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Orthopedics Nov 2017The musculoskeletal manifestations of hemophilia A and B are some of the most common presenting symptoms and continue to be challenging to practitioners. Hemophilic... (Review)
Review
The musculoskeletal manifestations of hemophilia A and B are some of the most common presenting symptoms and continue to be challenging to practitioners. Hemophilic arthropathy, if not initially adequately treated and managed, may lead to debilitating disease and eventually require the consideration of major surgery, including total joint arthroplasty. Thorough comprehension of the pathophysiology, diagnosis, and both medical and surgical interventions is critical in establishing an appropriate treatment regimen for these patients. Furthermore, a true multidisciplinary approach involving hematology, orthopedics, and physical therapy is essential for a patient with hemophilic arthropathy. The authors present a comprehensive review of hemophilic arthropathy from an orthopedist's perspective. [Orthopedics. 2017; 40(6):e940-e946.].
Topics: Adult; Arthritis; Arthroplasty; Female; Hemophilia A; Hemophilia B; Humans; Joint Diseases; Magnetic Resonance Imaging; Male; Orthopedic Procedures; Radiography; Ultrasonography
PubMed: 28662249
DOI: 10.3928/01477447-20170619-05 -
The Journal of the American Academy of... Apr 2019Dislocation arthropathy describes the development of progressive degenerative changes of the glenohumeral joint in the setting of instability. Although the specific... (Review)
Review
Dislocation arthropathy describes the development of progressive degenerative changes of the glenohumeral joint in the setting of instability. Although the specific etiology remains unclear, the trauma of a single dislocation, repetitive injury associated with recurrent dislocations, changes in shoulder biomechanics, and complications associated with instability surgery have all been implicated in its development. Pain and restricted range of motion are the most common patient complaints. Conservative management, consisting of pain control, activity modification, and physical therapy, is the first-line treatment after the development of arthropathy. If conservative management fails, multiple surgical options exist. Arthroscopic débridement can be attempted in young, active patients and in those patients with mild-to-moderate arthropathy. Open subscapularis lengthening and capsular release can be done in patients with prior instability repairs that are overly tight. In young patients with minimal bone loss and glenoid wear, surface replacement arthroplasty and hemiarthroplasty are surgical options. In older patients with moderate-to-severe arthropathy, total shoulder or reverse shoulder arthroplasty is the preferred treatment option. Further study is needed to better predict which patients will develop dislocation arthropathy and will thus benefit from early surgical intervention.
Topics: Arthroplasty, Replacement; Arthroscopy; Biomechanical Phenomena; Conservative Treatment; Debridement; Humans; Joint Diseases; Joint Dislocations; Orthopedic Procedures; Pain Management; Physical Therapy Modalities; Range of Motion, Articular; Scapula; Shoulder Dislocation; Shoulder Joint
PubMed: 30278009
DOI: 10.5435/JAAOS-D-17-00056 -
The Journal of the American Academy of... 2004The most common clinical manifestation of hemophilia is arthropathy secondary to recurrent hemarthroses and chronic synovitis. Joint-surface erosions secondary to... (Review)
Review
The most common clinical manifestation of hemophilia is arthropathy secondary to recurrent hemarthroses and chronic synovitis. Joint-surface erosions secondary to chronic synovitis often occur in early childhood and progress to advanced arthropathy by late adolescence. The knee, elbow, ankle, hip, and shoulder are the most commonly involved joints. Management of hemophilic arthropathy has advanced with the development of purified clotting factor concentrates and procedures to prevent chronic synovitis. Radiosynovectomy using beta particle-emitting radiocolloids has been effective in dramatically reducing the frequency of hemarthroses and resolving chronic synovitis. The most common surgical procedures used to manage hemophilic arthropathy are synovectomy, joint debridement, fusion, and joint arthroplasty. Late infection and arthrofibrosis complicate joint arthroplasty more often in these patients than in patients with other forms of arthritis. The high incidence of late infection may relate to frequent intravenous self-infusion of clotting factor combined with immune suppression. Despite the medical and surgical complexities of hemophilic arthropathy, orthopaedic procedures have a high incidence of patient satisfaction.
Topics: Autoantibodies; Blood Coagulation Factors; Chronic Disease; HIV Infections; Hemarthrosis; Hemophilia A; Humans; Joint Diseases; Orthopedic Procedures; Synovitis
PubMed: 15473675
DOI: 10.5435/00124635-200407000-00004 -
The Journal of Orthopaedic and Sports... Nov 2019A 30-year-old woman was referred to physical therapy for bilateral shoulder and thoracic spine pain concurrent with loss of range of motion. Notable medical history...
A 30-year-old woman was referred to physical therapy for bilateral shoulder and thoracic spine pain concurrent with loss of range of motion. Notable medical history included surgical removal of a pituitary adenoma that had resulted in excessive growth hormone secretion, developing into acromegaly with hallmark physical features. Following examination, radiographs were requested to evaluate the extent of arthropathies associated with acromegaly. Radiographs revealed advanced arthropathies of the bilateral acromioclavicular and glenohumeral joints, along with loss of disc height and anterolisthesis throughout the thoracic spine. .
