What is the treatment for a hematoma of the shin?

Treatment of Shin Hematoma

For a shin hematoma, immediately apply ice for at least 10 minutes, add compression, and elevate the limb—this combination is the most effective initial treatment. 1, 2

Immediate Management Protocol

Primary Treatment (First 24-48 Hours)

• Apply ice therapy immediately for a minimum of 10 minutes directly to the hematoma site using melting iced water through a wet towel 1, 2, 3

  • Ice reduces hematoma size significantly more effectively than compression alone (approximately 20 cm² reduction over 3 hours versus only 10 cm² with compression alone) 2
  • Use repeated 10-minute applications rather than continuous application to maintain reduced tissue temperature while allowing superficial skin to return to normal 3
  • Target temperature reduction of 10-15°C in the underlying tissue 3

• Apply compression during or immediately after cold therapy by using direct pressure or a compression dressing 1, 2

  • The combination of ice and compression is significantly more effective than ice alone for decreasing pain and controlling bleeding 1
  • Compression reduces total blood loss by approximately 610 mL compared to no cold therapy 2

• Elevate the affected limb whenever feasible to reduce swelling and blood accumulation 1, 2

• Rest the injured area and avoid activities that could worsen the injury or increase stress on the affected site 1

Assessment Requirements

• Measure the hematoma surface area and monitor for growth over the first several hours 2
• Check pulses both proximal and distal to the hematoma to ensure vascular integrity 2
• Evaluate perfusion to the entire lower extremity, looking for signs of compromised circulation 2
• Assess for compartment syndrome by monitoring for increased pain, numbness, or changes in skin color 1

Critical Pitfalls to Avoid

• Do not remove initial dressings prematurely to check if bleeding has stopped, as this disrupts clot formation 2
• Avoid aggressive manipulation of expanding hematomas, particularly if they are enlarging rapidly, as this may indicate arterial injury 2
• Do not apply ice for prolonged continuous periods as this can cause tissue damage; use repeated 10-minute intervals instead 3
• Be aware that reflex activity and motor function are impaired for up to 30 minutes following ice treatment, increasing susceptibility to further injury 3

When Surgical Evacuation Is Indicated

• Consider operative evacuation if the hematoma is significantly large or expanding rapidly, as accumulation of blood can cause tissue necrosis due to increased pressure 4
• Prompt recognition and evacuation should be performed when there is risk of overlying skin necrosis from tissue pressure 4
• Hematomas causing significant limitation in movement or signs of compartment syndrome require urgent surgical consultation 1, 4

Signs Requiring Immediate Medical Attention

• Rapidly expanding hematoma despite conservative treatment 1, 2
• Loss of pulses distal to the hematoma 2
• Significant limitation in movement of the affected limb 1
• Signs of infection including increasing redness, warmth, or fever 1
• Severe or progressive pain suggesting compartment syndrome 1
• Numbness or tingling indicating nerve compression 1