Knee and elbow knee and knee haemarthrosis: causes, treatment

Hemarthrosis

Hemarthrosis- Hemorrhage in the joint. It arises from the rupture of blood vessels that supply blood to the intra-articular structures. Often observed in the knee joint. May be traumatic or non-traumatic.

Traumatic hemarthrosis always develops with intraarticular fractures and often accompanies lighter injuries (tearing and tearing of ligaments, meniscus ruptures, bruises of joints).

Non-traumatic hemarthrosis can occur in diseases associated with blood clotting disorders or increased fragility of the vascular wall - in scurvy, hemophilia and hemorrhagic diathesis.

With hemarthrosis, the joint increases in volume and becomes spherical, pain and fluctuation (swelling) occur. The diagnosis is made on the basis of the examination.

To determine the cause of hemarthrosis, radiography, MRI, CT and other studies can be prescribed. Treatment - puncture of the joint and the imposition of a plaster bandage.

Hemarthrosis - the accumulation of blood in the joint. Most often it develops with trauma. Second place in terms of prevalence is haemarthrosis in hemophilia.

An exception is the knee joint, when a hemarthrosis occurs, special treatment is required in such cases.

Causes of hemarthrosis

The mechanism of injury can be almost anything. Hemarthrosis with bruises of the knee joint, as a rule, occurs as a result of a fall or (less often) a direct stroke.

Hemarthrosis with ligament rupture and meniscus rupture often results from a sports injury.

Hemarthroses with intra-articular fractures can occur as a result of an ordinary fall on the knee, and due to larger incidents: road accidents or height.

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In case of serious incidents, it is possible to combine with other injuries: thoracic injuries, fractures of the spine, pelvis and bones of extremities, TBI, blunt abdominal trauma and injuries of the genitourinary system.

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A more or less pronounced accumulation of blood is characteristic for the postoperative period with various planned surgical interventions on the knee joint, for example, when removing a meniscus, cross-linking ligaments, osteosynthesis of the condyle of the thigh with screws, osteosynthesis of the condyles of the tibia with plates or screws. With hemophilia, scurvy and hemorrhagic diathesis, hemarthrosis can develop even after minimal trauma. In a number of cases, the traumatic effect is so insignificant that the patient can not even remember it.

At the first degree of hemarthrosis (the volume of blood flowing to 15 ml) the joint is slightly enlarged in volume. The symptoms of the main injury predominate (usually a knee joint injury). Pain is local in the area of ​​damage, there are no joint pains in the joint.

Foot rest is loose or somewhat limited. With the second degree of hemarthrosis (the volume of blood flowing to 100 ml) the joint increases in volume, becomes spherical, its contours are smoothed. During palpation, fluctuation is determined.

With continued hemorrhage and a third degree of hemarthrosis (the volume of blood flowing more than 100 ml) the skin can become cyanotic, and soft tissues - very tight, strained. In some cases there is an increase in local temperature.

If hemarthrosis is caused by a bruise or has a non-traumatic character (arose due to hemophilia, scurvy, etc.).

), the patient complains of moderate bursting pains in the joint, especially pronounced with the discharge of large amounts of blood. Support for the leg is possible, the movements are somewhat limited.

In case of hemarthrosis, caused by more severe lesions (rupture of ligaments or meniscus rupture, fractures), symptomatology, characteristic of a particular trauma, is revealed.

Thus, if the ligaments are damaged, joint instability will be observed, a sharp pain will appear in the fracture, and support on the leg will not be possible, and so on.

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In the absence of timely treatment, a small amount of blood in the joint can dissolve independently. With the expressed hemarthrosis, the blood becomes more liquid after that, causing the swelling in the joint area to "soften".

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The joint as it swims, swelling on its lateral surfaces "slide down" when the position of the body changes. Along with this, the formation of clots, which in some cases can be felt under the fingers when feeling.

Consequences and complications of hemarthrosis

Because of the accumulation of blood in the joint cavity, the tissues are squeezed, their blood circulation is disturbed, which can become an impetus for the development of dystrophic changes (especially with repeated hemarthrosis).

Subsequently, the blood cells begin to disintegrate, the decay products enter the tissues, and this also has a negative effect on the hyaline cartilage and joint capsule.

In the tissues, hemosiderin accumulates (the pigment formed upon the destruction of blood cells), because of this the capsule, cartilage and ligament become less elastic.

