MANUAL MINORS
A haematoma in the calf muscles is the accumulation of blood in the muscle tissues due to the rupture of small blood vessels following direct trauma or a contusion. This injury commonly occurs during sports activities or accidental impacts.
The gastrocnemius and soleus muscles are most frequently affected. Symptoms include pain, swelling, skin discolouration (visible bruising), and, in severe cases, stiffness or difficulty moving the leg.
Diagnosis
Diagnosis is primarily based on physical examination. Patients typically report a recent trauma to the calf, followed by pain, localised swelling, and a visible area of haematoma.
In more severe cases, such as those affecting large areas of muscle or with active bleeding, ultrasound may be used to assess the extent of the haematoma and rule out muscle tears or blood clots.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Muscle tear | Sudden, localised pain, generally associated with physical activity, with a possible “snap” at the moment of trauma. |
Deep vein thrombosis (DVT) | Diffuse calf pain, swelling, warmth, and redness; confirmed by Doppler ultrasound. |
Acute compartment syndrome | Intense pain, severe swelling, pallor, and numbness, requiring urgent intervention. |
Muscle cramp | Temporary pain and spasm, without skin discolouration or evident haematoma. |
Simple contusion | Localised pain in the affected area without significant blood accumulation or major swelling. |
Emergency Management
Initial management of a muscle haematoma includes the RICE protocol (Rest, Ice, Compression, Elevation) to control inflammation and minimise bleeding. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain relief.
In cases where the haematoma is large or causes significant compression, haematoma aspiration or surgical decompression may be required, especially if associated with compartment syndrome.
Definitive Treatment
Definitive treatment of a calf muscle haematoma depends on the size and severity of the injury. Minor haematomas typically resolve with conservative measures, such as rest, physiotherapy to restore mobility and strength, and the use of elastic compression.
Larger or persistent haematomas that do not improve with conservative treatment may require surgical drainage. Intense activities should be avoided until the haematoma has fully resolved and normal muscle function has been restored.
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