**3. Etiology**

The muscle hematoma can be the consequence of an impact against an external blunt or against a bone (direct trauma) or of a excessive or uncoordinated contraction (indirect trauma ) (Fig 1). In a direct trauma, when the muscle is contracted, the contusion will impact more superficial

© 2013 Conforti; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

tissues while, in a relaxed muscle, the structural damage and the consequent hematoma, generally occur in depth, nearest the bone. The severity of the lesion depends on the site of impact, the activation status of the muscles involved, the age of the patient, and the presence of fatigue.

**Figure 1.** Hamstring subcutaneous hematoma occurred in consequence to a muscle rupture after a sudden eccentric contraction

interstitial fluid through the muscle fascia, in order to balance the same osmotic gradient. This fact causes a further increase in the swelling of the injured muscle up to the limits of extensi‐ bility of the muscle fascia or the muscle itself. The main symptoms related to the onset of an intramuscular hematoma consists of pain, especially during the first 72 hours after the trauma and, after a few days, involve a decreased contractility and muscle functionality and extensi‐ bility. The prognosis for intramuscular hematomas is worse than for intermuscular hemato‐ mas, and experts' opinions suggest treating these with drainage in order to avoid potential

The **intramuscular** hematoma is characterized by the integrity of epimysium and by blood extravasation into the body of the muscle affected by the trauma. This causes an increasing of the intramuscular pressure with consequent compression of the capillary bed, which contrasts the bleeding; therefore clinical signs and symptoms remain localized. Since the presence of blood flow may cause an increase in the osmotic gradient, the swelling may increase more than 48 hours after the traumatic event. This change of the osmotic gradient causes a passage of the interstitial fluid through the muscle fascia, in order to balance the same osmotic gradient. This fact causes a further increase in the swelling of the injured muscle up to the limits of extensibility of the muscle fascia or the muscle itself. The main symptoms related to the onset of an intramuscular hematoma consists of pain, especially during the first 72 hours after the trauma and, after a few days, involve

**Figure 2.** From Orthopaedic Sports Medicine: Principles and Practice Delee, Jesse C. M.D.; Drez,

**Figure 2.** From Orthopaedic Sports Medicine: Principles and Practice Delee, Jesse C. M.D.; Drez, David Jr. Saunders

Mixed

Deep intramuscular

The Treatment of Muscle Hematomas http://dx.doi.org/10.5772/56903 205

The size of the effusion can be more or less conspicuous depending on the athlete's muscle status of contraction and on the athlete's characteristics of vascularization and coagulation characteristics.

Antitrombine III or C protein or S protein deficit, or quantitative abnormalities in Leiden V or VIII or IX factors or anti-coagulants therapies or massive anti-inflammatory drugs use . External

Many classifications of muscle injuries have been performed in according with anatomical location, pathophysiological characteristics, clinical and radiological features (Tol et al., 2013) (Chan, N. Maffulli et al classification 2012**. )** (The Munich Consensus Statement ). Depending on the muscular structures involved, muscle injuries are distinguished in intramuscular, myofascial,

We will only classify hematomas on the basis of their localization in intramuscular, intermuscular or mixed and on the basis of their treatment in superficial or deep We will only classify hematomas on the basis of their localization in intramuscular, intermuscular or mixed and on the basis of their

Very influent in the severity of hematoma are inherited abnormalities of coagulation like

condition like a delayed or insufficient compression is important as well.

**4. CLASSIFICATION** 

myofascial/perifascial and musculo-tendinous**.**

Superficial intramuscular

treatment in superficial or deep. (Fig. 2)

Although **intermuscular** hematomas appear initially more dramatic due to the resultant bruising and swelling, intramuscular hematomas are considered a more serious condition

a decreased contractility and muscle functionality and extensibility. The prognosis for

In intermuscular hematoma the muscle fascia looks damaged thereby allowing the extrava‐ sation of blood flow between muscles and fascia. This causes the formation of a more or less wide livid and swelling area. Contrary to the intramuscular hematoma, the intermuscular

Finally in case of a **mixed** hematoma, after a first stage characterized by a temporary pressure increasing due to an extravasation, a rapid decrease in blood pressure can be observed. The swelling due to a blood extravasation appears usually after 24-48 hours, but after a sudden increase in pressure and swelling, the symptoms decrease and functional recovery is fairly

The knowledge of skeletal muscle regeneration principles and healing processes can help in

hematoma causes a painful symptoms limited to the first 24 hours post-trauma.

post-traumatic myositis ossificans or fibrosis.

David Jr. Saunders Company, 1994

Intermuscular

Company, 1994

2

rapid with an usually complete healing.

because the intact fascia creates an increasing of muscle pressure.

respecting the timing for return to competitions (Klein, 1990).

The size of the effusion can be more or less conspicuous depending on the athlete's muscle status of contraction and on the athlete's characteristics of vascularization and coagulation. Very influent in the severity of hematoma are inherited abnormalities of coagulation like Antitrombine III or C protein or S protein deficit, or quantitative abnormalities in Leiden V or VIII or IX factors or anti-coagulants therapies or massive anti-inflammatory drugs use. External condition like a delayed or insufficient compression is important as well.
