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  1. Hemophiliac Arthropathy
    1. Hemophilia is a X — linked recessive disorder characterized by the absence or deficiency of factor VIII (hemophilia A or classical hemophilia) or factor IX (hemophilia B or christmas disease). Hemophilia A is more common accounting for -85% cases.
    2. Both disorders are manifested only in males but carried by females. Reccurent spontaneous hemarthrosis - chronic synovitis and progressive articular destruction occur in both. Hemarthrosis is not common in other inherited disorders of coagulation; such as von Willebrand’s disease or factor V deficiency.
    3. Plasma clotting factor >40% of the normal are compatible with normal control of haemorrhage. Patients with >5% (mild hemophilia) may have prolonged bleeding after injury or surgery; those with <1% (severe hemophilia) have frequent spontaneous joint and muscle haemorrhage.
  2. Joint Bleeding
    1. Weight bearing joints are most commonly involved, with the frequency of involvement in decreasing order, knee> elbow> shoulder> ankle> wrist> hip.
    2. Joint assumes position of minimal discomfort & minimal intraarticular pressure, which is flexion (30- 65°) abduction (15°) & lateral rotation (15°) in hip; and slight flexion in knee. Pain, warmth, boggy swelling, tenderness and limited movements cause it to resemble with low grade infection
    3. Joint aspiration is avoided unless distension is severe or there is a strong suspicion of infection. Arthroscopy is also relatively contraindicated.
  3. Intramuscular Bleeding
    1. Bleeding into muscle is less common but equally harmful muscle necrosis, reactive fibrosis and joint contractures
    2. In lower limbs most common sites of bleeding is Iliopsoas>quadriceps.
    3. In upper limb the most common site of bleeding is deltoid.
    4. In muscle bleeding usually only those movements that stretch the affected muscle are painful, where as in hemarthrosis all movements are painful.
    5. Hemorrhage into iliopsoas muscle or retroperitoneum may mimic appendicitis or renal colic.
  4. Pseudo tumor
    1. It refers to progressive cystic swelling caused by uncontrolled hemorrhage within confined space. the hematoma increases in size and causes pressure necrosis and erosion of bone (mimicking tumor)
    2. It occurs in severe hemophiliacs only (clotting factor <1% of normal)
    3. Most hemophilic pseudotumors are caused by subperiosteal hemorrhage and the most common location is in thigh (50%)Q. Next in frequency are abdomen, pelvis, and tibia.
  5. Nerve Palsy
    1. Bleeding into peripheral nerve causes intense pain f/b sensory & muscle weakness.
    2. Neuropraxia is primarily due to compression of a nerve from the hematoma. The femoral nerve is most commonly involved as it is in closed, rigid compartment limited by iliacus fascia.
  6. Radiological Features
    1. Soft tissue swelling & capsular distension.
    2. Juxtaarticular osteopenia (not sclerosis)
    3. Overgrowth and osteoporosis of epiphysis
    4. Marginal erosions & subchondral cysts
    5. Narrowing of joint space (with cartilage destruction) & bony over growth
    6. Widening of inter condylar notch of femur and trochlear notch of ulna
    7. Enlargement of proximal radius and squaring of distal end patella
    8. Total loss of joint space and fibrous ankylosis.
Extra Edge:

Heamarthrosis is bleeding into a joint. Causes include trauma, bleeding disorders etc. Treatment of acute hemarthrosis involves factor replacement (in hemophillia) joint aspiration (in servere cases), ice & analgesics (to relieve pain) rest (by a sling for shoulder, bed rest for hip & compressive bandage /POP for elbow, knee & ankle).

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