Approach to Haemarthrosis
Haemarthrosis – accumulation of blood within a synovial joint
Synovial cavity
space between articular cartilage surfaces filled with synovial fluid
Pathophysiology
Bleeding may result from
Trauma
tears ligament/capsule, fractures into joint, meniscal injury
Coagulopathy
inherited (e.g., haemophilia A/B) or acquired (anticoagulants, liver disease, thrombocytopenia)
Vascular lesions
ruptured synovial vessels in pigmented villonodular synovitis, tumours
Clinical Features & Examination Tips
History
Acute swelling within hours after injury ➡️think haemarthrosis
Past bleeding tendency, anticoagulant use
Family history of bleeding disorders
Examination
Swollen tense joint, often warm but not erythematous
Painful and markedly restricted movement
Fluctuation on palpation, ballotable patella in knee
Look for bruising around joint or elsewhere
Investigations
1. Aspiration – confirms presence of frank blood (should be done under sterile conditions avoid if strong suspicion of fracture without imaging first)
Send for clotting studies on aspirate if needed
2. Blood tests
Full blood count (platelets)
Coagulation profile (PT, aPTT)
Factor assays if haemophilia suspected
3. Imaging
X-ray: exclude fracture
MRI: detect ligament/meniscal injury
Management Principles
Acute trauma ➡️ RICE (rest, ice, compression, elevation), immobilisation, analgesia, and orthopaedic review
Large tense effusion ➡️ aspiration for pain relief (unless contraindicated)
Coagulopathy ➡️correct underlying defect (e.g., factor VIII/IX replacement in haemophilia, vitamin K, reversal of anticoagulants)
Why it matters – Clinical Pearls
Haemarthrosis after minimal trauma is a red flag for bleeding disorders
In anticoagulated patients, always check INR urgently
Blood in the joint accelerates cartilage destruction – repeated episodes can lead to severe secondary osteoarthritis
عمرو الدبور
Approach ❤️
0
Показать ещё
