Case 2. Severe hematoma of the buttock following a gluteal compartment syndrome due to a vascular injury. Acute gluteal compartment syndrome: superior gluteal artery rupture following a low energy injury. ^/xck<2F{m! A rubber donut may be used to decrease the pain of sitting on a swollen buttock. An injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. Sprains and strains may be caused by repetitive movements or a single stressful incident. Grimm MR, Vrahas MS, Thomas KA. Ultrasonographic findings after intervention revealed a small, elongated anechoic image. In our case, the damaged blood vessel was an arteriole of the superficial branch of the superior gluteal artery. Many conditions and diseases can cause pain in the buttocks, commonly known as butt pain. Information. The gluteal region of the body (the buttocks) consists of three major muscles: gluteus maximus, gluteus medius, and gluteus minimus. Several fibrous tumors have a propensity to develop in the gluteal deep fat, fascia, and skeletal muscle. He fell a few months before I first met him and as a result he had severe pain in his right buttocks. N A comprehensive secondary examination can be an effective way to identify less obvious injuries, and radiography is a good initial screening tool. We used circular movements of the transducer, without angulations, and we used a coupling gel to cover the surface of the skin over the area of the hematoma. In order to prevent risk of new bleeding, we believe it is important that US therapy should not be initiated until the acute phase of the hematoma has passed. The recently global review of the prevalence of LBP in the adult general population was published in 2000 and showed point prevalence of 1233% and 1-year prevalence of 2265% . CT of abdomen/pelvis showed right gluteal haematoma measuring approximately 9.25.58.8 cm with surrounding subcutaneous fat stranding ( figure 1B,C ). Berna Studies have shown that bedside ultrasonography significantly improves clinicians' ability to differentiate between cellulitis and abscess and, thus, to initiate the most appropriate treatment from the outset. CT scan can help To observe the changes in condition, we had not prescribed the pain medication. A contusion may result from a direct blow to a muscle when players collide during sports. Check for errors and try again. Palpation, or feeling the buttock, may expose tenderness associated with a contusion. Ultrasound is the most widely available and the most frequently used electrophysical agent in physical therapy. US Endovascular Stent and Renal Artery Complete w Doppler (C) - CPT Code 76775 & 93975 IMG 505. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Titone C, Lipsius M, Krakauer JS. The purpose of this case report is to describe the management and outcomes of a patient with a large RSH secondary to oral anticoagulant therapy. Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Dohan A, Sapoval M, Chousterman BG, di Primio M, Guerot E, Pellerin O. Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. Please check for further notifications by email. Moving the hip may cause pain in the buttock due to muscle inflammation and damage. To figure out the cause and treat the problem often takes just someone who is willing to look for the problem. , Rukshin V, Tsang V, et al. Warming up and stretching before activities may help decrease injury risk. ), which permits others to distribute the work, provided that the article is not altered or used commercially. Jessica . Four hours later, the pain had gradually increased that the VAS reached nine meanwhile there was an obvious swelling appeared in the central of left buttock. When the gluteal muscles are inflamed, movement of the hip joint causes pain. . If possible, discontinuation of anticoagulants is the first step in management and may be sufficient to allow for hemostasis to occur and resolution of the muscular hematoma. Fat necrosis occurs, which can liquefy. No complications were observed with the application of the US therapy. A stool softener may be considered for a short period of time. Contrast material may be injected into a vein or the spinal fluid to enhance the scan. Effects of Exercise Training on Cognitive Function in Individuals with Heart Failure: A Meta-Analysis, Comparison of High-Intensity Interval Training to Moderate-Intensity Continuous Training for Functioning and Quality of Life in Survivors of COVID-19 (COVIDEX): Protocol for a Randomized Controlled Trial, Do Physical Therapists Practice a Behavioral Medicine Approach? The RSH was observed in US images and CT scans. [9], Arterial embolization is sometimes proposed as a treatment option for the management of spontaneous muscular hemorrhages and has the advantage of being less invasive than surgical evacuation while maintaining a clinical success rate of 57to 69%. Prosch H, Mirzaei S, Oschatz E et-al. , Zuazu I, Madrigal M, et al. