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A hematoma over a muscle, like a hematoma on the thigh or hip, is basically a bruise gone bad. Muscles that are attached to two joints are especially prone to contusions, and shallow muscles that attached to two joints like those on the thigh tend to "pop out" in particularly nasty bruises. These bruises can be observed as petechaie (blotched under 2 mm in diameter), purpura (2 mm to 1 cm in diameter), or ecchymosis (over 1 cm in diameter). Usually people are concerned with ecchymosis, the larger "bruise," also known as a hematoma.

The hematoma itself is an accumulation of blood over the site of an injury. Within a few hours after an injury, injured tissue begins to die. The body sends macrophages (white blood cells) to remove the dead or dying tissue. These relatively large white blood cells can get "stuck" in the capillaries under the skin serving the muscle. Blood pools inside the capillaries and also begins to break down.The capillaries "clog" and are unable to drain blood out of the injured tissue. This is the blood you actually see as the hematoma.

The net effect of this process isn't a bad thing. It stops excessive bleeding. It triggers production of new collagen and new muscle cells. However, the effects on the skin aren't pretty. Hemoglobin, the oxygen-carrying compound that makes blood red, breaks down into compounds that are yellow and green.

There are some things you can do if the basic problem is discoloration of the skin. Citrus bioflavonoids increase the production of enzymes that break down the green and yellow hemoglobin compounds. You take the citrus bioflavonoids by mouth. A scientifically imprecise way of describing what they do is that they "unclog" capillaries and allow normal circulation to the skin and the muscle and fascia (connective tissue) beneath it. Often the skin returns to its normal color and hardness or lumpiness around the bruise begins to soften. It can take 2 or 3 months for the treatment to work, and women who are on the anticancer drug tamoxifen shouldn't take products than contain tangretin, which is to say, "natural bioflavonoids" aren't a good idea. Standardized products that contain hesperidin and diosmin are OK.

Sometimes an ecchymosis just won't heal. The tissue gets harder and harder, and interferes with circulation. The side of the ecchymosis pointing away from the heart is the area that gets less blood, oxygen, and nutrients. This condition is termed "compartment syndrome." It usually requires surgical intervention. However, this is not just hard skin or a purple blotch that won't go away. This is a condition in which the skin on the distal (away from the heart) side of the hematoma begins to break down. There can be ugly ulcers, wounds that won't heal, and even muscle damage. Surgical intervention, however, usually takes care of the problem.

What can you do to minimize problems with hematomas?

  • Don't bandage a hematoma. Pressure on a hematoma makes it worse.
  • For the same reason, don't wear tight or constrictive clothing over a hematoma. If the hematoma is "hard," be careful about wearing constrictive clothing on portions of a limb below it. If you have a hardened hematoma on your thigh, for example, you should not wear tight socks.
  • A large bruise (over 75 mm/3 inches) requires medical attention. Especially large bruises can cause so much breakdown of hemaglobin and muscle tissue that they strain the kidneys.
  • Losing feeling in a limb that has a hematoma is a sign of nerve damage. This has to be medically addressed, preferably as soon as possible.

It takes time to resolve a hematoma. Untreated, some hematomas take several years to normalize. Citrus bioflavonoids for smaller, uncomplicated hematomas and medical intervention for larger, harder hematomas are reliably helpful.

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