How to Treat a Soft Tissue Hematoma
What Is a Hematoma?
A hematoma forms when a blood vessel breaks and blood leaks out into the surrounding tissue. This can form a clot, or retain its fluid state, depending on how old the injury is. Blood can come from an artery, vein, or capillary depending on where the damage occurs, and then accumulate in the soft tissue forming a bruise. Alternatively, it can seep into joint sockets causing mobility problems, damage to the socket, and a lot of pain.
If a hematoma is causing a lot of problems, or continues to grow, it will need to be drained by your doctor. The ruptured vessel will need to be sealed to prevent the hematoma growing back.
I am not a doctor. This information should not replace the advice of a qualified health care professional. If you have any worries, please consult your doctor.
What Causes a Soft Tissue (Subcutaneous) Hematoma
A subcutaneous hematoma occurs when a ruptured blood vessel leaks blood into the surrounding fatty tissue. This can cause a lump to form and a large bruise to appear on the affected area. You may find that if the hematoma is further away from the skin you may only feel a "fatty" or mobile lump without the bruise or only a light discoloration.
There are many ways a subcutaneous hematoma can form and the most common factors are blunt force trauma or through an injection. With a blunt force trauma injury, the symptoms will be very similar to that of an orthopedic hematoma (also known as a muscle contusion or bruise), but the blood sits in the fatty tissue rather than the muscle. People taking blood thinners are more at risk from this type of damage since their blood clotting is already restricted.
Injections can also be the cause of subcutaneous hematoma (which I get on a regular basis from my medication, Clexane). When an injection punctures the skin on the tummy or thigh it can graze, damage, or pierce straight through a blood vessel causing blood to seep out into the surrounding fatty tissue. If you're injecting Heparin or another type of blood thinner, this can make hematoma worse because your clotting is restricted and more blood can potentially enter the tissue.
Symptoms of a Soft Tissue Hematoma
A subcutaneous hematoma can look very different each time you get one. The most common symptoms I have experienced are on my tummy and they start with a small lump about the size of 10p piece that starts on the surface of the skin and goes back towards my spine. The lump will be very tender and hard and on the surface of the skin will be a great big bruise that goes from black to purple to green to brown and then gone. Those are the symptoms of a hematoma caused by an injection.
Of course hematoma will vary each time depending on the severity of the injury and you may need to get the hematoma drained if it continues to grow or is incredibly painful or large. Basically, when in doubt see your doctor.
It's been about 2 years since I've moved from Clexane injections to an anticoagulant called Warfarin, and I wanted to provide a quick update on my hematoma/scarring.
So, it's actually healed up really well. All of my hematoma have healed, and the scarring is so light that you can only see a few small dots of scar tissue if you know where to look.
The healing process was quite slow in the beginning, but after 4-6 weeks of no injections the bruising was clearing up and the hematomas began to shrink. It still took long time for the multiple hematoma to completely disappear, but the discomfort they caused was mostly gone within 6 months. I believe I haven't been bothered by them in over a year now.
Scarring From Hematoma
As you can see in the photo, I have a series of small white scars, and farther up I have some particularly nasty red scars too. These are all caused by an injection that I receive for a condition called Heterozygous Factor V Leiden. The problem of scarring arises when I inject and then develop a hematoma. It causes the tissue to stretch and scar some more which I'm obviously not happy about.
I took a look around the internet and found some great ways of removing or reducing scars and scar tissue, and making skin more supple. I discovered that if your skin is nice, healthy, and supple, you are at a decreased risk of scarring and hematoma: that's just one more reason to look after yourself. I made a habit of moisturizing with very gentle massage every night as it not only helped to keep my skin healthy but also helped in reducing some of the discomfort I felt as well.
Draining a Soft Tissue Hematoma
The video below is quite graphic, so if you wish to view it then go ahead. However, if you're squeamish or would simply prefer not to watch it, then feel free to carry on scrolling straight past it.
Graphic Video of a Hematoma Procedure
First Aid Treatment
Within the first couple of days you should be treating your injury with the RICE method where possible (Rest, Ice, Compression, Elevation). This method will help keep the swelling down and keep the size of the potential hematoma small, too.
Have you ever had a soft tissue hematoma?
What Causes A Hematoma To Rupture?
A ruptured hematoma is going to need some medical attention. A soft-tissue hematoma is likely to rupture when it needed to be drained in the first place and it has either:
- Had an excess of fluid build up and the pressure has become to great for the surrounding tissue;
- Suffered further injury causing more damage to the already weakened artery/vein
When in doubt please seek medical attention to have your injury evaluated.
The most effective treatment for a subcutaneous hematoma is, simply, time. However, if you have a large hematoma that is causing a lot of pain and inhibiting mobility you may have to get it drained by your doctor.
To drain a hematoma your doctor will make a small incision to gain access and then insert a syringe to relieve the area of built-up blood, clots, and fluid. This procedure only takes a few minutes are there is instant relief. Recovery from this procedure is fairly quick and there should be minimal problems in healing assuming everything went well in the procedure.
If your hematoma does not require draining then I would recommend wearing loose clothing to avoid irritation and to use arnica cream or gel a couple of times a day (morning and night) to help the body dissolve it.
How Long Does A Hematoma Take To Heal?
The answer to this question is entirely down to the size of the hematoma but I'll provide some guidelines for you to work with.
The smaller hematoma I have experienced (see picture above) usually lasted for a week to 10 days as they were caused by injections. However, my ability to heal is slowed due to my Heterozygous Factor V Leiden so if you have no previous or conflicting medical complaints then I would put the recovery time between 5-7 days.
A larger hematoma caused by blunt force will take longer to heal simply due to their size. Most people should find that their bruising reduces within 10 days and that the lump left behind should be gone within 6 weeks. Be aware that larger injuries and your body's natural ability to heal will impact this healing time though. If you have not seen any reduction in size after 10 days and it is still sore and generating heat then you should see you primary care provider for an assessment. Of course if are worried before the 10 days have passed then please don't hesitate to speak to them before as you may need treatment earlier.