Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6511-6516
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6511
Extracorporeal shock wave therapy treatment of painful hematoma in the calf: A case report
Ji Won Jung, Hyeon Seong Kim, Jung Ho Yang, Kyu Hoon Lee, Si-Bog Park
Ji Won Jung, Hyeon Seong Kim, Jung Ho Yang, Kyu Hoon Lee, Si-Bog Park, Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
Author contributions: Jung JW was the patient’s physiatrist, reviewed the literature and contributed to manuscript drafting; Kim HS and Lee KH reviewed the literature and contributed to manuscript drafting; Yang JH analyzed and interpreted the imaging findings; Park SB was responsible for manuscript revision for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Si-Bog Park, MD, PhD, Professor, Department of Rehabilitation Medicine, Hanyang University Hospital, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea. sibopark@hanyang.ac.kr
Received: September 18, 2020
Peer-review started: September 18, 2020
First decision: October 18, 2020
Revised: October 26, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 26, 2020
Abstract
BACKGROUND

Extracorporeal shock wave therapy (ESWT) can be applied to various musculoskeletal conditions including calcific tendinitis. Muscle injuries can lead to hematomas, and unabsorbed hematomas sometimes cause pain. We report a case of painful hematoma successfully treated with ESWT. To our knowledge, this is the first reported case of painful intramuscular hematoma treated with ESWT.

CASE SUMMARY

A 65-year-old man visited the outpatient department for left calf pain with swelling that had persisted since he slipped two weeks prior. The calf pain had persisted and was rated visual analog scale 7. On physical examination, there was a localized, stiff, ovoid mass on his left upper posterior calf. The pain was aggravated by dorsiflexion of the left ankle or weight-bearing on the left foot. Initial diagnostic ultrasonography showed a hematoma in the left gastrocnemius muscle; its texture was firm with low heterogeneity. We applied ESWT to the hematoma. His pain decreased immediately to a visual analog scale 3, and the mass was softened. The texture of the hematoma became more heterogeneous on ultrasonography. Due to planned overseas travel, he returned three months after the initial visit to report that the pain and swelling were dramatically relieved after ESWT.

CONCLUSION

We propose that painful hematomas could be a new indication for ESWT. Further investigation on the effects of ESWT for hematomas is needed.

Keywords: Extracorporeal shock wave therapy, Hematoma, Ultrasonography, Indication, Pain, Case report

Core Tip: Extracorporeal shock wave therapy (ESWT) is applied to various musculoskeletal conditions. We applied ESWT to a patient with a stiff, painful hematoma on his calf. The patient’s pain was immediately relieved, and the hematoma texture changed. We propose that painful hematomas could be a new indication for ESWT. Further investigation on the effects and appropriate protocols of ESWT for hematomas is needed.