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you. Become a Gold Supporter and see no third-party ads. Presentation of spontaneous muscular hematomas are more variable and most commonly present with localized or diffuse pain in the flank or abdomen. 1. Oral anticoagulant therapy was stopped. Ultrasound is the most widely available and the most frequently used electrophysical agent in physical therapy.11 Ultrasound is used in the management of a wide range of musculoskeletal disorders.12 The effects of US for patients with musculoskeletal disorders, which occur through a variety of biological and physical mechanisms, include muscle relaxation, reduced swelling, and pain relief.12,13 Most knowledge of the effects of US on living tissue has been gained through in vitro studies and animal models, but relatively little in vivo evidence that these effects actually occur has been published.12,14 Ultrasound can induce thermal and nonthermal physical effects in tissues.13 In a review of the purported effects of therapeutic US, Speed12 concluded that the thermal effects of US may include increased blood flow, reduction of pain, reduction of muscle spasm, increased tissue extensibility, and a mild inflammatory response. Your comment will be reviewed and published at the journal's discretion. Background and Purpose. He now no longer limps and is grateful. Y Additionally, there is increased mortality associated with an increased need for blood transfusion, which is in line with the accepted notion that hemodynamic instability is the most significant risk of morbidity and mortality to patients with this condition. When I first examined him, I immediately noticed a large lump in the gluteal muscles of his buttocks. Copyright Regenexx 2023. Gluteal injuries may have significant bleeding in these patients. , Chen X, Francis CW, et al. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. The next thing you know I had him on my exam table and our roles reversed the patient was examining the doctor. In: StatPearls [Internet]. Rectus sheath hematoma (RSH) is an uncommon and often misdiagnosed condition.1 The most frequent location is infraumbilical.2,3 The causes of RSH described in the literature include anticoagulant therapy, hematological disorders, trauma, physical exercise, coughing, sneezing, pregnancy, and hypertension.110 The most frequent predisposing factor is anticoagulant therapy, and the most important precipitating factor is coughing.2,10 Rectus sheath hematoma can be suspected in women above 60 years of age who have the clinical triad of acute abdominal pain, an abdominal mass, and anemic syndrome. The only code I can find for this tx is an i&d which is inaccuarate. Tumor, infection, trauma (with or without bleeding and iatrogenic or by other mechanisms), and aberrant development ( Chapter 8 ) can all be associated with cysts, localized fluid collections, and hematomas. They occur as a result of subcutaneous (i.e. take images of cross-sections of parts of the body. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was . Right gluteal region ultrasound depicted a heterogenous solid mass without areas of liquid consistency. Contusions occur when a direct blow or repeated blows by a blunt object strike part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. . A [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]. Juan D Berna-Serna, Juan Sanchez-Garre, Manuel Madrigal, Isabel Zuazu, Juan D Berna-Mestre, Ultrasound Therapy in Rectus Sheath Hematoma, Physical Therapy, Volume 85, Issue 4, 1 April 2005, Pages 352357, https://doi.org/10.1093/ptj/85.4.352. Berna and colleagues2,10 described patients with RSH type III who had a similar clinical profile to that of our case and who underwent conservative management but did not receive US therapy. . 