In some cases, the products of the decomposition of blood cells cause inflammation of the synovial membrane of the joint. The envelope begins to secrete an increased amount of inflammatory fluid, an effusion appears in the joint, an aseptic synovitis develops.

If inflammatory fluid is hematogenous (through the blood) or lymphogenous (via the lymphatic vessels) pathogenic organisms get into it, the synovitis can become contagious.

When the process spreads to the fibrous membrane of the joint capsule and the surrounding tissue, purulent arthritis can develop.

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The diagnosis of hemarthrosis is made on the basis of clinical data and medical history. In order to exclude damage to the bones, all patients with suspected hemarthrosis are referred for radiography of the knee joint.

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If necessary (for example, with suspicion of ligament rupture or cartilage damage), there may be other additional studies have been prescribed: CT of the knee joint or MRI of the knee joint, arthroscopy, etc.

Suspicion of non-traumatic hemarthrosis is an indication for a hematologist's consultation.

Treatment of hemarthrosis

When symptoms of hemarthrosis appear, contact the emergency department as soon as possible to get timely treatment and prevent the development of complications.

At the prehospital stage, it is necessary to provide rest to the limbs, placing it on a horizontal surface with a small pillow under the knee joint.

You can attach to the joint cold (hot water bottle with cold water or a bag of ice wrapped in a towel).

On the leg impose a plaster longure, 1-2 days are recommended to apply cold, keep the elevated position of the limb and limit the load.

In the subsequent appoint UHF. The period of immobilization depends on the main injury.

If the amount of blood in the joint exceeds 25-30 ml, puncture is necessary. Puncture is performed under local anesthesia. First, on the outer-lateral surface of the joint, a thin needle is introduced just below the patella to numb the soft tissues and capsule.

Then the needle is changed to a special, thicker and longer. The blood is removed, the joint cavity is washed with novocaine. If necessary, enter hydrocortisone or triamcinolone. Then, a tight bandage is applied to the joint and immobilized with a burst.

Sometimes the blood in the joint accumulates again, therefore, after 1-2 days a re-examination is prescribed. If necessary, repeat the puncture. Usually enough 1-2, rarely 3 punctures. Recommended elevated limb position and walking on crutches.

The period of immobilization, as in the previous case, is determined by the main trauma.

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Hemarthrosis of the third degree, as a rule, accompanies severe injuries. In such cases, patients are hospitalized in the trauma department and the main damage is treated. Punctures are performed as the blood accumulates in the joint.

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If the third degree hemarthrosis occurs in the absence of severe damage, this is also the reason for hospitalization in the trauma department.

Along with standard medical measures in such cases, a detailed examination is carried out: determination of blood coagulability, MRI, CT, examinations of other specialists, etc.

Persistently relapsing hemarthrosis is also an indication for an in-depth examination, since repeated accumulation of blood may be due to cartilage damage, which is not visible on the radiographs.

For example - to remove the damaged pieces of cartilage or the torn part of the meniscus.

Hemarthrosis in hemophilia, along with standard medical measures, requires transfusion of blood plasma and intravenous injection of antihemophilic globulin. Treatment is carried out in the hematology unit.

The prognosis for traumatic hemarthrosis is usually favorable, especially in case of timely treatment in a medical institution.

Recurrent hemarthrosis, as well as hemarthrosis in severe trauma and hemophilia can cause complications and the subsequent formation of arthrosis of the knee joint.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/hemarthrosis

Effective care for hemarthrosis in adults and children

Recommendations of orthopedist and rheumatologist ...

Usually diagnose hemarthrosis of the elbow joint or knee. Other joints in the human body are also prone to this danger, but hemorrhages in them have a small volume and dissolve spontaneously.

This pathology can also occur in patients suffering from hemophilia. Violations of blood clotting lead to the fact that any, even insignificant, stroke or bruise causes a hemorrhage.

Hemorrhages under the skin manifest themselves as bruises, and hemarthrosis is visually characterized by an increase in the joint volume

Types of hemarthrosis

information for reading

Doctors divide pathology into several basic classes.

Because of the onset, hemarthrosis is isolated:

• traumatic - appears due to fractures inside the joint, ruptures and tears of ligaments and blood vessels;
• non-traumatic - appears due to diseases that are accompanied by coagulability of blood or thinning of the walls of blood vessels.

By the nature of the course of the disease can be divided into acute and chronic forms:

• acute hemarthrosis occurs immediately after the injury or in the early stages of other diseases;
• The chronic form develops, if at once to not address for the qualified help and to not begin therapy.

