Hemarthrosis of the knee joint code ICD 10

What is hemarthrosis? This is a hemorrhage into the joint cavity, which occurs with closed injuries to the joint. In case of open injuries with a violation of the integrity of the joint capsule, accumulation of blood in the joint cannot occur, since the blood flows out through the wound.

Hemarthrosis often accompanies:

Joint bruises . With bruises, hemorrhages are always observed, the degree of which ranges from minor bruising to extensive hematomas. Hemorrhage occurs either in the tissue surrounding the joint or in the capsule cavity.
Sprains and tears of the ligamentous apparatus of the joint . They occur due to overstrain of one ligament or group of ligaments. This type of injury does not occur as a result of direct violence, as with a bruise, but during movement performed in a direction or volume unusual for the joint. In this case, the ligaments that strengthen the joint in a certain direction are subjected to supernormal load, exceeding the limit of their physiological elasticity. Ligament rupture occurs with hemorrhage into the joint cavity.
Intra-articular fractures . With an intra-articular fracture, more pronounced hemarthrosis is observed, since here blood flows into the joint cavity not only from damaged vessels of the capsule and ligamentous apparatus, but mainly from the vessels of the damaged bone. Even in cases where there is only a crack penetrating into the joint, hemorrhage into the joint cavity sometimes reaches significant sizes.

The most pronounced hemarthrosis is the knee joint, due to the superficial position of the latter, then in the elbow, ankle and shoulder joints. Hemarthrosis of the hip joint is difficult to determine because it is located deep in the muscles.

Causes and symptoms of the disease

A description of hemarthrosis is included in the reference book on the International Classification of Diseases, which contains diagnostic information.
In ICD 10, the disease is coded M25.0. Codes are used for the convenience of processing and storing information data. Clinical and diagnostic terms used in the Russian version of the ICD 10 reference book correspond to domestic practice. Hemarthrosis of the knee or other joint can be caused by various types of injuries.

Bleeding is possible when bones that have articulation in the joint are fractured or dislocated.
Hemarthrosis can occur as a result of sprained or torn ligaments.
Damage to the capsule or meniscus can also cause this disease.
Injury to blood vessels due to soft tissue bruises can cause bleeding and accumulation of blood in the joint capsule.

Symptoms manifest themselves more quickly in children, so after a bruise or injury, the child must be immediately shown to a specialist.

Hemarthrosis, which appears as a result of injury, is characterized by the presence of a certain clinical picture.

Due to the sudden rupture of blood vessels, blood begins to penetrate into the cavity of the injured joint, which leads to its rapid swelling.
Pain in the knee joint and decreased mobility are caused by an increase in the size of the capsule, which begins to put pressure on surrounding tissues.
After bleeding starts, the knee quickly swells and swelling appears on its sides.
If the blood continues to flow, then swelling appears on the front of the joint, its contours are smoothed out.
The rupture of a large vessel is manifested by cyanosis of the skin; with the destruction of small and medium-sized vessels, the skin acquires a purple tint, and hyperthermia of the integument is present.
There is a feeling of weakness in the joint, and the pain intensifies during palpation. Post-traumatic hemarthrosis manifests itself quickly, often its symptoms develop within 1.5-2 hours.

Causes of occurrence and preferential localization

Contusion of the knee joint
The main provoking factor in the development of hemarthrosis is almost always injury to the joint. The knee is more susceptible to injury than others due to its multiple functionality. Damage may result in:

bruise (potentially possible on any knee segment);
damage to ligaments and tendons (partial tear, rupture, sprain);
fracture of bone segments (simple, comminuted, displaced);
meniscus injury;
invasion of the cartilaginous structures of the joint (traumatic or degenerative-dystrophic).

Non-traumatic hemarthrosis is also possible if the patient has problems with blood clotting (hemophilia), scurvy or bleeding diathesis. Such people may experience hemarthrosis during any everyday processes that can cause damage to the vessel wall due to pathological fragility and loss of elasticity.

Postoperative hemarthrosis can occur due to incorrectly performed surgery and is associated with existing vascular damage. Hemoarthritis, as a condition, is just a secondary symptom of underlying vascular damage. Blood spilled into the joint capsule is a consequence of an existing injury. If this is the result of internal pathologies of the body, it can become chronic. It makes sense to treat it after the root cause has been eliminated or partially relieved, and this is the main condition for rehabilitation.

Traumatologists consider damage to the knee joint to be the predominant cause of hemarthrosis, while all others lead to pathology much less frequently. It is impossible to determine the predominant frequency of the right or left joints.