2), and at the 12th (Fig. US Endovascular Stent w Doppler to Eval for Endoleak (C) - CPT Code 76770 & 93975 IMG 506. The patient was prescribed strict bed rest and with sandbag pressure on the buttocks, followed by the pain gradually relieved. Postembolization angiography showing cessation of bleeding (arrow). Lambroza Should the gluteal injury be due to a direct blow or fall, resulting in a contusion, treatment aims to decrease the inflammation in the area. Severe Buttocks Pain After a Fall: A Patients Story. <> She was discovered in a kneeling position with bruises in the occipital area. 2 0 obj Speed A case of type III hematoma before ultrasound therapy (top) and after intervention (bottom). MRI costs more than CT, while CT is a quicker and more comfortable test for the patient. These are characteristic features of hematoma on ultrasound. In uncertain situations, imaging is frequently performed to . February 2023; They have been reported to be metabolically active on FDG-PETref. Blood transfusion is performed in all type III hematomas. Search Results. In contrast, spontaneous muscular hematomas are often the site of active bleeding. The exam was notable for a large hypoechoic fluid collection deep to the subcutaneous tissue and superior to the gluteal musculature (Figures 1 and 2). Access free multiple choice questions on this topic. In addition, during this time he went from an active elderly man to becoming dependent on a cane to hobble around. When compared to other fascial compartments, the gluteal compartments can be more challenging to evaluate for acute compartment syndrome (ACS) due to This cavity is surrounded by fibrous tissue and reactive inflammatory cells (lymphocytes, foamy histiocytes, and giant cells). ADVERTISEMENT: Supporters see fewer/no ads. Injuries may occur because of overtraining, especially with weightlifting and squats. Rectus sheath haematoma associated with low molecular weight heparin: a case series. The fluid collection had increased to 13 2 9 cm 3. A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries.A hematoma is benign and is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is . Endovascular embolization was selected in all cases, either alone or with the evacuation of the hematoma, with complete procedural success. | Check a doctor's response to similar questions: Axial view scanning at proximal, Madhan Pandian MD., FIPM., CIPS., RMSK LinkedIn: Assessment and Treatment of Carpal Tunnel Syndrome is never complete Symptoms and signs include pain and swelling. Piriformis syndrome (PS) is a painful musculoskeletal condition, characterized by a combination of symptoms including buttock or hip pain. GJ This leads to pain, making it difficult to sit on the buttocks, or stand and/or walk normally because of the decreased range of motion of the hip. On Day 11 post BMP, worsening pain and paresthesias prompted a Doppler ultrasound revealing a View Frank Gaillard's current disclosures, see full revision history and disclosures, the appearance depends on the temporal evolution of the granuloma, T2 hyperintense if the reaction is inflammatory, T2 hypointense if the reaction is fibrous. van der Windt A Clinical improvement is usually rapid in patients with type I or II RSH.2,10 Spontaneous resolution of RSH, especially in large hematomas (type III), however, takes place over several months.2 Surgical intervention would be indicated primarily in cases in which hemodynamic stability is not achieved. Although little evidence about benefits in the management of soft tissue injuries exists,12,13,15,16 we consider that its lack of use results from the lack of information about the capabilities of US therapy. Arteriole flexibility had decreased significantly in our case, making the arterioles prone to rupture with external forces and when subjected to aggressive massage therapy such as deep tissue massage therapy, the blood vessel ruptured. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-18164. A low back MRI revealed a large herniated disc (his back hurt some, but most of his attention was on the butt pain). The goal of gluteal injury treatment is to return patients to their normal level of function. ; In children: Ultrasound over the bone that has not fully developed may cause fractures or other problems with the part of the bones that are responsible for growth. In the setting of trauma, it is important for emergency room staff, nurses, and all consulting physicians to be aware of the potential for unidentified injuries and respond rapidly and appropriately. Check for errors and try again. Trauma, either by a fall or a direct blow to the buttock area, causes most gluteal injuries. Thank you for submitting a comment on this article. appears as a hyperechoic bony fragment and cortex irregularity at the insertion area with surrounding hematoma [6]. An injury can cause blood vessel walls . Rectus sheath hematoma nearly always presents acutely with sudden onset of abdominal pain and may mimic a variety of abdominal pathologies, such as appendicitis, perforated ulcer, ovarian cyst torsion, intestinal obstruction, ectopic pregnancy, or tumor.2,4,6,7,21 Ultrasound and CT are the imaging methods of choice for the diagnosis of RSH.2,810 The intervention of choice is