Friday, April 5, 2013

Arthritis from recurrent bleeding into the shoulder

Hemophilic Arthropathy of Shoulder Joints: Clinical, Radiographic, and Ultrasonographic Characteristics of Seventy Patients - J Bone Joint Surg Am, 2013 Apr 03;95(7):e43 1-8

The authors present the clinical, radiographic, and ultrasonographic characteristics of the shoulder joint were studied in a cohort of seventy consecutive patients with hemophilia.  Sixty-six patients had hemophilia A, and four had hemophilia B. The median age was thirty-four years (range, ten to sixty-three years). Fifty-six shoulders in thirty-five patients had shoulder bleeds, and twenty-seven patients (38.6%) had shoulder pain or limited motion. As determined with radiographs, eighteen (25.7%) of the seventy patients had hemophilic shoulder arthropathy. A strong correlation between the functional Oxford shoulder score and the radiographic Pettersson score was also noted (r = 0.749, p < 0.001). The ultrasonographic abnormalities in the fifty-six hemarthrotic shoulders included chondromalacia (76.8%), osseous irregularity (60.7%), bicipital tenosynovitis (60%), partial-thickness rotator cuff tear (35.7%), and full-thickness rotator cuff tear (17.9%). Older age, the absence of any previous prophylaxis therapy, and higher frequency of crutch use were the most significant factors associated with shoulder bleeds.

The authors found that shoulder arthropathy is relatively common in patients with hemophilia. Rotator cuff tears were common in the present study, and there was a strong correlation between shoulder function and the radiographic severity of the arthropathy. 

The authors did not provide an example radiograph; we offer the one below as an example.

While we do not see much of true hemophiliac arthropathy in our practice we do see patients who are on anticoagulants with similar finding that appear to result from recurrent bleeds into the shoulder.

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