21.04.2024

Hemarthrosis (bleeding in joint): is it dangerous for the joints?

Called a hemarthrosis blood in a joint, accumulated as a result of hemorrhage. The immediate cause is the violation of the integrity of blood vessels that provide blood to the structures of the joint. The most common location in which there is a hemarthrosis, it is the knee joint.

This pathology can be not only traumatic, but non-traumatic origin. Traumatic hemarthrosis was seen mainly as the result of intra-articular fractures and smaller injuries (injuries of ligaments, bruises). Nontraumatic hemarthrosis is diagnosed when abnormalities that are associated with the violation of blood coagulation system or high vulnerability of the vascular wall that occur in a number of diseases.

Hemarthrosis treated by aspiration of blood and the imposition of a plaster bandage. These manipulations should be performed in the clinic with follow-up physician – hemarthrosis is often complicated by osteoarthritis, in which joint cartilage is destroyed.

General data

Most often, this pathology occurs in traumatic injury of a joint, a little less – in hemophilia. Other causes are observed in total less than these two.

Theoretically, the hemarthrosis can occur in any joint, but in practice, the hemorrhage in most of the joints are negligible, and the blood caught in the joint cavity may disappear on their own, without any medical assistance. Exception to these rules is hemarthrosis of the knee joint – it often occurs with complications, and in any case requires treatment in hospital.

Hemarthrosis most often diagnosed in young and middle age – from 25 to 40 years. This is due to the greater activity of people who belong to this age category. For the same reason men hemarthrosis is diagnosed more often than women.

Reasons

There are two groups of causes of hemarthrosis:

  • traumatic;
  • non-traumatic.

The first group includes injuries of any Genesis (origin).

Non-traumatic causes of hemarthrosis is any pathology of a nontraumatic nature.

Injury, which can occur hemarthrosis, are observed in the action:

  • unintentionally;
  • intentional.

Unintentional injuries of the joints, which can occur hemarthrosis, are:

  • sports;
  • production;
  • household.

A separate category of injury that is caused as a result of:

  • accidents;
  • surgery.

Sports injuries – perhaps the most often observed reason for the formation of a hemarthrosis. The importance of the power component of such injuries.

Most often, trauma to the joints with hemorrhage in the cavity has exposed the people involved in such sports as:

  • football;
  • hockey;
  • basketball;
  • Rugby;
  • American football;
  • almost all kinds of

and so on.

The importance of team play – the chance of occurrence of hemarthrosis increases in violent confrontation. In other words, the runner runs discreetly and controls so as not to fall and not damage any part of the body (joint), and in the same football deliberately used violent methods of struggle with each other. On the other hand, in non-violent sports are also possible joint damage with hemorrhage in the cavity. So, to fall and be injured can the vaulter, the racer or athlete, figure skating.

Production trauma of the joints, accompanied by hemorrhage in the cavity, often observed in:

  • the lack of an adequate system of occupational safety in the workplace;
  • violation by the same employee rules of personal safety.

As a variety of injuries that may occur hemarthrosis, are injuries that people get involved in agriculture. Quite often this trauma is observed when interacting with large animals.

Bleeding in the joints on the background of household injuries occur not very often in life there is often unexpressed trauma of the joint, against which the vessel wall maintains its integrity.

Of all accidents is often a circumstance in which a person develops a hemarthrosis, stands in a traffic accident. This is often the case, if the person drives the motorcycle, while ignoring personal protective equipment – talking about special equipment, which, in addition to other parts of the body, protects the joints (particularly knee and elbow).

Somewhat less often the direct cause of the development of hemarthrosis can be a fall from a height:

  • of a tree;
  • from the rock;
  • the second (and higher) floor of a multistory building;
  • with forests;
  • from the viewing platforms

and so on.

Hemarthrosis, which develops after surgical intervention that occurs due to intraoperative damage:

  • conventionally deliberate – when surgeon performs consciously any invasive (associated with invasion of tissue) manipulation, but does not account for the proximity of the passage of large vessels;
  • unintentional vessels damaged by accident. This can happen due to the ignorance of the surgeon topography of the limbs, atypical vessels, or the human factor (accidental damage of the vessel during surgery, or not sufficiently confident of the technology expertise of a particular manipulation).

Non-traumatic causes of hemarthrosis are divided into two groups:

  • associated with disorders of the blood;
  • arising on a background of vascular pathology.

In the first case, such violations are developing due to:

  • deterioration of coagulability of blood;
  • gain antivitamin properties of blood.

Among all of these pathologies the most frequent cause of hemarthrosis is haemophilia – inherited disorder of blood coagulation, namely, the lack of biological connections, which ensure normal blood clotting.

Of all the pathologies of the vascular system, most often the background for the development of hemarthrosis are:

  • vasculitis is an inflammatory disease of the vascular wall and its subsequent destruction;
  • weakness of the vascular wall associated with lack of vitamins;
  • aneurysm of the vessel is the formation of protrusions on its wall in the form of a small pouch;
  • the dissection of the vessel wall;
  • congenital weakness of the vascular wall

and some others.

