Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;29(3):883-891.
doi: 10.1111/hae.14791. Epub 2023 Apr 20.

Monitoring recovery of joints after bleeding: Physical examination and ultrasound are complementary

Flora H P van Leeuwen  1 , Kathelijn Fischer  2 , Wouter Foppen  1 , Lize F D van Vulpen  2 , Merel A Timmer  2
Affiliations

Monitoring recovery of joints after bleeding: Physical examination and ultrasound are complementary

Flora H P van Leeuwen et al. Haemophilia. 2023 May.

Abstract

Aim: Traditionally, recovery after a joint bleed in people with bleeding disorders is evaluated by clinical symptoms. Following a bleed, however, asymptomatic joints may still show synovial hypertrophy and effusion on ultrasound. We evaluated the duration of full recovery from a joint bleed. Additionally, we determined how recovery differed when assessed by physical examination and ultrasound.

Methods: In this retrospective cohort study, we investigated joint bleeds in elbows, knees and ankles of people with haemophilia or Von Willebrand disease who attended the Van Creveldkliniek between 2016 and 2021. Physical examination (warmth, swelling, range of motion and gait) and ultrasound (effusion and synovial hypertrophy) were performed within 7 days after the onset of the bleed, 1 week after the first examination and monthly thereafter until patients had recovered fully. Joint bleeds were treated in line with the current international treatment guidelines.

Results: We evaluated 30 joint bleeds in 26 patients. The median recovery time was 1 month (range 0.3-5 months). In 47% of the joint bleeds, the recovery took longer than 1 month. The moment of recovery based on physical examination and ultrasound differed in 27% of bleeds. Both persistent abnormalities at physical examination in joints with normalized ultrasounds and persistent ultrasound findings in clinically recovered joints occurred.

Conclusion: Joint bleed recovery can take long and recovery times differed per bleed. Recovery differed when assessed by physical examination or ultrasound. Therefore, both should be used to closely monitor recovery of joint bleeds and offer personalized care.

Keywords: haemarthrosis; haemophilia; physical examination; ultrasonography.

PubMed Disclaimer

References

REFERENCES

    1. Berntorp E, Fischer K, Hart DP, et al. Haemophilia. Nat Rev Dis Prim. 2021;7(1):45.
    1. Fischer K, Steen Carlsson K, Petrini P, et al. Intermediate-dose versus high-dose prophylaxis for severe hemophilia: comparing outcome and costs since the 1970s. Blood. 2013;122(7):1129-1136.
    1. van Galen KPM, Mauser-Bunschoten EP, Leebeek FWG. Hemophilic arthropathy in patients with von Willebrand disease. Blood Rev. 2012;26(6):261-266.
    1. Jansen NWD, Roosendaal G, Lafeber FPJG. Understanding haemophilic arthropathy: an exploration of current open issues. Br J Haematol. 2008;143(5):632-640.
    1. Pulles AE, Mastbergen SC, Schutgens REG, et al. Pathophysiology of hemophilic arthropathy and potential targets for therapy. Pharmacol Res. 2017;115:192-199.

Grants and funding

LinkOut - more resources