Hemarthrosis of the knee joint: symptoms, first aid and treatment

Hemarthrosis is a disease manifested by hemorrhage into the internal cavity of the joint capsule. This condition can occur as a result of traumatic exposure or if the patient has poor blood clotting.

Hemarthrosis of the knee joint most often develops due to injury. Due to the hemorrhage that has occurred, the pressure of the joint fluid inside the joint increases.

Due to the complexity of the structure of the knee, elbow and ankle joints, blood accumulation does not resolve quickly. Such a pathology requires medical intervention and special therapy.

A description of hemarthrosis of the knee, elbow and ankle joint is included in the international directory of classification of diseases. It combines all diagnostic information. In ICD 10, hemarthrosis has code M25.0.

Codes are necessary for storing information data and making it easier to process. The diagnostic and clinical terminology used in the Russian version of the medical reference book corresponds to domestic practice.

Hemarthrosis of the knee, elbow or ankle joint can develop as a result of various injuries:

If articular bones are dislocated or fractured, bleeding may occur.
Hemarthrosis in the knee joint and its symptoms can occur due to sprain or rupture of ligaments.
Injury to soft tissue vessels can cause bleeding and accumulation of blood in the joint and capsule.
Damage to the meniscus or joint capsule can cause hemarthrosis.

Symptoms of the disease are more pronounced in children. Therefore, immediately after an injury, the child should be seen by a doctor. Traumatic hemarthrosis of the knee, elbow or ankle joint is characterized by the presence of a certain clinical picture:

Blood appears in the joint as a result of a sudden rupture of blood vessels and begins to flow into the cavity of the injured joint, which provokes its rapid swelling.
Pain in the joint and decreased mobility are caused by an increase in the size of the joint capsule. It begins to put pressure on surrounding tissues.
After bleeding begins, diarthrosis quickly swells, which is especially noticeable on the sides.
If the bleeding does not stop, the tumor begins to appear in front. The contours of the joint are smoothed out.
When a large vessel ruptures, the skin becomes blue. If the rupture occurs in small and medium-sized vessels, the skin acquires a purple tint and local hyperemia is noted.
A patient with diarthrosis feels weak, and during palpation the pain intensifies.

Symptoms of post-traumatic hemarthrosis of the ankle, knee and elbow joints develop within 1.5-2 hours.

To prescribe adequate treatment, the doctor must be confident in the correctness of the diagnosis. For this purpose they prescribe:

X-ray.
MRI.
Ultrasound of the knee joint.

In order to exclude infectious inflammation, arthritis and to determine signs of hemarthrosis, a puncture of the cavity of the joint capsule is performed. The presence of blood in the test indicates the presence of hemarthrosis of the ankle, knee or any other joint.

Note! Chronic hemarthrosis of the knee joint is a very dangerous disease. Untimely treatment of the pathology threatens the patient with multiple complications.

Treatment of the disease consists of removing blood exudate from the joint cavity. After this, the capsule is washed with saline and medications are injected into the cavity to eliminate bleeding, inflammation and pain.

Hemarthrosis in the primary stage is quite easy to cure. The treatment procedure is carried out under local anesthesia, in the following order:

Fluid and blood are removed from the internal cavity of the knee joint with a syringe with a thin needle.
The joint capsule is washed with saline, then the medicine is injected into it.
A sterile tight bandage is applied to the diarthrosis.

Using the puncture method, hemarthrosis of the knee joint can be cured in three weeks. If hemorrhage into the joint cavity recurs, degenerative changes occur. Therefore, curing secondary hemarthrosis is much more difficult. If the disease reappears, another method is chosen for surgery:

First, the joint is tightened with a bandage. This measure is necessary to create positive pressure.
Next, the main volume of liquid is aspirated.
At the next stage, a rinsing agent is introduced, which is then removed through a new puncture and with another needle.
The medicine is administered through the first puncture.
Treatment ends with the application of a fixing bandage, which immobilizes the joint.

When using this technology, the risk of recurrent bleeding is significantly reduced, so the disease can be cured with one procedure. With mild bleeding, the joint fluid resolves on its own and does not require surgery. In such a situation, the symptoms of hemarthrosis of the knee or ankle joint can be eliminated with folk remedies.

You can use absorbable compresses (arnica and wormwood herbs, clay), take anti-inflammatory infusions (nettle, yarrow), and pain-relieving honey ointments. After an injury, the limb must be ensured complete rest; the leg or arm must be in an elevated state.

