Joint Swelling and Hemarthrosis

Swollen and bruised knee after the Tough Mudder
Swelling in your knee may be hemarthrosis. Brett Sears, PT, 2012

I had ACL reconstruction surgery and my doctor said my knee swelling was due to hemarthrosis. What is hemarthrosis and why is it important in physical therapy?

Definition of Hemarthrosis

Hemarthrosis is the term used when bleeding into a joint occurs. Hemarthrosis is an important cause of joint swelling and pain. If you have suffered an injury or have had surgery and notice swelling in your joint, you may have hemarthrosis.

It is a good idea to check in with your doctor to confirm the diagnosis. Definitive diagnosis requires withdrawing the fluid from the joint with a needle and inspecting it for blood.

Hemarthrosis typically leads to loss of range of motion (ROM) around the affected joint, with a loss of flexion (bending) more common than a loss of extension.

Causes of hemarthrosis may include:

  • Trauma
  • Bleeding disorders
  • Neurologic deficits
  • Arthritis
  • Cancer
  • Surgery
  • Fracture near a joint, such that occurs with a Salter-Harris fracture
  • Vascular damage - such as torn blood vessels

Signs and symptoms of hemarthrosis may include:

  • Pain around a joint
  • Swelling in a joint
  • Pain to palpation
  • Redness around your joint
  • Increased tissue temperature around your joint

Treating Hemarthrosis

If you have acute joint swelling, check in with your doctor right away. Your doctor can prescribe treatments to help manage your condition. 

One way doctors treat hemarthrosis is via joint aspiration.

A needle is inserted into your joint, and the fluid is drawn out. This can help relieve your pain, decrease your swelling, and improve your joint ROM.

Physical Therapy for Hemarthrosis

Your doctor may refer you to physical therapy to help treat your hemarthrosis. Your PT will assess your condition and use various treatments to help control your swelling and improve your ROM.

Typically the RICE method is used to treat hemarthrosis. This acronym stands for rest, ice, compression, and elevation. The ice, compression, and elevation help to control the swelling around your joint by mechanically compressing it and by decreasing blood flow to your joint.

More recently, physical therapists are using the POLICE principle to help manage joint swelling. This stands for protection, optimal loading, ice, compression and elevation. Notice the "rest" portion of this protocol is eliminated. Why? Because rest can be helpful, but a more advantageous strategy is to protect your joint, and then use an optimal loading strategy to get your joint moving safely. Your physical therapist can show you the best type of loading, or exercise, strategy to use to treat your hemarthrosis.

Exercises may be prescribed by your physical therapist to treat your hemarthrosis. Exercises focus on improving joint ROM and mobility. If you joint is acutely painful and swelling, exercises should be gentle. As your joint swelling subsides, your PT can increase the intensity of your joint ROM exercises to maximize your mobility.

Sometimes when hemarthrosis is present, muscles around the affected joint may become weakened or inhibited.

Performing strengthening exercises for these muscles or muscle groups can help you return to optimal muscle function.

Your PT may use various modalities to treat your hemarthrosis. These may include:

Remember that your physical therapy should not include only passive modalities; you should also have an active strategy to treat your hemarthrosis and joint swelling.

If you have a condition or injury that causes swelling in one or more of your joints, you may have hemarthrosis. Your doctor can help you manage the pain and swelling, and your physical therapist can help you manage your hemarthrosis to help you return to optimal mobility and function.