Hemarthrosis - Bleeding into a Joint

Bleeding into a Joint Can Cause Pain and Swelling

x-ray showing knee injury
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What Is Hemarthrosis?

Hemarthrosis is the medical term for bleeding in a joint. When you have pain and swelling in a single joint (monoarticular), hemarthrosis is a common cause.

It is a cause for concern not only because of the pain, but because prolonged blood exposure can damage the cartilage. Studies done in vitro (in the test tube) showed blood exposure causes the death of the cells that produce cartilage and inhibit the production of cartilage components.

This is of special concern for osteoarthritis patients, who already have degeneration of articular cartilage. It is also a concern for people with hemophilia, as they are at risk for hemarthrosis and thus at risk for cartilage damage and loss.

How Is Hemarthrosis Diagnosed?

While your medical history, physical examination and imaging studies can be helpful in formulating the diagnosis of hemarthrosis -- it's a joint aspiration (arthrocentesis) that can offer a definitive diagnosis. Your doctor will want to enter the joint with a needle and draw off the joint fluid to be analyzed, first visually by your doctor but also it will usually be sent to the laboratory for full analysis.

Joint fluid that is associated with hemarthrosis is typically reddish, pinkish or brownish. Other abnormal characteristics of the joint fluid may suggest what is the underlying cause of your hemarthrosis.

What Can Cause Hemarthrosis?

There is a wide array of conditions that can cause hemarthrosis including:

  • trauma - a blunt injury or fracture of a joint can cause bleeding into it. A twisting injury or blow to the knee can also cause hemarthrosis and rapid swelling. In some cases, minimal knee trauma results in hemarthrosis, often due to underlying clotting or collagen disorders. In those conditions, it may not take much of a bump at all to result in hemarthrosis.
  • bleeding disorders - hemophilia is associated with acute hemarthrosis, with rapid joint swelling. This can also be seen in people who are under treatment with anti-coagulants such as warfarin.
  • neurological disorders
  • neoplasms (tumors) - a tumor may disrupt the blood vessels in a joint, plus the tumor may develop its own blood supply and this can result in hemarthrosis.
  • vascular damage
  • osteoarthritis - cases of spontaneous hemarthrosis have been seen in patients with lateral compartment osteoarthritis, often associated with a degenerative flap tear in the lateral horn of the meniscus.

Can Hemarthrosis Be Successfully Treated?

Treatment for hemarthrosis depends on the cause. For large bleeds, joint aspiration may be done within two days of the bleed to prevent damage the blood can cause in the joint. In acute hemarthrosis with hemophilia, clotting factors may be given. Pain control and rest-ice-compression-elevation (RICE) is often used as conservative treatment.

For osteoarthritis, some patients have reportedly experienced recurrent hemarthrosis after knee arthroplasty, while others report spontaneous hemarthrosis in the knee.

Synovectomy (removal of joint lining), meniscectomy and osteotomy have been used with success when treating hemarthrosis. Another technique, known as ablation, provides debridement limited to the diseased tissue.

If this happens to you, your doctor will make an appropriate assessment and offer treatment recommendations.


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Recurrent hemarthrosis after knee joint arthroplasty: Etiology and treatment. The Journal of Arthroplasty (2004).

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