If the cause of joint hemarthrosis is hemophilia, the pathology can remain latent for a long time. Cartilage tissue is destroyed by blood clots, it undergoes fibrous changes that lead to inflammatory processes. Hemarthrosis gradually disrupts the functioning of the ligaments, which causes rapid loss of joint functionality.

Hemophilia can cause serious joint problems even with minor injuries. Hemarthrosis in patients with hemophilia can occur suddenly. To reduce blood loss, treatment of such patients must be started immediately.

Signs of the disease after treatment do not disappear immediately, but gradually. Therefore, diarthrosis should be in a state of maximum rest.

Hemophilic hemarthrosis is treated only in a hospital setting. The risk of degenerative changes in cartilage tissue is the main danger of circulatory disorders that occur during injuries. Osteoarthritis, the causes of which are associated with scarring of tissue on the surface of the joint, progresses very quickly.

If proper treatment is not started in time, hemarthrosis of the joint can become chronic. Due to the constant presence of blood in the joint cavity, inflammation develops.

There is a high probability of developing bursitis, arthritis or purulent synovitis. If hemarthrosis is neglected or chronic, there may be a need for endoprosthetics or knee replacement. The patient must be under medical supervision throughout the entire recovery period.

A caring attitude towards your health will help you avoid post-traumatic complications and quickly return the full functioning of the joint.

Degrees of development and possible complications

Rupture of the knee joint
The degree of development of hemarthrosis depends not only on the severity of the injury, but also on the timing of seeking medical help, as well as the amount of humoral fluid poured into the synovium.

In fear of having to undergo treatment or simply see a doctor, adults and conscientious people are able to delay treatment not only until a severe stage develops, but also until severe complications arise that could have been avoided.

At the first stage, when the volume of effluent humor does not exceed 15 ml, hemarthrosis is a slight swelling of the top of the knee and minor problems with mobility. This is a fairly common occurrence in an active child and goes away on its own. The pain will be slight, support on the leg is easy, but a slight limp is possible.

The second stage (degree of development) occurs when the spilled blood exudate exceeds the 100-ml mark. The joint enlarges quite significantly, acquires a rounded shape and significantly limited mobility.

Further, if no measures have yet been taken, the development of the scenario can cause significant harm to the health of the joint. In this case, home methods no longer help, and the patient has to go to the clinic. The skin on the knee becomes very stretched, hardens, turns blue, and hyperemia of the skin begins, which is usually local in nature. If this is a consequence of a severe injury, the condition is also significantly aggravated by concomitant signs of the underlying disease - blockade or instability of the joint, severe or piercing pain, lack of support on the sore leg and pronounced signs of hematoma.

The third degree, even in the absence of an underlying injury, requires immediate hospitalization for inpatient treatment.

Becoming a dangerous condition at a certain stage, hemarthrosis can lead to complications, sometimes irreversible:

compression of soft tissues, blood vessels and nerve endings;
development of degenerative-dystrophic changes in the joint caused by compression;
loss of elasticity of cartilaginous and ligamentous structures;
arthrosis;
inflammation of the synovial membrane and the appearance of effusion;
development of synovitis;
involvement of the fibrous membrane and soft periarticular tissues in the resulting infectious process;
the appearance of purulent arthritis.

Not a single folk remedy or ointment can help in this condition. Immediate hospitalization is required and one can only wonder why there was no competent pre-hospital care, with the use of which all these terrible and painful complications could be avoided.

Diagnosis and treatment methods

X-ray of an injured knee

Diagnosis of the disease is carried out by a specialist who prescribes the following types of examination.

An MRI or ultrasound of the knee joint is performed, showing vascular damage in the injured area.
To exclude fractures, x-rays are prescribed.
The cavity of the knee joint bursa is punctured to exclude arthritis and infectious inflammation, as well as to determine signs of hemarthrosis (blood in the analysis).

Dangerous is the chronic form of the disease, which occurs in case of improper or untimely treatment. Hemarthrosis is treated by removing fluid from the joint cavity. Then the cavity is washed and drugs are injected into it to eliminate bleeding, pain and inflammation. The primary type of hemarthrosis is quite easy to treat.

Treatment is carried out under local anesthesia; the procedure involves this procedure.

A syringe with a thin needle is used to remove fluid and blood from the internal cavity of the knee joint.
The cavity is washed with medical solutions and the medicine is injected into it.
A tight bandage is applied to the joint. The puncture procedure can be performed several times.

Evacuation of blood from the kneecap after injury

As a result of puncture, hemarthrosis of the knee joint is cured within 3 weeks. When hemorrhages recur in the joint, degenerative changes occur, so secondary hemarthrosis is much more difficult to treat.

