What are the treatment and management options for a patient with an evolving subcutaneous hematoma at the site of recent trauma to the knee?

Management of Subcutaneous Hematoma Following Knee Trauma

For a subcutaneous hematoma at the site of recent knee trauma, conservative management with rest, ice, compression, and elevation (RICE) is recommended as first-line treatment, with monitoring for signs of skin compromise that would necessitate surgical evacuation.

Understanding Your Ultrasound Results

The ultrasound shows an evolving subcutaneous hematoma (collection of blood under the skin) at the site where you experienced trauma to your knee. This appears to be in the same location as a cystic-appearing lesion that was seen on your previous MRI. While the radiologist mentioned other possibilities like lipoma (fatty growth) or phlegmon (inflammatory mass), these are considered less likely than a hematoma given your recent injury.

Treatment Approach for Subcutaneous Hematoma

Conservative Management (First-Line)

1. RICE Protocol:

   • Rest: Limit activity that causes pain
   • Ice: Apply cold packs for 15-20 minutes every 2-3 hours for the first 48-72 hours
   • Compression: Use an elastic bandage to reduce swelling
   • Elevation: Keep the affected limb elevated above heart level when possible

2. Medication:

   • Over-the-counter pain relievers (acetaminophen) may help manage discomfort
   • Avoid NSAIDs (ibuprofen, naproxen) initially as they may increase bleeding risk

3. Monitoring: Watch for:

   • Increasing pain or swelling
   • Skin discoloration progressing to dark purple/black
   • Skin tension or "shiny" appearance
   • Numbness or tingling in the area

When Surgical Intervention Is Needed

Surgical evacuation should be considered if:

• The hematoma is under significant tension causing pain
• There are signs of skin compromise (necrosis risk)
• The hematoma is not resolving with conservative measures

The procedure typically involves:

• Simple aspiration using a large-bore needle
• Incision and drainage for organized hematomas
• A technique similar to liposuction may be used for evacuation 1

Timeline and Recovery

Most subcutaneous hematomas resolve within 2-4 weeks with conservative management. The body gradually reabsorbs the blood collection. However, larger hematomas may take longer to resolve.

Warning Signs Requiring Urgent Care

Seek immediate medical attention if you experience:

• Rapidly increasing swelling
• Severe pain not controlled with over-the-counter medication
• Signs of infection (fever, increasing redness, warmth)
• Skin changes suggesting necrosis (blackening of skin)

Special Considerations

In rare cases, large subcutaneous hematomas can be associated with underlying conditions affecting blood clotting or connective tissue 2. If you have a history of easy bruising or bleeding, mention this to your healthcare provider.

Follow-up Recommendations

• Follow up with your healthcare provider in 1-2 weeks to assess healing
• Consider a repeat ultrasound if symptoms worsen or fail to improve
• Complete resolution may take several weeks depending on the size of the hematoma

Remember that most subcutaneous hematomas resolve without complications when properly managed with conservative measures.