Ankle hemarthrosis causes swelling and cyanosis

In terms of severity, there are such types of hemarthrosis:

• I - if the amount of blood leaking into the joint is no more than 15 ml; edema small, local pain syndrome.
• II - the volume of the poured out blood is about 100 ml, the damaged part of the body has increased and is very similar to the inflated ball.
• III - the volume of blood more than 100 ml, the skin becomes cyanotic.

The first reason for hemarthrosis is trauma

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Each joint in the human body is a well-blooded part of the body.

If its integrity is damaged, bleeding may occur, and blood enters the joint cavity, where it accumulates.

The hemarthrosis of the knee joint or any other often develops as a result of injury, or is a consequence of a pathology that is in no way connected with trauma.

Causes of manifestation of hemarthrosis:

• Fracture of one of the bones that make up the joint - with this type of blood penetrates into the joint area from several places at once - from the damaged tissues of the joint bag, ligaments, cartilage, meniscus.
• A rupture of the soft tissues of the joint is the rupture of the meniscus, ligaments, capsules.
• Consequence of the performed operation, for example, after resection of menisci, arthroscopic intervention. Hemarthrosis after surgical treatment can develop due to the fact that blood from a badly bandaged vessel begins to accumulate in the joint cavity.
• Hemarthroses in hemophilia develop due to vascular damage and poor blood coagulation.

Often, hemarthrosis occurs in people suffering from hemophilia

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Post-traumatic hemarthrosis and other types of disease are accompanied by certain symptoms:

• enlargement and puffiness of the joint, the contour becomes indistinctly outlined;
• severe pain in the affected area;
• cyanotic skin tone;
• movements in the joint are limited;
• increase in the temperature of the skin at the site of injury.

As soon as the first signs of pathology have appeared, you need to urgently consult a doctor and take a survey.

Hemarthrosis can be complicated by infection, because blood is the best medium for the reproduction of bacteria

Diagnostic methods

Before giving help with hemarthrosis, the doctor must accurately diagnose. To do this, he examines the patient and finds out an anamnesis of the disease.In order not to miss a bone fracture, the doctor recommends radiographing the joint.

If there is a suspicion of ligament rupture or injury to cartilage tissue, it can be recommended more informative examinations: computer or magnetic resonance imaging, arthroscopy and others. If there is even the slightest chance that a patient has a non-traumatic hemarthrosis, he is referred to a hematologist.

Modern diagnostic methods will quickly confirm the diagnosis

Treatment of joint hemarthrosis

To treat a hemarthrosis it is necessary only after the reason of occurrence of a pathology will be precisely established.

Basically, hematarthrosis is treated by performing a joint puncture: removing blood and further inserting into the articular cavity of Kenalog or Hydrocortisone.

Practically in all patients, a single injection of the drug will immediately stop sudden bleeding and greatly facilitate your well-being.

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After puncture, a tight bandage is applied to the joint. After a day or two, a second examination of the surgeon is recommended. sometimes a hemorrhage into the joint continues.

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If hemarthrosis is severe and neglected, the treatment will require the use of orthodontics - an operation that involves the reconstruction and restoration of joint mobility.

You need to do everything possible to remove blood from the joint, otherwise it squeezes surrounding tissues, disrupting their nutrition

In a number of cases, with advanced hemarthrosis, it is necessary to resort to endoprosthetics.

The prosthesis perfectly takes root, and all thanks to the fact that it was created from neutral materials.

Hemarthroses in hemophilia require treatment in the hematological unit, where the patient is transfused with blood plasma and injected with antihemophilic globulin.

To prevent another hemorrhage in hemophilia, it is recommended to take medications that increase blood coagulability.

If conservative methods of treatment have not helped or assisted, without operation to not manage

Prognosis and complications of the disease

The prognosis of hemarthrosis is favorable, if, of course, the patient turned to the doctor on time.

After a few days after a hemorrhage in the joint, a lysis of blood takes place-the coagulation of the protein components, turning them into elastic bunches.

Gradually the clots become hard and can become the reason leading to the restriction of movements. In the process of lysis, the risk of developing degenerative changes in the joint is high.

All this threatens the rapid wear of the articular cartilage.

In addition to the possibility of development of orthopedic complications, untreated hemarthrosis is dangerous inflammation of the joint. The inflammatory process will have an aseptic character.

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And if the trauma inside also penetrates pathogenic microorganisms, a purulent process can develop. Blood is a favorable environment for the reproduction of bacteria.

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Only a doctor, after setting an exact diagnosis and finding out the cause of the disease, can pick up the right treatment complex.

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A source: http://SustavInfo.com/bolezni/artroz/simptomy-i-lechenie-gemartroza/

Hemarthrosis: Symptoms and Treatment

Category: Joints, bones, muscles 18299

• Swelling of the affected joint
• Pain in the affected joint
• Puffiness of the joint
• Pain when touching the affected joint
• Changing the contour of the joint
• Cyanosis of the skin at the site of damage to the vessel
• Weakness in the joint
• Redness of the skin at the site of damage to the vessel

Hemarthrosis is a complex disease in which a hemorrhage occurs in the joint cavity.

As a rule, it arises from traumatic injury, which caused the rupture of blood vessels supplying it with blood. The most common hemarthrosis of the knee joint.

In more rare cases, hemarthrosis of the elbow, hip and shoulder joints develops.

This disease also often occurs in people who have an anamnesis of hemophilia. Violation of blood coagulability leads to the fact that even with a minor bruise of the joint in it immediately enters the blood.

Mechanism

If a person develops hemarthrosis, then any damage can lead to congestion in the joint cavity of the blood.

This is due to the rupture of blood vessels, the main function of which is the supply of intraarticular tissues.

Gradually, blood circulation is disrupted, and pressure in the joint cavity will grow.

If untimely and incorrect treatment, the acute stage of the disease will go to chronic. A secondary infection may also be involved. All this provokes the development of purulent synovitis or purulent arthritis.

Etiology

Depending on the causes of the pathological process, hemarthrosis is divided into traumatic and non-traumatic.

Traumatic hemarthrosis

The main cause of its development - a bruise or injury to a particular joint. When falling on the knee or because of a direct blow on it, hemarthrosis of the knee joint develops. For a more accurate formulation of the diagnosis, the location of the localization of the process is also taken into account.

For example, the history of the disease indicates - a hemarthrosis of the right or left knee joint. In most clinical situations, it is the right joint that suffers, since it is the supporting one in many people.

Often, when falling, people rely on their right foot or right arm.

Hemorrhage can occur because of a sports injury. Most often there is a rupture of ligaments or meniscuses. Such injuries are more common among athletes involved in gymnastics, power and running sports.

Causes of traumatic hemarthrosis

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Also, the common cause of hemarthrosis development of the knee or elbow joint is intra-articular fracture.

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With planned operations on the joints, a hemorrhage into his cavity can also occur.

In most cases, it is insignificant and does not pose a threat to human health.

But if the blood still fell into the articular cavity, then after the surgical intervention the doctor for some time monitors the patient's condition.

Non-traumatic hemarthrosis

This type of pathology develops in the presence of human pathologies associated with impaired coagulability of the blood:

• scurvy;
• hemophilia;
• hemorrhagic diathesis.

Blood vessels burst, and blood fills the joint cavity. In most clinical situations, it is hemophilia that causes the hemorrhage to the joint.

The disease affects people of all ages, and is also diagnosed in children.

With hemophilia, blood can fill more than one joint cavity, and several at once, which is very dangerous for health and requires adequate and timely treatment.

Degrees

Hemarthrosis in medicine is divided into three degrees, depending on the severity of the symptoms:

• 1 degree.In this case, the structures and tissues of the joint are not damaged;
• 2 degree.Damaged only soft tissue - fatty pendants, articular bag, menisci and ligaments;
• 3 degree.The most difficult and dangerous for health. Damage to the cartilage surfaces and bone tissue. Treatment is long and complex.

Symptomatology

There are several characteristic symptoms of hemarthrosis of the elbow, hip or knee joints:

Hemarthrosis of the joint

• pain. First, the pain syndrome is not so pronounced, but it increases as the blood enters the joint cavity and stretches its capsule. If the treatment is not timely started, there will be inflammation and degenerative changes, which will also be accompanied by constant severe pain;
• edema and swelling of the knee. The degree of its increase directly depends on the amount of blood accumulated in the joint cavity, as well as the speed of its admission there. On average, 40 to 100 ml of blood accumulates in 1-2 hours;
• weakness in the right or left knee, elbow, shoulder joints;
• contours of the joint are smoothed out;
• if a large blood vessel is damaged, reddening or cyanosis of the skin at the point of its rupture is noted;
• tenderness in palpation.

It is important to notice these symptoms in time to guide the patient into honey. an institution for the provision of qualified assistance.

Diagnostics

Diagnosis of hemarthrosis of the right or left knee or elbow joint is based on data that were obtained during medical examination, as well as additional examination. The most effective are the following methods:

• intraarticular puncture - an information technique, as it allows to detect the presence of blood in the joint;
• diagnostic arthroscopy;
• MRI;
• Ultrasound of the knee joint.

Diagnosis of knee hemarthrosis

If there is a suspicion of hemophilia, the doctor may appoint a patient to consult a hematologist, genetics or other specialists of a narrow profile.

Treatment

Medicamentous treatment consists of several stages:

• removal of accumulated blood from the joint cavity;
• intra-articular injection of an STD (to relieve unpleasant symptoms);
• Reception of synthetic medical means to eliminate the cause of bleeding.

The choice of methods of treatment largely depends on the degree of hemarthrosis:

• if the blood has entered the joint in an insignificant amount, the doctor does not perform the puncture, as it will dissolve independently. On the affected joint, a special gingival limestone is applied and it is recommended to apply cold for two days. At this stage, you can use folk remedies to eliminate unpleasant symptoms and pain in the affected joint. The consequences of timely treatment are favorable;
• at the second degree of pathology in the joint accumulates up to 30 ml of blood. Under anesthesia, the doctor performs a puncture. After this manipulation, intra-articular drugs with anti-inflammatory and analgesic properties are administered. These include Kenalog and Ketanov. On top of the joint impose a fixing tight bandage. Symptoms of the disease soon pass;
• The third degree, as a rule, appears because of the transferred heavy trauma. The patient must be placed in the hospital without fail, where all the necessary procedures will be carried out. First, a puncture is performed to extract the accumulated blood. If the joint is damaged to a great extent, then the only sure way to restore it is to perform an endoprosthesis.

If hemophilia is present, complex treatment will be required. Along with the treatment of the joint, intravenous injection of antihemophilic globulin is carried out. In severe cases, transfusion of blood plasma is indicated. If this is not done, the consequences can be deplorable.

Diseases with similar symptoms:

Purulent arthritis (concurrent symptoms: 4 of 8)

Purulent arthritis is an ailment of an acute nature, in which a certain joint in the human body is affected. The development of the disease is provoked by pyogenic bacteria.

The infection can penetrate into the joint cavity in various ways, but most often this is due to trauma with damage to the skin.

In most clinical cases, pathogenic bacteria "attack" the joints, which are most affected by the load.

... Infectious arthritis (coinciding symptoms: 3 of 8)

Modern medicine offers many treatments for this disease, but in spite of their diversity and effectiveness, every third patient, the infection causes irreversible violations in the joints, which lead to a complete loss of all of them functions.

... Arthritis of the knee joint (coinciding symptoms: 3 of 8)

Inflammatory process, manifested in the form of pain symptoms of the musculoskeletal system and affecting predominantly knee joints, is called arthritis of the knee joint.

The disease manifests itself not only in people of advanced age, but also affects adults and even children. Arthritis of the knee joint is manifested in the form of characteristic signs of pain in the patella and the joint itself.

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In this case, it is very difficult for a person not only to walk, but also to perform flexion and extension of legs.

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... Gouty arthritis (coinciding symptoms: 3 of 8)

Gouty arthritis (gout) is a disease of inflammatory nature, which is accompanied by restriction of mobility of joints and can lead to their deformation.

In most cases, the disease occurs in men, while their peak incidence increases by 40-50 years, women are sick rarely - according to statistics, it affects 5-8 women out of 1000.

... Reactive arthritis (coinciding symptoms: 3 of 8)

The disease, which is characterized by inflammation of the joints due to infectious diseases of various organs and systems, is called reactive arthritis.

After infection of the body with infections in the second or fourth week, development of reactive arthritis can occur.

...

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Hemarthrosis or blood in the joint, symptoms and stages of the disease

Hemarthrosis is not an independent disease, but is a secondary sign of articular pathology.

This diagnosis is made when blood is accumulated inside the joint cavity because of vascular rupture. The most commonly diagnosed hemarthrosis of the knee joint, less often - ankle, shoulder, hip and elbow.

Haemarthrosis of the knee joint

This disease has different symptoms and severity, occurs in adults and children, requires treatment, has serious complications and can cause irreversible processes.

Flow

This causes a violation of blood circulation, its accumulation in the cavity, the formation of clots and an increase in intra-articular pressure on surrounding tissues.

