Wideman gets helped off the ice after being crushed by Tuomo Ruutu. (Photo credit: Chris Gordon)
Editor’s Note: On Thursday, TSN’s Bob McKenzie reported that Dennis Wideman was in a Washington hospital with a significant leg hematoma as a result of a hit by Carolina’s Tuomo Ruutu. Later that night, Capitals officials confirmed that Wideman suffered a hematoma, likely compartment syndrome, but that muscle damage appeared limited. We had no idea what that was or the potential ramifications, so we thought, why don’t we ask two experts who actually know what’s going on.
Those experts are friends of the blog Catherine Gardner and Chris Gardner. Cat’s background includes having a bachelor’s degree in biology from UVa, 11 years EMS experience as a Nationally Registered Paramedic, six years as an EMT instructor, seven years of HS teaching experience and a NCEE (Nationally Certified EMS Educator) certification.
Chris has a degree in Astrophysics from UVa and a Masters in Systems Engineering from GWU. He also has 11 years of EMS experience as a volunteer in Prince William county in roles from Street Medic through Rescue Chief. Plus, these two went on dates to the Capital Centre to watch hockey and came back from their honeymoon in time to watch Game Four of the Stanley Cup finals against the Red Wings. So there really is no one better to ask. Take it away, guys.
There has been plenty of speculation about the nature and severity of the injury to Dennis Wideman on Twitter, the interwebs and radio. Early reports were saying it was a “hematoma”, and later it was being reported that doctors had to create incisions in Wideman’s leg to relieve pressure and saying Compartment Syndrome was likely. Given that these are a lot more specific than the usual “lower body injury”, lets dive in and see what may be going on:
Let’s start with the easy part. A contusion is a bruise. It occurs when tiny blood vessels in the skin are broken and bleeding under the skin creates the characteristic blue-black discoloration we’ve all seen. A hematoma develops the same way, however it involves larger blood vessels that bleed more and results in a collection of blood. While painful and swollen, most hematomas heal on their own over time, just like a bruise. The most common example is probably the goose-egg you get on your noggin’ when you lose a fight and smack your forehead on the ice.
Some hematomas can be drained, some cannot. If the blood collects in a “pool” it can potentially be drained. Some hematomas bleed within the muscle and do not form a pool of blood. Think of it like the following. Put a wet sponge in a plastic bag. The sponge is the muscle tissue, the water is blood and the bag is your skin. A needle inserted into the sponge (muscle) cannot draw out all the water (blood). Similarly incision in the skin (plastic bag) will not result in draining of the entire area.
As it turns out, Wideman’s injury seems to have resulted in potential “Compartment Syndrome” which is defined as swelling within a closed anatomical space, and a bit more significant than “just a hematoma”. First it helps to understand the anatomy involved. In our bodies, our muscles are separated into compartments by tough, fibrous membranes called fascia (fash-uh) which wrap our muscles into bundles. If you’ve ever seen the silvery white membrane on the outside of a roast or on the back of ribs, that’s fascia. Inside the fascia are a section of muscle tissue, a bundle of nerve fibers and blood vessels that serve the muscle in that compartment. When an injury causes swelling or bleeding to the muscle tissue inside the fascia, the muscle swells, and a pool of blood may form (Hematoma), but the fascia may not be able to stretch enough to allow this swelling to occur. This results in the blood vessels and nerve tissue within the compartment being compressed, compromising both nerve function and blood supply to the muscle. This is Compartment Syndrome, it is bad, hurts a lot and can result in permanent damage if not treated. From what Knuble tells us, it sounds like Wideman’s swelling was pretty impressive.
The treatment typically performed on patients who develop compartment syndrome, is called a fasciotomy (fash-ee-ot-uh-mee). In this procedure, an incision is made through the skin and fascia, releasing the pressure that is built up and allowing the muscle tissue to swell without compressing the nerves and blood vessels within the compartment. (Picture the slices down the sides of a plump, cooked hot dog.) Once the swelling goes down, the incision is closed. We don’t have confirmation that this is what was done for Dennis, but every indication is that it was. Feel free to image search the term Fasciotomy, but be warned, our Hot Dog example is much more family blog friendly.
The recovery period for compartment syndrome varies widely. Factors include how long it takes for swelling to go down, the number of muscle compartments that were affected and general health of the patient. Recovery after a fasciotomy that is due to an injury and only affects one leg (as is the case with Wideman) is among the quickest of recovery times for this procedure. Wideman is an athlete, so he has that in his favor, on the other hand, he needs to recover to a NHL level. The range of expected recovering times extends from about two to eight weeks for similar injuries. It is highly dependent on details of the patient, the specific injury and the cuts themselves. So when the team says “week to week”, in this case they are about as specific as anyone can be.