JOINTS (Knee, elbow, hip, ankle, shoulder and wrist)

Bleed in the joints occurs while playing or due to fall, direct blow and accident. It may also occur without apparent cause. Treatment will include Factor replacement and physiotherapy normally.
Signs and Symptoms:
• Swelling, pain, and decreased functional use of a limb
• For infants and toddlers, the earliest sign may be the failure to use the arm or leg normally. The skin over the joint may be warm and the child may be fractious (irritable). As the child grows older he will be able to describe his sensation as a bleed occurs.
Activity and mobility increase with age and many children with severe hemophilia may have experienced their first joint bleed in the weight bearing joints, i.e. ankles and knees by the age of three.
Treatment indicated: Factor Replacement, Rest, and Physiotherapy. (Short-term splinting may be required)
Synovitis (Chronic joint swelling):
HOW IT OCCURS:
All joints are lined with a tissue called synovium which produces a fluid that lubricates the joint. For persons with hemophilia, this lining often becomes thickened as a result of repeated bleeding episodes. Synovitis can be acute (lasting for only a couple of weeks) or chronic (a persistent joint swelling that does not go away). As more haemorrhages occur within a joint, the synovium becomes more thickened thus reducing the space within a joint, which in turn may lead to nipping of this membrane during movement, causing further bleeding. If this cycle of bleeding continues there will be eventual further damage (hemophilic arthropathy). Hemophilic synovitis is commonly seen between the ages of 6 and 16 years.

Signs and Symptoms:
• Persistent swelling (large but not tense) - minimal or tenderness
• Full range of joint movement,
• Lack of rapid improvement with factor replacement
• No heat are the signs and symptoms of synovitis.

Treatment:
• Aggressive prophylactic therapy
• Intense physiotherapy programmes, i.e. ice and exercises.
• Sometimes treatment by injection of rifampicin or radioactive substance in the joint is required
• Surgery may be indicated in some case to remove the synovium.
Management of chronic synovitis in the knee joint:
• Apply splint in the manner shown in fig. for 6-12 weeks
• This is to be worn throughout the day and can be removed while going to bed
• Perform Isometric Thigh muscle exercise(tightening the patella) 10 times every hour.