Collection of blood outside the blood vessels is the part of our everyday lives. Small ones are in the form of bruises, and greater swellings emerge with sprained joints and partially or completely ruptured muscles.
Hematoma is formed when, during a blow or sprain, one or more blood vessels break and blood goes into the sub dermal area, into the joint itself, or between the muscles. With bruises we talk of subcutaneous capillary hemorrhage, where the quantity of blood is fairly small and is spread on a large surface, so it passes quite quickly without leaving a trace. Other hematomas, with sprained joints and ruptured muscles or ligaments, often demand treatment, for the pain they cause and the possibility of permanent damage.
Blood that flows outside of the blood vessel coagulates very fast. This clot (or hematoma) is a foreign matter in the locomotor system and it gets in the way of joints and muscles performing their tasks. The body gradually absorbs the hematoma breaking it into molecules, and evacuating it via blood and lymph. But this process can take some time, and sometimes, because of its position and shape, hematoma cannot be fully absorbed. If this happens, especially with muscle hematoma, connective tissue deposits within the hematoma (which is also called „organizing“) and then calcium is eposited in the tissue. Then we have a bone deposited inside the muscle, which can cause permanent pain and low mobility. In this case most common therapy is to remove the calcified matter surgically, and lately shock wave therapy (ESWT) is used.
Luckily, this turn of events happens rarely, because the pain of sprained joint or muscle is so intense people usually seek help immediately. Treatment has three phases. Right after the injury, further flow of blood outside the blood vessel has to be stopped or reduced. There are two solutions to this problem – first one is compression with elastic bandage, which serves to enhance the pressure on that area in order for the blood vessel to close. Also, you should apply ice which will reduce inflammation and help with creating the hematoma on the damaged blood vessel. We could also use taping. Rest is strongly advised in the first 48 hours. After this period, hematoma has most likely turned to thick gelatinous mass and this is the best time to try to remove it. Depending on its position and size, you should apply massage in order to spread it wide and ease the absorption. Ultrasound therapy helps because micro vibrations enhance the absorption. After two to five days hot-cold therapy should be applied, to enhance the blood and lymph circulation in the damaged area. Also, lighter physical activity is advisable.
The worse thing for a bigger hematoma is longer inactivity, especially if you have a cast. This slows the blood and lymph flow, and hematoma cannot be absorbed. Today we apply orthosis or elastic bands, which prevent further injuries, help via compression, and enable mobility.