The causes of hemarthrosis can be combined – thus, bleeding into the joint will be more pronounced if the traumatization of the vessel is observed on the background of pathology (e.g., aneurysm).

The development of the pathology

Bleeding develops when violated the integrity of the vessel wall, whether traumatic or non-traumatic reason.

If hemarthrosis arose on the background of injuries, the mechanisms of its formation can be very different:

  • bleeding in the knee joint often occurs on the background of falling (accident) or direct blow to the joint (this is common in sports with power component);
  • hemarthrosis when rupture of ligaments and menisci damage often observed during athletic injury;
  • intra-articular bleeding with intraarticular fractures (e.g., received in a car accident or falling from height)

and so on.

If it happens a serious traffic accident, the hemarthrosis occurs in combination with injuries of the following nature:

In the event of polytrauma (multiple injuries) development of hemarthrosis with more frequent complications – primarily adjusted life threatening condition (head injury, abdominal trauma with internal bleeding), whereas a damaged joint with concomitant bleeding in it can take classes only after there is an understanding that the life of the victim threatens nothing.

Hemarthrosis that occurs during surgical intervention, most often seen in operations on the knee joint – it can be:

  • removal of damaged meniscus;
  • the restoration of the integrity (stitching) cruciate ligaments;
  • osteosynthesis (metal bond structures) of the condyles of the femur (the bone its anatomical appendages);
  • osteosynthesis of the condyles of the tibia

and so on.

Of all combined reasons most often lead to gemartrozy grass (even minimal) occurred on the background of such pathologies as:

  • hemophilia;
  • hemorrhagic diathesis – a group of diseases characterized by increased bleeding tendency and bleeding.
Symptoms of hemarthrosis of the joints

Depending on the amount of blood extravasated in the joint, and the clinical manifestations are three degrees of hemarthrosis.

A hemarthrosis in the first degree is the outpouring of blood into the joint volume to 15 ml. Seetsya the following symptoms:

  • a slight increase in joint volume;
  • pain;
  • the function of the joint is not disturbed or limited.

Characteristics of pain:

  • localization – local, in the region of the joint;
  • distribution – practically without irradiation;
  • nature – aching;
  • intensity – minor, tolerable;
  • the appearance is observed in the accumulation in the joint a certain amount of blood can be amplified when you try to make movement in the joint.

A diagnosis of hemarthrosis in the second degree when put streamed blood in quantities up to 100 ml with the following Symptoms:

  • increased joint volume;
  • the smoothness of its contours – the joint is spherical;
  • increased pain – they can be more intense not only in functional stress on the joint, but also at rest.

A haemarthrosis of the third degree is considered to be an extravasation of blood into the joint with a volume of 100 ml. Often this condition is observed with continuous bleeding.

Note the following signs:

  • the significant increase in the joint;
  • a significant increase in pain, they become unbearable;
  • cyanotic hue of the skin covering the joint;
  • “tohost” and tension of the soft tissues in the joint;
  • sometimes increased local temperature.

If hemarthrosis is observed on the background of rather serious consequences (it can be a rupture of ligaments, fractures and so on) will also manifest symptoms, which is characteristic for the main damage:

  • when rupture of ligaments instability appears, the “looseness” of the joint;
  • when the fracture is concerned about a sharp pain in case of fracture of the lower extremity support foot impossible

and so on.

If hemarthrosis was the result of a violation of the non-traumatic nature, then experience the following symptoms:

  • moderate joint pain expander nature, especially intense when pouring into the joint cavity of large amounts of blood;
  • a marked deterioration in function of the movement of the limb when it is limited. If the joint of the lower limb, the support leg difficult to do.

If the hemorrhage was small, insignificant portion of the blood in the joint cavity may disappear independently without treatment. If hemarthrosis expressed, after some time, the blood extravasated in the joint, becomes more liquid, therefore the tension of the tissues is reduced.

Diagnosis

Diagnosis is based on characteristic complaints of the patient, anamnesis (the fact of injury or illness, fraught with bleeding), results of additional research methods (primarily physical).

In the physical examination study evaluated:

  • when inspecting the shape and dimensions of the joint, the condition of the skin, its ability to perform flexion and extension;
  • palpation (feeling) – the degree of pain, presence or absence of tension of soft tissues, fluctuations (a characteristic “waves” under your fingers), blood clots.

At the first degree of hemarthrosis the joint size of the former, the function is almost preserved, there was some palpable tenderness.

At the second degree described the pathology of the joint is increased in size, palpation is determined soreness, and a slight fluctuation of the voltage of the soft tissues.

When the third degree of hemarthrosis the joint like a bloated ball can be visible bulging at its anterolateral surfaces.

Instrumental methods of investigation used in the diagnosis of hemarthrosis, the following:

  • radiography – to determine the presence of fluid (blood) in the joint cavity;
  • CT scan – using computer sections it is possible to explore in more detail the condition of the tissues in the joint;
  • magnetic resonance imaging – with the help of tomographic images, one can obtain the most detailed information about the condition of the joint and the soft tissue around it;
  • arthroscopy in the joint cavity enter the arthroscope (type of endoscope), and examine its condition from the inside and thus reveal the blood and blood clots. The method also allows to identify the source of bleeding.

