Treatment of Hard Hematoma on the Shin
Apply localized cold therapy with compression as soon as possible to reduce hematoma size and promote resolution. 1
Initial Management
Cold therapy should be initiated immediately using ice packs or cold compresses applied to the affected area. 1 The evidence, though of very low quality, demonstrates that cold compression can reduce hematoma size by approximately 20 cm² over 180 minutes compared to compression alone, which reduces size by less than 10 cm². 1
Application Protocol
- Apply ice for a minimum of 10 minutes to any size hematoma 1
- Use cool or non-freezing water/ice packs—avoid direct ice contact that could cause tissue damage 1
- Combine cold therapy with direct compression over the hematoma site 1
- The cold therapy is intended for relatively small, limited-size injuries and should not cause hypothermia when applied locally 1
Assessment Requirements
Close assessment of the hematoma site and adjacent extremity must be performed, including: 1
- Measurement of swelling extent
- Assessment of circulation to the extremity
- Evaluation for signs of compartment syndrome (severe pain, pallor, paresthesias, paralysis)
- Check for underlying fractures if trauma mechanism was significant
When to Consider Evacuation
Operative evacuation should be considered if the hematoma is significantly large and causing: 2
- Overlying skin necrosis due to increased tissue pressure
- Signs of tissue ischemia
- Failure to resolve with conservative management
Large hematomas can result in tissue necrosis through increased pressure and cellular/biochemical changes leading to ischemia. 2 Prompt recognition and evacuation may be necessary to avoid these complications.
Common Pitfalls
- Do not apply heat in the acute phase, as this increases blood flow and can worsen bleeding 1
- Avoid excessive manipulation of the area during the first 24-48 hours
- Do not ignore expanding hematomas or those associated with severe pain, as these may indicate ongoing bleeding or compartment syndrome 1
- The evidence for elevation alone is inadequate, so prioritize cold compression over elevation as a standalone intervention 1
Duration and Follow-up
Continue cold therapy applications intermittently during the first 24-72 hours post-injury. 1 The hematoma should gradually decrease in size and firmness over 1-2 weeks as the blood is reabsorbed. If the hematoma remains hard, enlarges, or develops signs of infection (warmth, erythema, fever), medical evaluation is warranted for possible evacuation or alternative diagnosis.