Injury

After a thigh injury from a car accident, a large area of muscle appears sunken and has formed a hard lump?

Dear Dr.
Chen,
I would like to ask about my mother: she was in a car accident last year where her thigh was crushed by a motorcycle, resulting in swelling and bruising.
However, instead of applying ice first, she applied heat.
Although the bruise has faded, there is now a hard lump about the size of a fist, and the area is noticeably indented.
It is also very painful to touch.
I want to take her for a consultation but I'm unsure which department to visit.
Should I make an appointment with the Rehabilitation Department? (I have been considering whether it should be Neurology, Surgery, or another specialty.) What is this condition called?
Additionally, since the injury, all the joints in that leg have been painful.
Could this be related to the thigh injury? I would appreciate your help in resolving these concerns so that my mother can alleviate her suffering as soon as possible.

Best wishes for everything to go smoothly!

Xiao Mi, 20~29 year old female. Ask Date: 2005/05/26

Dr. Xu Zhenrong reply Rehabilitation

Hello Xiaomi,
Regarding the issue you raised, the general approach to managing an injury is as follows:
1.
Rest is the best treatment.
Immediately stop any movement of the injured area to avoid further irritation and damage.
2.
Do not massage the injured area, especially around the injured joint or soft tissue, as inflammation and swelling are present.
This can exacerbate tissue damage, leading to what is known as "secondary injury."
3.
Apply ice for the first three to four days.
Use ice packs or a cold, damp towel to reduce bruising and swelling, and to alleviate pain.
The method is to ice for twenty minutes and then rest for ten minutes.
Do not apply ice directly to the skin to avoid frostbite.
After this period, switch to heat therapy for the next three to four days.
Heat can improve circulation and promote metabolism, helping to repair damaged tissue.
Continuing this treatment for an extended period yields better results.
Each heat application should last about thirty minutes and can be done several times a day.
4.
Stabilize and support the injured area using braces or splints, and elevate the affected limb to assist with venous return.
5.
You may use elastic bandages for wrapping, but be careful not to wrap too tightly.
If the extremities become purple or numb, it indicates that the bandage is too tight and should be loosened.
6.
In severe cases, seek medical attention promptly.
If there is rapid swelling in the injured area or noticeable deformity in the limb, a fracture may have occurred, which can lead to significant internal bleeding or displacement or rupture of ligaments and tendons.
If the injured area shows hard tissue and muscle indentation, it may be due to swelling, hematoma, or muscle atrophy following the injury.
For issues related to the ankle joint, I recommend visiting a rehabilitation clinic for a thorough physical examination to determine if there are any problems with the bones or ligaments.
This will allow for professional physical therapy consultation and services for your mother.
Thank you for your letter.
Wishing you good health.
Sincerely,
Hsu Chen-Jung
Taipei Hospital, Department of Health, Executive Yuan

Reply Date: 2005/05/26

More Info

In the case of your mother's thigh injury from the motorcycle accident, it sounds like she is experiencing muscle hardening and indentation, which can be quite concerning. The symptoms you describe—swelling, bruising, and the hard, painful area—are indicative of a muscle contusion or hematoma that may have led to muscle fibrosis or scar tissue formation. This can occur when muscle fibers are damaged and subsequently heal improperly, leading to stiffness and pain.

When a muscle is injured, the body responds with inflammation, which can cause swelling and bruising. If heat was applied before the swelling had a chance to subside, it could have exacerbated the situation by increasing blood flow to the area, potentially leading to more swelling and discomfort. The hard area you mentioned could be a result of muscle fibers healing in a disorganized manner, leading to a condition known as myositis ossificans in severe cases, where bone tissue forms within the muscle.

Given the symptoms, it is advisable to consult a healthcare professional. The best course of action would be to see a physician specializing in physical medicine and rehabilitation (PM&R), commonly known as a rehabilitation doctor or physiatrist. They can assess the injury, determine the extent of the damage, and recommend appropriate treatment options. If there are concerns about nerve damage or if the pain is severe, a referral to an orthopedic surgeon or neurologist may also be warranted.

In terms of treatment, rehabilitation will likely involve a combination of physical therapy to improve range of motion and strength, as well as modalities such as ultrasound or electrical stimulation to promote healing and reduce pain. Stretching and strengthening exercises will be crucial in restoring function to the affected area. Additionally, if there is significant scar tissue, techniques such as myofascial release or deep tissue massage may be beneficial.

It's also important to address the pain in the other joints of the leg. This could be related to compensatory movements due to the initial injury, leading to overuse or strain in other areas. A comprehensive evaluation will help determine if these issues are interconnected and how best to manage them.

In summary, your mother's symptoms are likely related to the initial thigh injury, and seeing a rehabilitation specialist would be the most appropriate step. They can provide a tailored treatment plan to address both the muscle hardening and the pain in the joints, helping her to regain function and reduce discomfort. It is essential to act promptly to prevent further complications and to facilitate a smoother recovery process.

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