conservative.2,4,9,10 Surgical intervention is indicated primarily in those cases where hemodynamic stability is not achieved.5, Our patient had RSH with a clinical picture of abdominal pain, an abdominal mass, and anemic syndrome. Practitioners should carefully monitor for symptoms of blood loss such as tachycardia, hypotension, and pallor, which can result in anemia and, in more severe cases, organ failure. Intact gluteal muscle. The US examination showed a predominantly echogenic image, indicating that the hematoma had a coagulation component.10 The CT findings revealed a hyperdense image (Figure, top image). %PDF-1.5 , Robertson VJ, Duck FA. VJ My doc did needle aspiration w/ ultrasonic guidance of a hematoma on pt.'s gastrocnemius. Berna These are characteristic features of hematoma on ultrasound. Oxford University Press is a department of the University of Oxford. Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm. The patient was sent to hospital by ambulance and examination findings on admission were as follows: blood pressure: 160/100 mm Hg, conscious with stable vital signs, protruding and obviously swollen of the central of left buttock, and the numbness of the back of the thigh, down through the leg and foot. This activity outlines the evaluation and management of muscular hematomas and examines the role of the interprofessional healthcare team in improving the management of patients who develop muscular hematomas. Subscribe to our newsletter and receive the . ULTRASOUND MUSCULOSKELETAL GUIDED INJECTION/ASPIRATION BILATERAL. 3. Of note, the recurrence of these hematomas is common, and careful monitoring is important to identify relapse. Traumatic hematomas are generally managed conservatively, especially in patients who are not currently receiving treatment with anticoagulants. Sharafuddin MJ, Andresen KJ, Sun S, Lang E, Stecker MS, Wibbenmeyer LA. Persistent swelling in the gluteal muscle after a ski accident a few months ago. energy to make images of parts of the body, particularly, the organs and soft Deep tissue massage is a form of massage used to work with tissues in layers to relax, extend, and unlock the persisting, incorrect tensions, in the most effective and energy-efficient manner. , van der Windt DA, de Winter AF. Timely identification and management of a Morel-Lavalle lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. [Level 5]. In infants and children, these superficial lesions are easily diagnosed with ultrasound. The gluteus muscles function to move the hip and to a lesser extent help with knee movement in association with the iliotibial tract. Overuse injuries may take longer to heal, but the goal is to return patients to their normal level of function. Arterial elasticity is negatively correlated with age and high blood pressure can also cause hardening of arterioles . Arterioles are normally elastic; however, with increasing age, the vessel wall stiffens as a result of blood vessel wall thickening, intimal calcification, and lipid deposition . At the time the article was last revised Daniel J Bell had no recorded disclosures. A CT scan is a low-risk procedure. (I can not guarantee the accuracy of all reimbursement rates, please double-check yourself if needed). We applied this intervention as a result of information from a physical therapist in our hospital. His story might be helpful to other patients with buttock pain after falling, as his case was one of a bright, shiny object which looked like the cause of his pain and a more subtle problem which turned out to be the cause. Zissin R, Ellis M, Gayer G. The CT findings of abdominal anticoagulant-related hematomas. AJR Am J Roentgenol. We struck up a conversation about his severe buttock pain after a fall. A CT-angiogram may be warranted to evaluate better the hematoma and the source and from which vascular structure it originates. University of Washington: Musculoskeletal radiology. Surgery is not commonly considered but may be an option when nonsurgical treatments have failed, and torn muscles need to be repaired. IMG4463. However, after several visits to his family doctor produced no results other than a refusal to perform an MRI, he was frustrated. Messages 242 Location Dallas, GA Best answers 0. . Eur J Vasc Endovasc Surg. The muscles of the buttocks are the gluteus maximus, medius, and minimus, as well as the piriformis and the short external rotators. