MUSCULAR BLEEDING IN THE CALF MUSCLE (Haematoma musculi)
Anatomy:The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. It is these muscles that are most frequently subjected to ruptures and bleeding. On the lower leg there are many other muscles, where bleeding is relatively rare.
Tendo calcaneus (Achillis)
LOWER LEG FROM THE REAR
Cause: If a muscle is subjected to a blow the muscle belly, which contains blood vessels, is pressed against the bones, causing an injury and rupture of the muscle fibres and blood vessels. The rupture usually occurs deep in the muscle. In other cases the bleeding can occur after a larger or smaller muscle rupture in the calf. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.
Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle). In other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the subcutis). The pain is aggravated upon activation and stretching of the muscle.
Examination: In light cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In case of more pronounced pain medical examination is required to ensure the diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed for ensuring the diagnosis (Ultrasonic image)(article). The larger the bleeding, as evaluated by ultrasound, the longer the healing process.
Treatment: The treatment primarily consists of relief, as with muscle rupture in the calf. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. Some recommend treatment with rheumatic medicine (NSAID) and advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle).