Hemarthrosis – filling the joint with blood. Unfortunately, injuries are often found in people of any age and at different times of the year. At the time of the injury, which is accompanied by rupture of blood vessels, bleeding occurs in the cavity of the joint capsule. A blood-filled joint is deformed by stretching the walls of blood, which causes pain. Another cause of pathology can be blood diseases and weakness of the walls of blood vessels. For the treatment of hemarthrosis, a puncture is performed and the joint is immobilized.
Description of hemarthrosis
Most often, hemorrhage in the joint is diagnosed in people of young and middle age. This is due to increased physical activity, carelessness, which leads to injuries. Any joint can be a place of localization of injuries complicated by hemarthrosis. If blood enters the joint bag in small quantities, there is a high probability that treatment will not be required and the internal hematoma will resolve on its own.
Another scenario is ahead if the integrity of the knee joint is impaired. In this case, inpatient treatment is indispensable. Knee hemarthrosis threatens with serious complications and requires strict adherence to the doctor’s recommendations.
Causes of appearance
Given the etiology, hemarthrosis is divided into traumatic and non-traumatic. The first group appears as a result of damage to large vessels surrounding the joint, and the second category develops in the presence of a history of blood diseases or increased fragility of the vascular wall.
Types of injuries that provoke hemarthrosis:
- severe bruising with internal bleeding as a result of a blunt bump or fall;
- rupture of ligaments or meniscus during sudden movement during training or sporting events;
- closed fractures – violation of the anatomical integrity of the joint and blood vessels lead to the development of complications;
- after surgery on the movable joint as a result of damage to the vascular wall.
Non-traumatic hemarthrosis is preceded by two categories of pathologies:
- diseases associated with impaired blood composition;
- conditions occurring in combination with vascular diseases.
The first group includes hemophilia, in which blood coagulation is impaired. A rare hereditary pathology occurs in the male and is in the danger of hemorrhage in the joint with minor damage.
Vascular pathologies that cause hemarthrosis:
- Vasculitis – inflammation of the vessel wall;
- Aneurysm of the vessel – stretching of the artery with the formation of protrusion;
- Congenital vascular pathology;
- Fragility and dystrophy of the vascular wall with a deficiency of vitamins and minerals.
Clinic of pathology
With hemarthrosis, the blood fills not only the cavity of the joint capsule, but also all the sinuous lumens of the knee joint. As a result, the walls are stretched, and a swelling appears in the joint area. With strong filling, the joint can become spherical in shape.
Pain is one of the main signs that characterize hemarthrosis. Pain syndrome is a consequence of the pressure that blood exerts on the walls of the joint and surrounding tissues. Stiffness and loss of motion function appear in the joint.
Conventionally, in medical practice, hemarthrosis is divided into three degrees, depending on the fullness of the joint:
- The first degree – the amount of biological fluid does not exceed 15 ml, while the joint increases slightly, almost no edema is observed. Aching pain, strictly localized in the area of the damaged area, causes slight discomfort and may intensify when trying to make a movement.
- The second degree – the blood volume is approximately 100 ml. Excessive filling makes the joint swollen with smooth contours, resembling a ball in shape. A pain symptom gains strength, and accompanies not only active movements, but also a state of rest.
- The third degree, resulting from heavy bleeding, when the joint bag is filled with more than 100 ml of blood. In this case, a strong increase in the joint occurs, the pain becomes unbearable and is bursting. The skin over the damaged area turns blue against the background of a local increase in body temperature. On palpation, a strong tension of the tissues is noted, when you press the joint with two fingers of one hand from opposite sides, a slight push is felt.
The manifestations of additional symptoms in traumatic hemarthrosis include piercing pain, the joint becomes unstable, soreness occurs when pressure is applied to a bone 6 cm above or below the joint.
Non-traumatic hemarthrosis does not cause severe pain, the syndrome is moderate. The characteristic manifestations include switching off from the process of movement not only the damaged joint, but also the entire limb.
Accumulated blood during prolonged stagnation tends to decompose and causes damage to articular tissues. The natural reaction of the body will be the development of inflammation in the injured joint. In addition, blood is a favorable environment for the propagation of pathogenic microorganisms. Joining an abscess infection threatens the development of purulent arthritis, which causes general intoxication of the body.
