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What Is Hemarthrosis?

Medically Reviewed by Melinda Ratini, DO, MS on June 02, 2021

Hemarthrosis is a condition characterized by an artery bleeding in a joint cavity where two bones meet. It's common following an injury or in people who suffer from bleeding disorders like hemophilia. Learn about the signs of hemarthrosis and how to treat and prevent bleeding in your joints.

Understanding Your Joints

Your body has many joints, from small ones that allow you to bend your fingers to larger ones like your hips and knees. You have a joint that allows a range of motion where any two bones meet.

Some joints are synovial joints, named after the fluid between your bones. Synovial fluid protects your bones by serving as a cushion. It allows bones that meet to slide past one another during movement without friction that may cause damage. 

Synovial joints include your:

  • Shoulders
  • Hips
  • Elbows
  • Wrists
  • Hands
  • Knees
  • Ankles
  • Feet 

Non-synovial joints include your:

  • Spine
  • Ribs
  • Skull
  • Pelvis

Understanding the Causes of Hemarthrosis

When blood flows into your synovial joints, it negatively impacts the synovial fluid, leading to joint damage. If it happens because of an injury, you’re likely to heal and recuperate. But if it repeatedly happens to a joint, it can lead to arthritis. When damage is severe, you can’t move your joint without pain. Most of the time, repeated cases of hemarthrosis are due to an injury rather than a blood disorder.

‌‌Injuries range from minor to severe. In a minor injury, you may not even realize you have hemarthrosis, even with signs of damage to your joint. An injury doesn’t have to be painful to be traumatic to your joint.

When an artery bursts in one of your joints, synovial fluid mixed with blood floods the joint area. If you experience swelling following an injury, it likely involved damage to your soft tissue, bone, ligaments, or cartilage.

Blood disorders and other conditions that contribute to hemarthrosis include:

  • Hemophilia
  • Other coagulation factor deficiency disorders
  • Advanced liver or renal disease
  • Vitamin K deficiency
  • Disseminated intravascular coagulation‌
  • Anticoagulation medication use‌

Other health conditions that may lead to hemarthrosis include: 

  • Neurologic deficits
  • Arthritis
  • Neoplasm‌
  • Vascular damage

Diagnosing Hemarthrosis

If you think you're prone to joint bleeding, talk to your doctor. You may have one or more painful joints, persistent or recurring swelling, and loss of movement in your joints. First, your doctor asks about your concerns, so be prepared to provide as many details as you can.

Next, your doctor completes a physical exam to determine the following steps. Your doctor will want to rule out other possibilities and pinpoint a reason for your hemarthrosis. Tests may include:

  • Taking a sample of your joint fluid
  • X-rays
  • Imaging tests like MRIs‌
  • Blood Test‌

If your joint is swollen, your doctor may want to extract a sample to see if any blood is mixed in with your synovial fluid. They use a sterilized needle to inject into the joint and withdraw a sample. This technique may also be used to relieve pressure on your joint.

Your doctor tests the fluid for signs of a bacterial infection, gout, and other disorders. Your doctor may not test joint fluid if you already have a known chronic health condition like osteoarthritis.

An X-ray won’t show damage to your soft tissue or cartilage. It will help determine if damage to the area was severe enough to fracture your bone or uncover a bone tumor or osteonecrosis.

An MRI or CT scan is more detailed than an X-ray and shows your joints, tendons, and muscles in addition to bones. These scans are used to look for abnormalities in your joints that may contribute to hemarthrosis. They also show minor fractures that may not appear on an X-ray.

Treating Hemarthrosis

In hemophilia, replacement of the missing blood factor should be done as soon as bleeding in a joint is suspected. When hemarthrosis is treated early, you can prevent chronic joint disease. No matter the cause of hemarthrosis, the following treatments are typically used as well: 

  • Home treatment, such as immobilization, ice packs, and compression
  • Physical therapy‌
  • Orthopedic surgery
  • Pain medicine

Preventing Hemarthrosis

The best way to address hemarthrosis is to prevent it. In hemophilia, this means using regularly scheduled infusions as prophylaxis or a preventative measure. In all cases of hemarthrosis, the same treatments used to address the condition may also help prevent damage from being severe. Your doctor may use a splint to immobilize your joint and allow it to heal quicker. It’s important to rest a joint that sustains damage to prevent continued bleeding.

Your doctor wants you to increase your strength around joints that are particularly affected by hemarthrosis. This helps to improve your range of motion and balance, leading to fewer injuries during everyday activities.

It’s also important to maintain a healthy diet and healthy weight. When you get the right nutrients, like calcium and vitamin D, to maintain strong bones, you’re less likely to suffer from hemarthrosis. When you maintain a healthy weight, you have less pressure on your joints, limiting the everyday wear and tear that occurs.

Show Sources

SOURCES:

CDC: “Joint Disease.”

Hemophilia of Georgia: “Untreated Bleeding in the Joints.”

Lombardi, M., Cardenas, A., Hemarthrosis, StatPearls, 2020.

Merck Manual: “Joint Pain: Single Joint.”

UpToDate: “Overview of hemarthrosis.”

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