Hemarthrosis

HEMARTHROSIS (from Greek haima—blood and arthron—joint), hemorrhage into the joint cavity. It is most often associated with traumatic injury to the joint, but can also occur in other joint diseases, for example, in hemorrhagic diatheses (hemophilia, scurvy). Hemarthrosis of the knee is observed most frequently in the following intra-articular injuries, which were previously grouped into the general category of 'derangement interne': rupture of the cruciate ligaments—anterior or posterior (less often both), damage to the meniscus, and intra-articular fractures. In other joints, hemorrhage also occurs most often after severe trauma and intra-articular fractures. In all these traumatic injuries, the joint capsule often also suffers, in which there may also be ruptures of blood vessels with subsequent hemorrhage into the joint. In joint diseases that belong to the type of hemorrhagic diatheses (hemophilia), even a minor injury can cause a hemorrhage that does not resorb for a long time. Having poured into the joint, the blood, mixing with the synovial fluid, may not coagulate for a long time. Partially, the blood is resorbed through the lymphatic vessels, but part of the fibrin settles on the articular surfaces and the synovial membrane, organizes, and undergoes all phases of organization. Diagnosis of hemarthrosis is not difficult in superficially located joints (knee, shoulder, ankle) and is difficult in joints hidden behind a large muscle layer (hip joint). An increase in the volume of the joint, fluctuation, limitation of mobility, pain, and recent trauma suggest the presence of hemarthrosis. The question is resolved with absolute accuracy by puncture. A long-remaining effusion can lead to expansion of the joint capsule, loss of tone of the periarticular muscles, and a decrease in the stability of the joint. Treatment for hemarthrosis should be aimed at more rapid resorption of the hemorrhage. In the first 1-2 days, the joint should be rested by applying a pressure bandage and ice. Subsequently, one should resort early to light movements and massage, which promotes the absorption of the effusion. Prolonged fixation, on the contrary, leads to subsequent stiffness of the joint. In persistent hemarthrosis, repeated aspiration with the application of a pressure bandage is indicated. Through careful clinical and radiological examination, it is necessary to establish an exact diagnosis of the intra-articular injury, keeping in mind that hemarthrosis is only one of the signs of the injury. In the presence of a meniscus tear, rupture of the cruciate ligaments, or an intra-articular fracture, treatment should be directed accordingly. Therapy in such cases is almost exclusively surgical.