The articulation swells, becomes spherical, increases in volume, there is pain and a feeling of bursting, there is a loss of functions and a restriction of the volume of movements.

Causes

To cause a hemorrhage in the joint cavity there are two reasons: various injuries and somatic diseases.

Traumatic hemarthrosis develops in 100% of cases with intra-articular fractures and can accompany lighter injuries, for example, bruise of the elbow or dislocation of the ankle joint.

For non-traumatic reasons is a group of diseases associated with a clotting disorder: hemophilia, hemorrhagic diathesis.

In these cases, even a minimal injury can cause bleeding.

The most common causes of hemarthrosis

Hemorrhage and accumulation of blood in the cavity can affect any large joint.

There is hemarthrosis of the knee, ankle, shoulder, elbow and hip joints.

The treatment should be referred to a surgeon or traumatologist, the doctor will examine, collect anamnesis.

If there was a trauma, then the radiography of the affected joint would be prescribed without fail, in order to exclude damage to the bones. If a non-traumatic nature of hemarthrosis is suspected, the patient will need a consultation with the hematologist.

Symptoms and degrees of hemarthrosis

Hemarthrosis has a common similar symptomatology, nevertheless, depending on the location of the affected joint, some features of the course of the disease can be traced.

For example, hemarthrosis of the knee joint is a common consequence of various injuries, due to the fact that the legs of a person are often subjected to shocks and bruises.

Injuries to the knee joint limit the victim's ability to move - they require rest for the injured limb and the use of crutches.

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In turn, the elbow joint, being a very complex anatomically functional node with a special blood circulation and innervation, is highly reactive.

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Even after minor trauma or an injury of the elbow joint, local soreness, swelling, partial impairment of functions, hemorrhage appears.

Hemarthrosis of other joints

Ankle joint during the movement assumes a heavy load, provides the rotation of the foot, stability and support the whole body.

Having a complex structure, the ankle joint is extremely vulnerable to injury, especially the stretching and rupture of ligaments, which can be accompanied by hemarthrosis, is common.

Symptoms of hemarthrosis

• a tumor and an increase in the joint volume;
• a spherical shape;
• smoothing out the contours of the joint;
• local or spreading pain;
• limitation of the volume of movements;
• tension of soft tissues;
• cyanotic skin color.

Degrees of hemarthrosis

Z stage (degree) of the disease

1. At the first degree, a small amount of blood enters the cavity, which does not exceed 15 ml. Dominant symptoms of the main injury, local pain, a slight swelling.
2. At II degree the blood volume in the joint reaches 100 ml, the articulation increases in volume, takes a spherical shape and smoothed out contours, there are bursting pains in the joint.
3. With continued bleeding, when more than 100 ml of blood accumulates in the cavity, the third degree is diagnosed.

   It is characterized by previous symptoms, to which tension of soft tissues and burgundy-cyanotic skin color are added.

Treatment

If a person has the abovementioned symptoms of hemarthrosis, timely treatment will ease the condition and prevent the development of complications. At the pre-hospital stage, the injured joint should be restored to rest and, if possible, give it an elevated position.

At the 1st degree of hemarthrosis the blood accumulation is insignificant, it does not require special manipulations and will dissolve independently. On the joint impose a fixative bandage, recommend several days of applying cold, to ensure peace and limit the load.

If the blood volume is more than 30 ml, a puncture is used: blood suction and rinsing of the joint cavity. At the end of the procedure, medications are introduced into the cavity and immobilization is performed, the duration of which depends on the underlying injury.

If necessary, repeat the puncture.

Hemarthrosis III degree, as a rule, appears as a result of severe injuries and requires combined treatment in a hospital of the main injury and hemorrhage in the joint.

Poorly treatable and recurrent hemarthrosis of the knee joint is an indication for additional, more detailed examination, since it is required to establish the cause of the repeated bleeding.

Consequences and complications

For example, if there was a left hand injury, and a hemorrhage occurred, but no treatment was performed, then In the joint of the blood, clots are formed which will subsequently undergo fermentation (destruction blood cells). The processes of fermentation disrupt the integrity of the cartilaginous tissue and can provoke the development of degenerative diseases of the elbow joint.

Possible consequences of the disease

In case of recurrence with repeated hemorrhages in the cavity of the left elbow joint, the fermentation process always occurs much more intensively and causes more harm.

The accumulation of blood disrupts the circulation of tissues in the joint cavity and can cause dystrophic changes, often occurring in recurrent hemarthrosis.