Laboratory methods of diagnosis are employed, if a haemarthrosis has developed on the background pathology of the blood. Run:

Also in this case you will need to consult a hematologist.

Differential diagnosis of

A differential diagnosis of haemarthrosis are often carried out with such diseases as:

  • osteoarthritis – non-inflammatory lesions of the joints, which in the first place, is characterized by destruction of articular cartilage;
  • arthritis – inflammation of the joint.
Complications

Complications of hemarthrosis are:

  • dystrophic changes. Arise for the reason that the blood in the joint cavity puts pressure on the articular cartilage. Degenerative disorders often occur with repeated hemarthrosis;
  • osteoarthritis. Occurs because of the appearance and accumulation in the joint hemosiderin, a compound that is formed by the decay of blood streamed. Hemosiderin devastating effect on hyaline cartilage of the joint;
  • aseptic arthritis – inflammation occurs due to irritation of the tissue decay products of blood streamed;
  • purulent arthritis develops when joining the infectious agent and the spread of the pathological process on the fibrous membrane of the articular capsule and the surrounding soft tissue of the joint;
  • aseptic synovitis – non-infectious inflammation of the synovial membrane of the joint. Mechanisms of development is almost the same as the mechanisms of development of arthritis;
  • infectious synovitis – infectious inflammation of the synovial membrane of the joint. Occurs when the joining of pathogenic microorganisms.
The treatment of hemarthrosis of the joints

Successful treatment of hemarthrosis depends on the timely treatment of the patient in the emergency room – continuing bleeding into the joint cavity is fraught with unpleasant consequences.

First aid for this is as follows:

  • the rest of the limb it is placed on a horizontal surface;
  • local cold – hot water bottle with cold water, a container with ice and so on.

If the quantity is shed abroad in joint blood does not exceed 15 ml, it is absorbed independently. The patient does not hospitalitynet, puncture joint do not. The treatment of the following:

  • the rest of the limb;
  • overlaying a plaster splint for fixation of joint. The mobilization period depends on the severity of the primary injury;
  • topically – cold for a few hours;
  • the elevated position of the limb (to ensure blood flow and prevent swelling of the joint);
  • after a week – physiotherapy treatment methods (UHF, SHF, etc.).

If the amount of blood in the cavity of the joint exceeds 25-30 ml, make it a puncture with aspiration of blood. It is performed like this:

  • is the local anesthesia of the soft tissues;
  • change the needle on thicker, it punctured the joint capsule;
  • the blood is aspirated, the joint cavity is washed with any antiseptic;
  • to prevent inflammation can enter the hydrocortisone or triamcinolone;
  • on the joint impose tight bandage;
  • spend immobilization splint.

If there are signs of re-accumulation of blood in the joint, a second puncture. In most cases, 1-2 or 2-3 LPS enough.

After puncture the limb should be elevated. If was the affected joint of the lower limb, it can only walk on crutches. The period of immobilization plaster Longuet depends on the degree of severity of the underlying damage.

Hemarthrosis of the third degree occurs, as a rule, in severe injuries of the joints. The patient, who appealed to the emergency room, should be hospitalized in the trauma Department, where the treatment of trauma. If the injury is not heavy, but diagnosed with hemarthrosis of the third degree, it is also an absolute indication for hospitalization of a patient in the hospital.

The appointment of the following:

  • ensure complete rest of the limb;
  • puncture joint doing as it accumulated in the blood;
  • assign antibiotic therapy to prevent infection of blood in the joint;
  • after the elimination of blood in the joint after a week from the date of the injury is prescribed physiotherapy treatments.

You may need surgery to find the bleed and stop it.

Special attention should be given persistently retidiviruuschem the hemarthrosis. Treatment should be preceded by a detailed survey of repeated hemorrhage into the joint cavity can occur due to damage to the articular cartilage, and they may not be seen on x-ray image. It is therefore advisable to perform arthroscopy of the joint. In this case it is not only a diagnostic procedure but also therapeutic during it you can perform a number of manipulations (in particular, remove the damaged cartilage fragments).

If a haemarthrosis has developed against the background of hemophilia or other violations of the blood coagulation system, it requires an appropriate correction is:

  • a blood transfusion;
  • intravenous antihemophilic globulin.

The treatment of such a patient is carried out in the Hematology Department.

Prevention

Development of hemarthrosis can be prevented, if you prevent any joint injuries or pathological condition that can lead to bleeding in the joint – disorders of the blood and blood vessels.

If such injuries or pathological condition has already occurred, you need to stop them as quickly as possible.

Also important are:

  • treatment of major diseases that can cause disorders of the blood vessels;
  • vitamin – especially vitamin C, which helps the blood vessels ceases to be friable and brittle.
Forecast

The prognosis of traumatic hemarthrosis in most cases favorable, if the patient immediately after the injury has addressed in medical institution.

The prognosis of hemarthrosis, which arose on the background of any abnormalities of blood vessels or blood, as well as in severe injuries, worse. In this case, there are often complications – in particular, developing arthrosis that is difficult to treat.

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