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Hip Joint Changes in Hemophilia

Hip Joint Changes in Hemophilia Hip Joint Changes in Hemophilia 1 Max Kahn , M.D. Baltimore, Maryland ↵ 1 Read before the Radiological Society of North America, at the Eighteenth Annual Meeting, at Atlantic City, Nov. 28–Dec. 1, 1932. Excerpt WHILE there are many cases of hemophilia in which joint disturbance is one of the outstanding symptoms of the disease, there are other cases in which the patient may remain free from joint symptoms throughout his lifetime. Schloessman (1) estimates that one-third of all hemophiliacs are free from joint symptoms, whether sporadic cases be examined or whether the members of a single family of males be investigated. The usual onset of symptoms is in the first or second year, following the small injuries to which the joints are normally subjected. Many cases, however, appear to have their onset between the ages of 9 and 13 years, just before adolescence. Apparently hemorrhages in the region of the joints, which are responsible for the hemophilic arthropathy, may, in some cases, occur spontaneously. The knee joint is by far the most frequently involved, followed in the order of their frequency by the elbow, ankle, and hip joints. The hands and shoulder joints are rarely involved. In isolated instances, the fingers or the temporomandibular joints may be affected. In the German literature, joint changes in some cases have been followed for fourteen or fifteen years. In one case, at the age of two, the pain and heat appeared spontaneously, producing a swelling in the sternoclavicular and ankle joints. From that time on to the age of 10, there was pain and limitation of motion in the various joints of the arms and legs, usually lasting for from six to eight days. As a result of these, the knee, elbow, ankle, and hip joints became affected. Most of the attacks occurred without noticeable trauma. In one instance, there was a large hemorrhage into the left knee joint, resulting in flexion and limitation of motion which confined the patient to bed. At the age of 15, the patient had marked enlargement of the left elbow and marked contraction of both knees, which were flexed to about an angle of 45° on the left, and 90° on the right. Both knee joints were thickened and painful. With the exception of the elbow, the other joints remained free from permanent changes. At the age of 30, there were permanent contractures about the left knee so that the patient was compelled to walk on crutches. In the first or second year of the joint disturbance, the roentgenogram is usually negative. Later, when limitation of motion occurs in the joint, the roentgenogram will show atrophy of the neighboring bones. This is followed by destruction of the joint surfaces, with peri-articular irregularities, resembling arthritis deformans. The joint cartilage disappears and the joint surfaces approach each other. Synostosis may occur. Accompanying these intra-articular changes, there are usually peri-articular manifestations. The earliest of these may be a hazy shadow in the soft parts, caused by peri-articular hemorrhage, which later may be followed by calcification and ossification. Copyrighted by The Radiological Society of North America, Inc. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Hip Joint Changes in Hemophilia

Radiology , Volume 22 (3): 286 – Mar 1, 1934

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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1934 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/22.3.286
Publisher site
See Article on Publisher Site

Abstract

Hip Joint Changes in Hemophilia 1 Max Kahn , M.D. Baltimore, Maryland ↵ 1 Read before the Radiological Society of North America, at the Eighteenth Annual Meeting, at Atlantic City, Nov. 28–Dec. 1, 1932. Excerpt WHILE there are many cases of hemophilia in which joint disturbance is one of the outstanding symptoms of the disease, there are other cases in which the patient may remain free from joint symptoms throughout his lifetime. Schloessman (1) estimates that one-third of all hemophiliacs are free from joint symptoms, whether sporadic cases be examined or whether the members of a single family of males be investigated. The usual onset of symptoms is in the first or second year, following the small injuries to which the joints are normally subjected. Many cases, however, appear to have their onset between the ages of 9 and 13 years, just before adolescence. Apparently hemorrhages in the region of the joints, which are responsible for the hemophilic arthropathy, may, in some cases, occur spontaneously. The knee joint is by far the most frequently involved, followed in the order of their frequency by the elbow, ankle, and hip joints. The hands and shoulder joints are rarely involved. In isolated instances, the fingers or the temporomandibular joints may be affected. In the German literature, joint changes in some cases have been followed for fourteen or fifteen years. In one case, at the age of two, the pain and heat appeared spontaneously, producing a swelling in the sternoclavicular and ankle joints. From that time on to the age of 10, there was pain and limitation of motion in the various joints of the arms and legs, usually lasting for from six to eight days. As a result of these, the knee, elbow, ankle, and hip joints became affected. Most of the attacks occurred without noticeable trauma. In one instance, there was a large hemorrhage into the left knee joint, resulting in flexion and limitation of motion which confined the patient to bed. At the age of 15, the patient had marked enlargement of the left elbow and marked contraction of both knees, which were flexed to about an angle of 45° on the left, and 90° on the right. Both knee joints were thickened and painful. With the exception of the elbow, the other joints remained free from permanent changes. At the age of 30, there were permanent contractures about the left knee so that the patient was compelled to walk on crutches. In the first or second year of the joint disturbance, the roentgenogram is usually negative. Later, when limitation of motion occurs in the joint, the roentgenogram will show atrophy of the neighboring bones. This is followed by destruction of the joint surfaces, with peri-articular irregularities, resembling arthritis deformans. The joint cartilage disappears and the joint surfaces approach each other. Synostosis may occur. Accompanying these intra-articular changes, there are usually peri-articular manifestations. The earliest of these may be a hazy shadow in the soft parts, caused by peri-articular hemorrhage, which later may be followed by calcification and ossification. Copyrighted by The Radiological Society of North America, Inc.

Journal

RadiologyRadiological Society of North America, Inc.

Published: Mar 1, 1934

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