Overview and Treatment of Hemarthrosis

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Hemarthrosis is bleeding in a joint caused by conditions such as hemophilia, physical trauma, or other factors. It is often suspected because of the pain, swelling, and joint stiffness it can bring about, which could take weeks or months to resolve. Treatment is essential since lengthy exposure to blood can damage the cartilage of your joints.

Causes

A variety of conditions can cause hemarthrosis. It can appear after a joint injury or it may develop spontaneously if you are prone to bleeding.

Common causes of hemarthrosis include:

  • Traumas, such as a major joint injury, strain, or tear. Any of these can cause rapid bleeding into one or more of your joints.
  • Bleeding disorders such as hemophilia, a hereditary disease in which the blood does not clot properly. While hemophilia is the most common bleeding disorder, there are several bleeding disorders that can make you prone to excessive bleeding as well.
  • Blood thinners such as aspirin, or anticoagulants such as warfarin, may make you more susceptible to bleeding in any part of your body, including your joints. You can bleed spontaneously, but typically, bleeding occurs as a result of mild to moderate trauma.
  • Osteoarthritis, often associated with a degenerative flap tear in the meniscus (a protective covering of your joint), can result in bleeding into a joint.
  • Surgery can sometimes lead to complications such as bleeding into a joint.
  • Neoplasms (cancer) may disrupt the blood vessels in a joint. Additionally, a tumor may develop its own blood supply, which can include fragile blood vessels that can easily tear or bleed, resulting in hemarthrosis.

    Symptoms

    Signs and symptoms of hemarthrosis can range from mild to severe and are generally worse if there is a large amount of bleeding.

    Symptoms include swelling, bruising, stiffness, pain, redness or warmth in the joint.

    While it is wise to bring any such symptoms to your doctor's attention, it is especially so if you are particularly at risk for this condition.

    Complications

    If allowed to progress, hemarthrosis can inflame and thin cartilage, causing pain, weakness, degenerative arthritis, or additional bleeding into the joint. In severe or prolonged cases, the condition can result in permanent changes in joint structure and function.

    Diagnosis

    Your doctor can usually identify the condition by visually examining your joints. When you have pain and ​swelling in a single joint (monoarticular), hemarthrosis is considered a possible cause. Imaging studies may also be helpful in identifying blood in and around your joint.

    Joint aspiration (arthrocentesis) can offer a definitive diagnosis. Your doctor will insert a needle into your joint, collecting a sample of the joint fluid. The fluid will first be analyzed visually by your doctor and may also be sent to the laboratory for full analysis.

    The joint fluid that is associated with hemarthrosis is typically reddish, pinkish, or brownish. Other characteristics of the joint fluid may also help identify the underlying cause of your hemarthrosis.

    Treatment and Prevention

    Treatment for hemarthrosis depends on the cause and may include simple at-home remedies, medication for the relief of pain and swelling, removal of the blood, and/or medication to prevent bleeding.

    Treatment options your doctor may suggest include:

    • Resting and using ice, compression, and elevation (RICE) is often used for the management of pain and swelling.
    • Avoiding blood thinners would help you heal faster. Many over-the-counter pain medications, such as Advil (ibuprofen) and Aleve (naproxen), are also blood thinners and can exacerbate bleeding. Do not take any pills for pain relief unless recommended or prescribed by your doctor.
    • For large bleeds, joint aspiration may be done within two days of the bleed to prevent damage that the blood can cause in the joint.
    • Surgeries such as synovectomy (removal of the joint lining), meniscectomy, and osteotomy have been used for the treatment of hemarthrosis. Another technique, known as ablation, provides debridement (careful removal) limited to the diseased tissue.
    • Tailored physical therapy (PT), designed to use your joints while avoiding overuse or damaging motions, can help you recover and prevent deformities. PT may be the only therapeutic intervention you need, or it may accompany joint aspiration or surgery. Electrical therapy with transcutaneous electrical nerve stimulation (TENS) has been used for pain control with limited success.

      As a preventive measure, blood-clotting medication (prophylactic blood clotting factors) may be recommended if you are at risk of developing hemarthrosis due to hemophilia. In general, blood-clotting medications can be dangerous, potentially inducing blood clots that can cause strokes or heart attacks. These drugs can prevent bleeding, but not remove blood. You will only receive blood-clotting medications if you have a bleeding disorder, and you will be closely monitored for complications if you receive this treatment.

      A Word From Verywell

      Hemarthrosis is not a common condition, but it's worth knowing about the potential complications. Mild to moderate joint bleeding should resolve with time. Treatment can alleviate the pain, discomfort, and swelling associated with the condition, and can help prevent long-term complications and joint damage. If you have swelling of one or more joints in your body, you should see your doctor. If you experience rapid or severe swelling, you should seek prompt medical attention.

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      Article Sources

      • Manners PJ, Price P, Buurman D, Lewin B, Smith B, Cole CH. "Joint Aspiration for Acute Hemarthrosis in Children Receiving Factor VIII Prophylaxis for Severe Hemophilia: 11-year Safety Data." The Journal of Rheumatology. 2015 May;42(5):885-90.

      • van Baardewijk LJ, Hoogeveen YL, van der Geest ICM, Schultze Kool LJ. "Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated." The Journal of Arthroplasty. 2018 Apr;33(4):1177-1180.e1.