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica. If you have questions or comments about this blog post, please email us at [emailprotected]. Would 10160 work for muscle hematoma aspiration as well? {i$RVO"b1c"e,/K{V)y R|M"(w5D /x$6a&;gYTlG]hk )cKku`uO;ZR`Y o IIBvMB+BHVnlc?rmDv[ZdkVV"+}k+7F$H`7B,E2(`">']c/QT-u, ~~vmGbF)z>{#ziYy&Qv<22_ :IQ@ ]'\=0F71k@M"S) jJ=ys=!N= 0CWro+fO1Lsa6j',[|TMW_Oq({y%87+>=1o@ Showing 1-25: ICD-10-CM Diagnosis Code M76.00 [convert to ICD-9-CM] Gluteal tendinitis, unspecified hip. The gluteus medius tendon, . . Tough Journeys: When Cancer Strikes People Living With Dementia, Sea Spray Can Waft Polluted Coastal Water Inland, Cats, Dogs 'Part of the Family' for Most American Pet Owners: Poll, Dozens of Medical Groups Launch Effort to Battle Health Misinformation. They see their family doctors who prescribe anti-inflammatory drugs and maybe some PT, but when the pain doesnt get better, theres often a reluctance to really dig deeper. Dec 2012. ^7! &:1wUV_]KX The thigh, hip, and pelvic region are the most commonly affected locations. Common entities that arise in the subcutaneous and deep fat of the gluteal region include fibrous tumors, cellulitis (Figs. The term hematoma describes an area of blood that collects outside of the larger blood vessels. - Nearby vascular surgery. Case Description. Ultrasound reveals a large collection in the subcutaneous tissue of the right gluteal region, encapsulated, with septa ("web appearance"), heterogeneous hypoechoic content, and absence of internal flow on Doppler. CW After the first 5 sessions of US therapy, the abdominal discomfort ceased and a progressive diminution of the abdominal mass was observed. These infections are generally diagnosed and managed clinically; however, clinical and laboratory findings sometimes lack sensitivity and specificity, and a definite diagnosis may not be possible. IH'm_Cx\M~D dFI4GQ': ( Ws283b`m?hf#LN0 Lf4;?a~w?,9JWW7xSO2@#Zhy}iNZ''7fG_;X>od\L56t{{p27eN8I7=5s b9thSCi$c=p%4= Bz~We[PaesAkvz?-$b7iGni%!P8WX_ _xH>4sge.2!c73zzjb!g<9.Al~([k$[!l1)e7"q)MV7|;h)#r)CYjK%oDhtEpBp}84KIN48XPG3OoNW(q'?7S>N7NAM19{Z>KPnk6-_ythwpk':lkU=l|!VUWi.-HE9ceu!^T5fO%yU]A7J4,Mb@]zPQ Treatment with oral anticoagulants (coumarin) was restarted 8 days after the heparin, and the patient started receiving US therapy on the following day. A CT scan was performed at the end of US therapy. Br J Radiol. A hematoma is the result of a traumatic injury to your skin or the tissues underneath your skin. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Bell D, Sharma R, et al. The most common causes of fat necrosis are: physical . Treasure Island (FL): StatPearls Publishing; 2022 Jan-. He was the head of the ultrasound department for many years. Citation, DOI & article data. Other muscles, nerves, and bursae in the gluteal region that may cause, Hip rotator muscles: Piriformis, obturator, quadratus, and gemellus muscles, Most commonly, gluteal injuries are due to local. Case report: Gluteal injection site granulomas: false positive finding on FDG-PET in patients with non-small cell lung cancer. Subsequent endovascular embolization treatment which used the small coil to stop bleeding of the tiny artery via femoral artery vessel was done and the pain was relieved gradually (Figure 0003). Spontaneous muscular hematomas similarly require an interdisciplinary approach to achieve the best outcomes. . The procedure started with intravenous unfractionated heparin in prophylactic doses of 100 IU/kg/d and continued with subcutaneous low-molecular-weight heparin (enoxaparin) in doses of 2,850 IU anticoagulation factor Xa every 12 hours. intralipomatous) rather than intramuscular injection of drugs, which results in granuloma formation and cause localized fat necrosis, scar formation and dystrophic calcification. DOI: 10.5603/demj.2019.0023 Corpus ID: 204913688; Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin @article{Demir2019UltrasoundUO, title={Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin}, author={Fatih Demir and G{\"u}lden Kazanc and Jacek Smereka and Damian Gorczyca}, journal={Disaster and Emergency Medicine Journal}, year={2019} } Michaels L, Poole RW. PAIN MED. Some of these patients have injured muscles, tendons, nerves, or ligaments-but all too often they get blown off. Moreno-Gallego While he had a massive collection of blood from his fall that nobody found until an ultrasound revealed the issue, that turned out to be window dressing. Angiography showing a ruptured superficial branch of the superior gluteal artery (arrow). Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-1393, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1393,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/gluteal-injection-site-granuloma/questions/364?lang=us"}. Seroma: Anechoic fluid collection internal debris; minimal or no wall hyperemia. The intervention, including the use of US therapy, may have enabled a rapid resolution of the hematoma. The outcomes suggest that US therapy accelerates the reabsorption of the hematoma and quickly relieves the abdominal pain. All rights reserved. