BIG Bump on Shin

[ALCapshaw2]

Anyone else still up at this early hour (01:22 AM CST)?

I just noticed that I have a fairly large 'bump' (about 3 inches in diameter and raised 1/2 inch in the middle) with only slight discoloration just below my left knee. I 'assume' I bumped my shin somewhere walking my energetic 50 lb puppy.

FWIW, this is on my 'donor' leg where the sapheous vein was harvested for Bypass Surgery several years ago.

SO, fellow Coumadin'ers, what to do?

Elevate the leg?

Let the fluid be reabsorbed?

Go to ER?

Coumadin always seems to make these little mishaps more 'interesting'...

'AL Capshaw'

 

[geebee]

Good morning Al.

Usually when I have a bump that large, which I attribute to running into something or the like, and it has a raised spot (harder than the other tissue around it?), the entire area is quite discolored early on. You know, those wonderful shades of grape purple and fire engine red, with a little midnight blue thrown in for more color?

If your's is still only slightly discolored, you might want to consider having it checked. It could be a spider bite or something like that (unless I am misreading your description).

It you are sure it is a bruise, then you could probably go by what my cardio tells me each time I get a worse bruise and call him.
"Gina, you are already on the medicine we use for hematomas - coumadin".

Unless something appears to be really bleeding under the skin (which is very apparent when it happens) you really can't do much about it except let it reabsorb.

Now, if you cannot walk, your leg feels hot or you have excessive pain for the size of the bruise, you should seek medical attention (although the ER is probably not necessary). In addition, if you are worried about it, you should go to your doctor if for nothing else but easing your mind.

I hope it gets better soon.

 

[tobagotwo]

Could be you aggravated the knee, and this is from a joint injury or condition, rather that a bump or bruise - so-called "water on the knee" (sinovial effusion).

Do you have bursitis or arthritis? This could be a temporary manifestation of it. Or of torn cartilage or similar injury. Or, as you said, a bruise, although there would likely be more discoloration than you described.

If there is persistent warmth or redness to the area, you should see the doctor, but otherwise, it's likely to be annoying, but temporary.

If it continues or becomes too interfering, you can have arthrocentesis done, where they take a sample of the fluid to help determine its cause. You should probably throttle down on your puppy's antics (I know you hate to), or at least switch hands holding the leash when you walk, to avoid torquing you knee during your next walk.

Let's hope it just goes away for you.

This isn't your month, is it, Al? I hope things improve for you soon.

Best wishes,

 

[ALCapshaw2]

Here's "The Rest of the Story":

I called the "RN4U" line at the BIG local Hospital.

The nurse was concerned and told me she needed to "check it out" and asked for my phone number.

Nurse called back. ER Doc said I needed to be seen
"IMMEDIATELY". "DO NOT DRIVE yourself.
WAKE UP someone to bring you in."

3 HOURS later, I finally saw an ER Doc who said:

"You broke a blood vessel between the shin and skin.
Keep an ice pack on it. Keep it elevated.
Don't walk too much for a couple of days.
Your Coumadin should keep you safe.
Lets draw an INR just to check."

I asked what to do if this happens again.

Nurse said: "Always check it out."
Doc said: "If it's not still bleeding (you WILL know)
just treat as advised (above). If it continues to swell,
gets HOT, or is painful, come to ER or see PCP."

Obviously Coumadin patients with Hematoma's
don't get the same 'priority' as Heart Patients
with Chest Pain!

At least the ER Doc's I've seen (and that's been a LOT)
have appeared to be knowledgable, capable, and thorough. I'm thankful for that.

'AL Capshaw'

FWIW, we're trying to find a more appropriate home
for this very ENERGETIC, PLAYFUL, STRONG, and UNDISCIPLINED Spitz / German Shepherd / Chow (Heavy on the MIX) 50 lb. 1 yr. old PUPPY that we adopted / saved from the local Animal Control Center. That should reduce the number of bruising incidents considerably!

She REALLY enjoyed playing with the 95 lb Alaska Malamute 2 yr. old Male who came to 'visit' to see if they would be compatible playmates. Fingers crossed they will adopt her. It would be good for BOTH dogs. New baby in their family is a concern.

 

[Marty]

Compartment syndrome

Compartment syndrome

After a hard fall on the golf course last Thanksgiving I developed a lump on the front of my left thigh and severe pain. An orthopedist was contacted who immediately ordered an MRI which showed a bad bleed into the quadriceps muscle. Even though the pain was so bad I couldn't walk or stand he decided to treat with bed rest and Percoset.If bleeding continues they have to do something, but he said if he tried to drain the compartment ,the muscle would pop out like a bloody sponge and they could not close the incision. It would probably need a skin graft later. If the compartment pressure gets too high you can get nerve damage and muscle necrosis. Eventually about a week after the accident, the blood broke out of the compartment and I got a beautiful purple leg all the way down to the foot.The pain slowly eased. Now what did I do with the Coumadin? After consultation with my cardiologist I held for three days.( the only hold since my surgery). The INR was then 1.5. I was then told to "gingerly" bring it up to 2.5 which I did with the help of my trusty Coaguchek. I now keep my INR between 2.5 and 3.0. Before I kept it between 3.5 and 4.0 I'm fully recovered and back to working out and playing golf with no problems. Compartment syndrome occurs in people like marathoners and other athletes. It is most dangerous when it occurs below the knee.

