Bruise with Lump

Question:

Recently I had a really bad fall and the recuperation took a couple of months. Anyway my point is that I have noticed the emergence of a hard lump under bruise on the affected spot. I have never experienced bruise with lump before, so I am naturally concerned. Does that mean the healing process is still not complete?

Answer:

You are not unique with this lump after bruise condition. It is actually a fairly common phenomenon. But let us start with the basics.

Actually, general bruises tend to recover fast. They emerge as a form of signal to us that we have sustained an injury to the soft tissues just below the skin, most likely from a hard and strong impact on the affected area. When the tissues are at this damaged stage, our blood will start to accumulate there, which in turn introduces a discoloration; turning from red to blue and then to yellow as the healing process starts to kick in. Such bruises would typically take between two to four weeks to completely recover.

Then there are the more severe bruises. These are defined according to a host of parameters; such as the degree of impact, the extent of trauma, and whether a fracture or serious sprain occurred as a result of the impact. Naturally this will induce an elevated sense of pain, greater inflammation and, obviously, more serious bruising. Generally, all these could manifest within an hour of the injury.

Other than the naturally expected degree of pain and the usual skin discoloration, those less-than-severe bruises do not exhibit any unusual symptoms. But in the case of severe bruises, patients could observe an irritating hard lump under bruise. This condition is classified as a hematoma.

Depending on the patient, hematomas tend to manifest themselves in the form of rubbery, sponge-like or hard lumps (these are the common characteristics but not all patients show all the characteristics). Despite the peculiar nature of a hematoma, it usually does not warrant serious concern so long as it does not appear on the head following a head injury. If this does happen, it is prudent for the patient to seek urgent medical help. Please take note that a head hematoma does not emerge immediately after the injury; rather, it will only manifest several weeks later (so be mentally prepared for it to surface).

Barring the injury to the head, a hematoma is not a condition that should keep you awake at night. In most cases, they will simply be reabsorbed into our system (pretty much like those bruises). However, you will need to pay attention if the existence of such hard lumps become persistent and start to cause problems. If you begin to notice extraordinary pressure being applied on the affected spot, the usual suspect is a skin condition known as 'compartment syndrome'. In this context, the additional pressure exerted by the hard lump can be significant enough to cause a reduction in oxygen and blood flow to the area. These are of course the critical elements for our survival. Compartment syndrome could be life-threatening and it has to be dealt with urgently.

In the case of compartment syndrome, there are also some other accompanying symptoms, which are:

  • intensifying pain,
  • numbness,
  • skin pallor (when a loss in color of the affected area is observed), and
  • failure to detect a pulse on the bruised extremities.

This loss of circulation can also be detected when you sense a tingling sensation that envelops the fingers and the toes, or when these body parts do not respond to compression or ice treatment. If it is no longer possible to manage the abovementioned symptoms at home, my suggestion is to have the bruises examined by a medical practitioner. It takes a fairly aggressive treatment option to deal with compartment syndrome. Surgical intervention is often needed to break up the hard lump so as to relieve the pressure.

In addition to being mentally prepared to deal with this life-threatening condition, it is perhaps helpful also to understand how risk-averse one is to compartment syndrome. All things being equal, the more likely candidates are those who are used to taking higher doses of anti-inflammatory pain medications (things like aspirin, Midol or Advil). The reason is that such drugs tend to thin the platelets that coagulate the blood, so it becomes less sticky. The result is an inevitable buildup of blood in bruised parts of the body.