Topics: Acromegaly; Acromioclavicular Joint; Adult; Disability Evaluation; Female; Humans; Joint Diseases; Pain Measurement; Physical Therapy Modalities; Pituitary Neoplasms; Radiography; Shoulder Joint; Thoracic Vertebrae
PubMed: 31672115
DOI: 10.2519/jospt.2019.8302 -
Rheumatology (Oxford, England) Jul 2022
Topics: Aged; Humans; Joint Diseases
PubMed: 34849608
DOI: 10.1093/rheumatology/keab770 -
Hand Clinics May 2011Hemophilia is a hereditary disease in which circulating levels of coagulation factors are lacking, resulting in a propensity toward bleeding. Intra-articular hemorrhages... (Review)
Review
Hemophilia is a hereditary disease in which circulating levels of coagulation factors are lacking, resulting in a propensity toward bleeding. Intra-articular hemorrhages are a hallmark of hemophilia and may lead a cascade of cytokine elaboration and inflammatory-mediated changes, which ultimately result in cartilage loss and arthropathy. Diarthrodial joints, such as the knee, elbow, and ankle, are most commonly affected. This article highlights issues surrounding hemophilic arthropathy of the elbow and focuses on preventive measures, management strategies of the hemophilic elbow, and treatment options for established arthropathy.
Topics: Arthritis; Arthroplasty, Replacement, Elbow; Cartilage, Articular; Debridement; Elbow Joint; Hemophilia A; Hemorrhage; Humans; Joint Diseases; Magnetic Resonance Imaging; Synovectomy; Synovial Membrane; Tomography, X-Ray Computed
PubMed: 21501786
DOI: 10.1016/j.hcl.2011.01.007 -
Hepatology (Baltimore, Md.) Sep 2019
Review
Topics: Adolescent; Arthroplasty, Replacement, Knee; Follow-Up Studies; Hemochromatosis; Humans; Iron Overload; Joint Diseases; Knee Joint; Male; Osteoarthritis, Knee; Radiography; Severity of Illness Index
PubMed: 30562413
DOI: 10.1002/hep.30469 -
Blood Reviews Nov 2012von Willebrand disease (VWD) affects approximately 1% of the population. Joint bleeds are not a predominant symptom of VWD, however they do occur. Especially in patients... (Review)
Review
von Willebrand disease (VWD) affects approximately 1% of the population. Joint bleeds are not a predominant symptom of VWD, however they do occur. Especially in patients with severe VWD, joint bleeds have been described in up to 45% of the patients. Recurrent hemarthroses can lead to joint destruction which is the main cause of morbidity, as is observed in hemophilia patients. In VWD however, the occurrence, severity, onset, treatment and impact of arthropathy have not been well described. This literature review summarizes all publications on arthropathy in patients with hereditary VWD, published until 1-5-2012. Joint bleeds in VWD are associated with low FVIII levels and seem to occur at young age. Depending on the severity of VWD, arthropathy occurs in 2-30% of the patients. Radiological joint damage can be seen but has not systematically been studied. Arthropathy can affect daily functioning and interfere with the quality of life. For acute management of joint bleeds FVIII/VWF concentrates can be used in VWD patients unresponsive to desmopressin or desmopressin in responsive VWD patients. When severe joint bleeds have caused synovitis and arthropathy, chemical or radioactive synovectomy and surgical joint procedures seem feasible to prevent further joint damage. Additional research is needed to learn more about the severity, onset and impact of arthropathy in VWD. Ongoing studies will hopefully answer the question whether prophylactic treatment with coagulation factor concentrates should be considered standard of care in severe VWD to prevent arthropathy.
Topics: Hemorrhage; Humans; Joint Diseases; Joints; von Willebrand Diseases
PubMed: 23010260
DOI: 10.1016/j.blre.2012.09.002 -
Seminars in Ultrasound, CT, and MR Jun 2017Inflammatory arthropathy predominantly affecting the axial skeleton can cause pain, stiffness, disability, and ankylosis. This article discusses the use of... (Review)
Review
Inflammatory arthropathy predominantly affecting the axial skeleton can cause pain, stiffness, disability, and ankylosis. This article discusses the use of cross-sectional imaging in the domain of inflammatory pelvic and axial arthropathy highlighting the key distinguishing features of common known diseases and their differential diagnoses.
Topics: Diagnostic Imaging; Humans; Inflammation; Joint Diseases; Pelvic Pain; Pelvis
PubMed: 28705372
DOI: 10.1053/j.sult.2016.11.007 -
Journal of General Internal Medicine Sep 2018
Topics: Female; Finger Joint; Hand Deformities, Acquired; Humans; Joint Diseases; Lupus Erythematosus, Systemic; Radiography; Young Adult
PubMed: 29987749
DOI: 10.1007/s11606-018-4559-7