Often an unpleasant consequence of fermentation is inflammation of the synovial membrane - synovitis, which, in case of attachment of pathogenic flora (through blood, lymph, or non-compliance with sterility during puncture) from aseptic into an infectious one and can cause purulent arthritis.

A source: https://nebolitsustav.ru/bolezni/gemartroz-kolennogo-sustava.html

Hemarthrosis: symptoms, treatment, rehabilitation

Hemarthrosis is a hemorrhage into the joint cavity that arises in the event of joint damage and, as a result, rupture of the blood vessels that supply this joint with blood.

In most cases, bleeding in the joint is observed after a trauma or a joint injury.

Hemorrhage can occur in any of the joints (hip, ulnar, humerus), but the most common is hemarthrosis of the knee joint.

Quite often, hemarthrosis is observed in the presence of hemophilia, the first signs of this pathology usually appear in early childhood and accompany the patient all his life together with a number of inconveniences and severe pain.

Symptoms of hemarthrosis

Hemarthrosis of the first degree:

• pain in the joint;

• swelling in the joint and small swelling;

• the amount of hemorrhage does not exceed 15 ml;

• support on the leg is slightly difficult, but it is possible and thus it is not accompanied by attacks of the strongest pain.

Hemarthrosis of the second degree:

• the amount of hemorrhage in the joint does not exceed 100 ml;

• The joint acquires the shape of a ball, its volume significantly increases;

• when you feel the joint, you can distinguish the presence of blood clots in it;

• there is a lot of pain.

Hemarthrosis of the third degree:

• the amount of hemorrhage in the joint exceeds 100 ml; in most cases, such changes are triggered by a dislocation or fracture;

• the skin in the joint region acquires a cyanotic hue, the soft tissues become strained and hard;

• in some cases, the skin becomes hot to the touch and the overall body temperature rises;

• support on the foot is almost impossible.

Causes of hemarthrosis

It is accepted to distinguish two types of hemarthrosis: non-traumatic and traumatic.

The main cause of the development of pathology is a bruise or injury to the joint. If the knee is bruised, the hemorrhage usually occurs after falling to the knee, slightly less often in the case of a direct stroke.

Also, hemorrhage in the joint is possible when getting a sports injury (for example, when meniscus ruptures, ligaments) - such damage sportsmen who are engaged in power and running sports are exposed (football, sports gymnastics, karate, wrestling, handball, basketball).

One of the reasons for the development of hemarthrosis may be an intraarticular fracture, which also occurs with falls, which injure the joint, as well as when falling from a height, an accident, unsuccessful landings during a parachute jump.

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Quite often such traumas cause serious consequences, for example, craniocerebral injuries, chest injuries, fractures of hands, legs, spine.

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Minor hemorrhage in the joint cavity may appear during the execution of the planned operation on joint, for example, when cross-linking ligaments, osteosynthesis of the tibia by plates, removal meniscus. In such cases, in the process of rehabilitation after surgery the attending physician necessarily controls the joint condition.

Hemarthrosis of non-traumatic origin occurs when a person has a disease that are associated with a violation of blood clotting (hemorrhagic diathesis, scurvy, hemophilia) and fragility of the walls vessels. Blood vessels in this case can be ruptured, even in the absence of a pronounced effect, and fill the cavity of the joint with blood.

Consequences of hemarthrosis

In the presence of this pathology, the blood begins to accumulate in the joint cavity. Blood clots begin to squeeze adjacent tissues, which causes a violation of blood circulation in them, as a result of a violation of normal trophic tissue.

Blood cells decay, and the products of their decay begin to penetrate into neighboring tissues, reducing the level of elasticity of the latter. In addition, the hyaline cartilage suffers, the ligaments lose their elasticity.

During the movement, the load on the cartilaginous tissue significantly increases, which provokes further destruction and development of arthrosis.

Post-traumatic synovitis usually has a prolonged course (more than two months). It is difficult to treat this pathology, in addition, there is a high probability of recurrence for several months or years.

In cases where the fibrous membrane of the articular capsule suffers, purulent arthritis begins.

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This disease develops when an infection joins the blood that fills the joint.

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The tissue of the joint begins to envelop the pus, after which the cartilage is damaged, which leads to a significant decrease in the motor activity of the joint.

Diagnostics

After bruises, dislocations, joint injuries, a person experiences severe pain and turns to a traumatologist. In the presence of a significant hemorrhage (more than 50 ml) it is possible to palpatorically determine the presence in the joint of blood clots.