 

[ALCapshaw2]

<SNIP> If the compartment pressure gets too high you can get nerve damage and muscle necrosis. Eventually about a week after the accident, the blood broke out of the compartment and I got a beautiful purple leg all the way down to the foot.

The pain slowly eased. Now what did I do with the Coumadin? After consultation with my cardiologist I held for three days.( the only hold since my surgery). The INR was then 1.5. I was then told to "gingerly" bring it up to 2.5 which I did with the help of my trusty Coaguchek. I now keep my INR between 2.5 and 3.0. Before I kept it between 3.5 and 4.0 I'm fully recovered and back to working out and playing golf with no problems. Compartment syndrome occurs in people like marathoners and other athletes. It is most dangerous when it occurs below the knee.

I'm hoping my bruise isn't as serious as the one you describe Marty! MOST of the swelling has gone down and I have a nice purple-ish bruise about 2 inches in diameter that is still 'hard' to the touch and slightly raised but not as much as before. I can walk on it but there IS some discomfort / throbbing when walking after having had my leg elevated (resting on the back of the sofa).

SO, my next question is: How do I tell if this is 'normal' or needs further attention? INR was 2.7 Sunday at the ER and I have returned to my normal dosing which may raise my INR slightly. Previous target range was 3.0 to 3.5

'AL Capshaw'

 

[hensylee]

My bro developed a small bump (node-liike) on the upper part of his leg just above the bend of the ankle. It was lilac colored as his ankle bone was. I took him to local dr who dubbed it infection, gave him an antibiotic, ordered warm compresses. I don't think it was infection, but he eventually began to get better until he bumped his toe in the shower wall, the entire lower leg and foot turned the most mottled black, blue, purple, pink you ever saw. It was a bruise. The coumadin caused the bleed inside - but again warm compresses. It's ok now. But I would never let it go and simply hope for the best. Always Check it out.

 

[Birky]

hematoma

hematoma

I fell in the bathroom and slid into the side of tub. Had a good sized wound and leg really blew up. Had a hematoma on the back of my leg the size of a baseball. I had an appointment with the Ortho Dr. and he looked at it. Put me on Leviquin for infection but wasn't too concerned about a clot since I am on coumadin. I was swelled down to my toes and eventually turned a nice purple. Still have a little lumb back there and I guess it will eventually go away. It is a little sore to touch but a lot better.

 

[ALCapshaw2]

Shin Bruise Day 9

Shin Bruise Day 9

The original Bruise is looking better (colors fading, swelling around bruise is diminishing).

OTOH, the whole lower leg /calf looks swollen, the foot is very swollen, and there are dark areas above the heal and red areas around the ankle. I 'assume' this is normal from reading the above responses.

My entire SHIN becomes painful when lowering my leg to the floor, especially when I raise my upper body, as the blood flows into the lower leg. It takes a few minutes for this PAIN to subside. When I then apply weight to the leg, the SHIN becomes quite painful again for a few steps until it 'adjusts'. Turning my foot outwards seems to help reduce the discomfort.

Does this sound normal to those of you who have experienced leg bruises? I suspect the loss of my sapheous vein (for bypass surgery grafts) just exacerbates the swelling problem.

My Internist didn't seem too concerned, just telling me to use warm compresses and to continue to elevate my leg (to waist level when sitting).

'AL Capshaw'

 

[Guest]

It ain't normal but there is probably no more specific treatment.

 

[ALCapshaw2]

How can I tell if the bruised blood vessel is still bleeding?

Where can I find my pulse on my foot / ankle?
(I've not been able to find one, even on my good leg)

'AL Capshaw'

 

[geebee]

Usually you will see new red around the original injury sight if it is still bleeding.

I have never been able to take my pulse in my foot so I can't answer that one.

I must say, if your leg is as swollen as you say, it would make me worried also. However, I guess your internist must know what he is talking about if he's seen it since the swelling.

Take care.

 

[Mb]

Hello!

Two years ago, when my daughter had just become a nurse, they invited her in to watch a procedure being done on a 40 yo man, who had "bumped" his shin, and was on coumaden. She said his shin/leg looked horrid. They opened up the skin, and removed the old blood. She said the stench was not to be believed....and she does NOT have a touchy stomach. I think I recall that they were worried that it could cause a massive infection....if it wasn't already infected. The man needed NO pain meds, as he couldn;t feel the area at all. They cleaned the wound, dressed it, and back to his bed he went. Just thought I'd throw this in.....as it was also a shin injury. Marybeth

 

[mabell]

Wow this is an old thread and I am an even older member. I have a lil ol bump above my ankle, result of having bumped my bike's kick stand. Have been too distracted last 4 days by a death in family to think much about it and it has really gotten smaller daily. Also, bruising has decreased today. Reading these messages made me feel better and also made me remember how much this forum has helped me in the past. My mitral valve replacement was 8 years ago and I am working harder than ever, traveling, and generally leading a rewarding life, thanks to procedure. Best wishes to all!--Mary Ann Bell, Huntsville TX (formerly Spring TX) St. Jude's Valve still ticking like a cheap watch.

 

[lance]

Hematomas

Hematomas

When I experience bruising I use my Softclix on the hard knot releasing the trapped blood. The blood slowly oozes out until the oozing stops on its own. I know knees are complicated so it might not be as simple.