Inflammation can also spread to the inner (synovial) membrane, causing synovitis. More often this complication accompanies the chronic course of hemarthrosis. A great danger is the formation of fibrin filaments and their deposition on the intraarticular surface, which leads to the formation of scars that impede movement.
Damage to tissues with hemarthrosis negatively affects the structure of the cartilage, leading to its degeneration. Destructive processes cause arthrosis of the joint with its subsequent deformation and destruction.
Recognizing hemarthrosis is easy. An experienced specialist is enough to visualize clinical symptoms and knowledge of the history that precedes the pathology. To determine the degree of damage to bone tissue after an injury, radiography is prescribed. If there is a suspicion of injury to the connective tissue, MRI and arthroscopy are performed.
To determine the non-traumatic form, coagulation indicators are evaluated. A consultation with a hematologist will help you correctly decipher the result of the analysis and prescribe the appropriate treatment.
Injury of any nature requires consultation of a traumatologist. Sometimes it’s impossible to correctly assess the degree of damage yourself, and delaying treatment for later is fraught with the development of complications. A favorable outcome from treatment primarily depends on an early diagnosis of hemarthrosis: the sooner treatment is started, the faster recovery will occur.
As part of the first medical treatment of the injured area, it is necessary to create peace. If the lower limb is affected, it is laid on a flat surface so that the foot is above the level of the heart. To prevent edema in the injured joint, you will need not only a physiological position, applying cold is recommended for no more than fifteen minutes. A time limit is required to prevent hypothermia of the joint. As a cold, you can use chilled foods, a heating pad with ice or a hypothermic package for first aid.
With hemarthrosis of the knee, the patient is taken to a hospital for further examination. After confirming the diagnosis, an effective treatment regimen is prescribed. Therapy at home is possible if the volume of accumulated blood does not exceed 15 ml. In this case, they are limited to bed rest, in the first two days the limb is placed on a raised platform and cold is applied every four hours. The leg remains fixed during the treatment of the main injury. The intraarticular hematoma resolves independently over time.
With the accumulation of a large volume of blood, a more complex treatment will be required, which is carried out in a dispensary. To extract blood, a puncture is prescribed under sterile conditions. Under local anesthesia, a needle is inserted into the cavity through which blood is removed. An analgesic (Novocaine) is poured into a cleaned capsule, with extensive damage – steroid hormones (Hydrocortisone, Triamcinolone), as an anti-inflammatory and decongestant.
After the above procedures, a pressure bandage in the form of a ring and a plaster cast on the back of the thigh and lower leg are applied to the knee. At rest, the limb should remain for about three weeks. After the first puncture, blood in the joint may appear again, in this case the procedure is repeated 2-3 more times.
The presence of an infectious factor, as the main cause or complication of hemorrhage, entails the appointment of antimicrobial antibiotic therapy (Ceftriaxone, Ampicillin). To determine the causative agent, an exudate is collected, followed by a cytological and bacteriological study.
Hemarthrosis with heavy bleeding is a complication of severe injuries with damage to large vessels. There are situations that a pathological condition occurs without injury. In this case, an in-depth examination is carried out with the participation of hematologists and phlebologists for the presence of diseases of the blood or peripheral vessels.
A major cause for concern is the repeated occurrence of relapses. A common cause of recurring hemarthrosis can be damage to the cartilage tissue with the separation of small pieces from it. Diagnostic examination is carried out using an arthroscope, which is inserted into the joint through a microscopic hole. If foreign bodies are detected, they are removed during the manipulation.
Hemarthrosis associated with hemophilia requires specific therapy: transfusion of blood plasma with concentrates of coagulation factors and the introduction of specific antiglobulin, which normalizes the amount of enzyme to improve blood coagulation. For treatment, such patients are hospitalized in the hematology department.
To prevent the appearance of hemarthrosis, it is enough to eliminate the causes that provoke its appearance:
- if possible be careful, avoid injuries;
- during sports related to team play, during which a power confrontation is expected (football, hockey, basketball), wear protective equipment or preventive orthoses;
- in the presence of hereditary blood diseases, timely carry out planned treatment;
- Vitamin therapy courses and a balanced diet strengthen blood vessels and immunity.
After a knee injury of any nature, contact the emergency room to determine the severity of the injuries in order to initially diagnose the accumulation of blood in the joint. Timely medical care and proper treatment predict a favorable outcome for a full recovery.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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