If the disease recurs, the operation is performed in a different way.

To create positive pressure, the joint is compressed with a bandage.
Treatment begins with aspiration of the main volume of fluid.
A rinsing agent is then injected and removed using another needle through a new puncture.
The drug is administered through the first puncture.
The treatment is completed by applying a bandage to the joint, fixing it in a stationary state.

When using this method, the risk of recurrent bleeding is reduced, so hemarthrosis can be eliminated in one procedure.

With minor bleeding, the fluid in the joint resolves without puncture. In this case, it is possible to treat minor damage with folk remedies. You can take anti-inflammatory infusions (yarrow, nettle), use absorbable compresses (clay, arnica and wormwood herbs) and pain-relieving ointments based on honey.

Flow

With hemarthrosis, the vessels supplying intra-articular tissues rupture and, as a result, hemorrhage into the joint.

This causes disruption of blood circulation, its accumulation in the cavity, the formation of clots and an increase in intra-articular pressure on surrounding tissues. The joint swells, becomes spherical, increases in volume, pain and a feeling of fullness appear, loss of function occurs and range of motion is limited.

Blood in the knee joint

If the disease is left without proper treatment, complications may develop: a chronic form of the disease, secondary infection, arthritis.

Danger of disease in the presence of hemophilia

Hemarthrosis of the knee joint, which is caused by hemophilia, may not appear for a long time. Under the influence of blood clots, cartilage tissue is destroyed, fibrous changes occur in it, leading to the appearance of inflammatory processes. Gradually, hemarthrosis disrupts the functioning of the ligaments, which causes a rapid decline in the functionality of the joint. With hemophilia, joint problems can occur even with minor trauma.

In patients with hemophilia, hemarthrosis may develop suddenly. To reduce blood loss, treatment of such patients should begin immediately.

Bleeding is eliminated by administering antihemophilic globulin.
Transfusions of plasma and other necessary blood components are carried out.
After treatment, the symptoms of the disease disappear gradually, so the joint should be at maximum rest.

Hemophilic hemarthrosis is treated only in a hospital setting. The danger of circulatory disorders during injuries lies in the risk of changes in cartilage tissue. Osteoarthritis can progress rapidly, the causes of which are associated with scarring of tissue (in the form of adhesions) on the surface of the joint.

In the absence of qualified treatment, hemarthrosis of the knee joint can become chronic. If inflammation develops due to the constant presence of blood in the joint cavity, there is a high probability of complications such as infectious arthritis, bursitis, and purulent synovitis. In advanced and chronic cases, endoprosthetics, which is a type of surgical intervention, may be required. During the rehabilitation period, the patient must also be under medical supervision.

Symptoms and degrees of hemarthrosis

Hemarthrosis has generally similar symptoms, however, depending on the location of the affected joint, some features of the course of the disease can be traced. For example, hemarthrosis of the knee joint is a common consequence of various injuries, due to the fact that a person’s legs are often subject to shocks and bruises.

Injuries to the knee joint limit the victim's ability to move - they require rest for the injured limb and the use of crutches.

In turn, the elbow joint, being a very complex anatomical and functional node with special blood circulation and innervation, is characterized by high reactivity.

Even after a minor injury or bruise of the elbow joint, local pain, swelling, partial dysfunction, and hemorrhage appear.

Hemarthrosis of other joints

When moving, the ankle joint takes on a large load and provides rotation of the foot, stability and support for the entire body. Having a complex structure, the ankle joint is extremely vulnerable to injury; sprains and ruptures of ligaments are especially common, which can be accompanied by hemarthrosis.

This condition is manifested by high pain in the ankle joint, swelling and swelling of not only the joint itself, but also the foot.

Symptoms of hemarthrosis

swelling and enlargement of the joint;
spherical shape;
smoothing the contours of the joint;
local or arching pain;
limitation of range of motion;
soft tissue tension;
bluish skin color.

Degrees of hemarthrosis

3 stages (degrees) of the disease

In grade I, a small volume of blood enters the cavity, which does not exceed 15 ml. The symptoms of the main injury, local pain, and slight swelling dominate.
In grade II, the blood volume in the joint reaches 100 ml, the joint increases in volume, takes on a spherical shape and smoothed contours, and bursting pain appears in the joint.
With continued bleeding, when more than 100 ml of blood accumulates in the cavity, stage III is diagnosed. It is characterized by the previous symptoms, to which are added soft tissue tension and burgundy-bluish skin color.