Almost always, the doctor prescribes a radiograph of the joint in order to obtain a complete picture of the patient's injuries.

In the presence of non-traumatic hemarthrosis, consultation with specialized specialists is required.

Treatment of hemarthrosis

When injuring the shoulder, elbow, pelvis, knee, you should contact the trauma doctor as soon as possible.

Certainly, it's not always possible to get to a doctor in a matter of minutes, so you need to take primary measures to prevent possible complications.

The first first aid for the development of hemarthrosis includes such actions:

• Provide the victim complete rest and immobilize the damaged joint to prevent additional stress on him. It is better to transfer the patient's limb to an elevated position (for example, to press the hand against the trunk, or put a leg or shoulder on the pillow), which will reduce puffiness;

• impose an iodine network on the damaged area - this will reduce swelling;

• attach to the joint cold - ice, wrapped in a towel or rag, a hot water bottle with cold water.

First of all, the doctor will determine the degree of hemarthrosis in order to estimate the approximate volume of blood gathered in the joint.

Treatment for first-degree hemarthrosis is usually limited to the imposition of an immobilizing plaster bandage, since the blood volume is not more than 15ml usually resolves itself, accordingly, the need for puncture for the deposition of blood from the joint cavity is not present necessity. Apply ice to the joint and reduce the load, physiotherapy is prescribed - UHF.

Treatment of hemarthrosis of the second degree consists of such activities:

• If the volume of blood flow in the joint exceeds 25 ml, it is necessary to perform a puncture for pumping blood from the joint. Puncture is performed under local anesthesia.

  Blood from the joint cavity is removed through the needle, after which the cavity is rinsed with a solution of novocaine (for children - 5-10 ml of 1% solution of novocaine with 50 mg of hydrocortisone, for adults - 20 ml of 2% solution novocaine).

  After this, the joint is immobilized with a plaster bandage.

• After 1-2 days, a repeated diagnosis is performed: when the blood accumulates in the joint, repeated puncture is performed. Usually, hemarthrosis therapy consists of 1-2 punctures, but in rare cases 3-4 manipulations may be required.

• The joint requires complete rest. If there is hemarthrosis of the knee joint, it should be kept on the pillow and moved with crutches.

• After 10-12 days, therapeutic exercise is prescribed, which includes simple movements in the joint, light massage, physiotherapy (paraffinotherapy, ozocerite, baths). Gypsum bandage is removed.

  The next two weeks are aimed at the intensification of joint loads, the gradual restoration of normal functioning.

  Restoring the joint is well promoted by proper nutrition: seeds, nuts, tea with raspberries and currant activates the process of joint regeneration, while sharp and fatty food slows down the given process.

A third degree of hemarthrosis is usually preceded by a serious injury.

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The patient should be hospitalized and conduct an additional in-depth examination: determination of the degree of blood coagulation, consultation with a hematologist, MRI, arthroscopy of the knee joint.

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When carrying out arthroscopy, the damaged pieces of meniscus and cartilage are removed, intra-articular lesions are subjected to correction.

When, as a result of an injury, the joint has been severely damaged or fractured completely, the puncture will not have the desired effect.

In such severe cases, the only effective solution is arthroplasty of the joint - replacement of the joint, which was severely damaged, by an artificial joint.

In case of traumatic hemarthrosis, the prognosis is quite favorable, although much depends directly on the severity of the injury. The faster qualified medical care is provided, the less the risk of recurrences and complications of this pathological condition.

Hemarthrosis in the presence of hemophilia along with a standard therapy scheme is also accompanied by blood transfusion, and intravenous injection of antihemophilic globulin is also required.

Treatment of hemarthrosis in such cases is performed in conditions of hematology department.

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Since the hemorrhage in the joint with such a disease often develops again, the prognosis regarding the preservation of the full range of joint functions is rather vague.

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Prevention of hemarthrosis

• Avoiding injury to the joints: compliance with safety techniques at work, wearing sportsmen and workers with special clothes and shoes.

• When getting a joint injury, it is extremely important to correctly provide pre-medical care, if possible, take the drug to increase blood coagulability, which will significantly reduce the amount of blood poured into the joint cavity.

• With hemorrhagic diathesis, scurvy, hemophilia, it is necessary to undergo scheduled medical examinations from the attending physician.

A source: http://doctoroff.ru/gemartroz