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The gluteus medius muscle is important in walking. A frequency of 1 MHz was used because the RSH was situated at a depth of more than 2 cm because of abundant subcutaneous fat. To further evaluate the efficacy of US therapy in the resolution of RSH, future research will be needed, such as randomized clinical trials to determine the usefulness of US for managing hematomas in people without clotting dysfunction, to determine an optimal protocol for the management of hematomas, and to provide greater knowledge of the physiologic mechanisms of the effects of US on hematoma. Ultrasound (US) is one of the most common modalities used in intervention for musculoskeletal disorders, although its effectiveness is debated. , Sakamoto I, Kohzaki S, et al. Follow us on socials. MedTerms medical dictionary is the medical terminology for MedicineNet.com. The patient rated her pain at this point as 2 (discomforting). However, while this was the "low hanging fruit," he also had evidence on exam of sciatica (pinched S1 nerve in his back). After a stay in the ER where x-rays showed no fractures, his family doctor followed the religion of take NSAID drugs and stay off it.. 2011 Oct;30(10):1431-6. doi: 10.7863/jum.2011.30.10.1431. Hematomas are commonly due to injuries or trauma in the area. Once familiar with the entity they rarely pose any diagnostic confusion. We believe that US therapy should not be administered when the hematoma is recent because of the risk of new bleeding. Download : Download high-res image (432KB) Download : Download . How do medical professionals diagnose a gluteal injury? Nonetheless, practitioners must be cautious to avoid overprescribing anticoagulants, which can occur in up to 33% of such cases. , Baker KG. Nonthermal effects may include cavitation and acoustic microstreaming.12 A combination of thermal and nonthermal effects may result in stimulation of fibroblast activity, increased protein synthesis, increased blood flow, and tissue regeneration.12 Nonetheless, the effectiveness of US remains questionable.1216. diagnose broken bones, tumors or lesions in areas of the body, blood clots in The real cause of his severe butt pain and inability to walk was a pinched nerve in his low back. Our doctors define difficult medical language in easy-to-understand explanations of over 19,000 medical terms. Weekend warriors and professionals alike all experience sports injuries. stream Fu Sun. 1970;102 (6): 626-8. MedicineNet does not provide medical advice, diagnosis or treatment. The laboratory data on admission indicated excessive anticoagulation with an international normalized ratio (INR)20 of 5.2, which was well above the recognized correct range (23.5). 1996-2021 MedicineNet, Inc. All rights reserved. Search for other works by this author on: Disorders of the rectus abdominis muscle and sheath: a 22-year experience, Rectus sheath hematoma: diagnostic classification by CT, Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants, Spontaneous hematoma of the rectus muscle: critical review of 50 cases with emphasis on early diagnosis and treatment, Acute abdomen in abdominal wall hemorrhage in anticoagulation, Rectus sheath hematomas in hematological disorders, Spontaneous rectus sheath hematomas: clinical and radiological features, Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma, Conservative treatment of large rectus sheath hematoma in patients under anticoagulant therapy, Ultrasound usage and dosage in sports physiotherapy, Therapeutic ultrasound in soft tissue lesions, Ultrasound therapy for musculoskeletal disorders: a systematic review, A review of therapeutic ultrasound: biophysical effects, Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomized trials, A review of therapeutic ultrasound: effectiveness studies, Enhancement of fibrinolysis in vitro by ultrasound, Ultrasound enhancement of thrombolysis and reperfusion in vitro, Standardization of the prothrombin time for monitoring orally administered anticoagulant therapy with use of the international normalized ratio system, Rectus sheath hematoma simulating penappendiceal abscess, Augmentation of in-stent clot dissolution by low frequency ultrasound combined with aspirin and heparin: an ex-vivo canine shunt study, In vitro thrombolysis enhanced by standing and travelling ultrasound wave fields, 2005 American Physical Therapy Association.

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