interesting haematoma case

[Laura01]

Two weeks ago a patient came into the clinic with the biggest haematoma on her back that i have ever seen in my life. The patient had fallen down wet marble steps on holiday approximatley 7 weeks ago. It is situated to the right lateral sacrum and measures about 12cm in diameter. the edges of it feel very fibrous whereas the middle is relatively soft, its almost like a crater. She reports that when it initially happened the area which is now raised was a flat white cirlce and upward of this area to the shoulder and below to the knee was black and blue. it is giving her considerable back and sciatic type pain. She has been to see a surgeon who won't consider aspirating it and thinks best just to let it run its course. She said it has a special name since its quite rare but can't remember (like reformulating or something). At the moment another therapist and myself are giving deep masssage in the direction of the lymph nodes and using phyback electrotherapy which has reduced her pain. However I am at a bit of a loss as to where to go next. Has anybody else experienced this and what treatment would you suggest?
I will try to get photos if possible.
thanks

[Lennyvasanthan]

hi laura01,
i too have had similar experiences like you, except that the patients i treated were hemophiliac's... good u are trying with deep massage... always better to start from the edges of the hematoma and then progress inwards, if u have a pulsed shortwave diathermy machine, wil help u a lot (there's no evidence at hand, v are on the process of starting a research),pulsed ultrasound also might help you...

[jwilso]

hi lennny, could you please explain why you start outside and work inwards with masage to a haematoma. i have been trying to work out why for myself but i havent come up with the answer.

cheers,

john

[Lennyvasanthan]

hi john...
good Q, the reason is that the center of the hematoma is the area where the damage is... so in a ideal situation never touch the center if the healing process is not complete... the periphery is mobilised so that the hematoma can be dissipated (to provide room)...

[jwilso]

thank you. makes sense now

[Laura01]

this was the approach i was going with also since the edges felt fibrosed i was aiming to work out these adhesions. I have been using a type of electrotherapy called phyback, which is essentially a pulse generator with great results.