Swelling, limited mobility of the knee joint along with subcutaneous hematomas - these symptoms are often observed after injury. A disease that is accompanied by hemorrhage into the joint cavity is called hemarthrosis. How to properly treat this disease and what rules to follow to avoid worsening?
Most often, hemarthrosis is diagnosed in winter - during icy conditions.
What are the causes of hemarthrosis
Most often, the disease results from a bruise, dislocation or subluxation, rupture of a ligament or meniscus. Trauma leads to damage to the blood vessel - blood enters the cavity. This happens, for example, when falling while skating or skateboarding, if the athlete does not use knee pads, as well as in everyday life - even when going down the stairs unsuccessfully.
Very rarely, the cause of hemarthrosis is a blood disease, such as hemophilia or hemorrhagic diathesis, as well as other coagulation pathologies.
S80—S89 Knee and lower leg injuries
S80 Superficial injury of the leg
- S80.0
Contusion of the knee joint - S80.1
Contusion of other specified and unspecified part of the leg - S80.7
Multiple superficial injuries of the leg - S80.8
Other superficial injuries of the leg - S80.9
Superficial injury of the leg, unspecified
S81 Open wound of the leg
- S81.0
Open wound of the knee joint - S81.7
Multiple open wounds of the leg - S81.8
Open wound of other parts of the leg - S81.9
Open wound of the leg, unspecified location
S82 Fracture of lower leg bones, including ankle joint
- S82.00
Patella fracture, closed - S82.01
Open patella fracture - S82.10
Fracture of the proximal tibia, closed - S82.11
Open fracture of the proximal tibia - S82.20
Fracture of the body [diaphysis] of the tibia, closed - S82.21
Open fracture of the body [diaphysis] of the tibia - S82.30
Fracture of the distal tibia, closed - S82.31
Open fracture of the distal tibia - S82.40
Closed fracture of the fibula - S82.41
Open fracture of the fibula - S82.50
Fracture of the medial malleolus, closed - S82.51
Open medial ankle fracture - S82.60
Fracture of the external [lateral] malleolus, closed - S82.61
Open fracture of the lateral malleolus - S82.70
Multiple closed fractures of the tibia - S82.71
Multiple open fractures of the tibia - S82.80
Fractures of other parts of the leg, closed - S82.81
Fractures of other parts of the leg, open - S82.90
Fracture of unspecified part of the tibia, closed - S82.91
Fracture of unspecified part of the tibia, open
S83 Dislocation, sprain and overstrain of the capsular-ligamentous apparatus of the knee joint
- S83.0
Patella dislocation - S83.1
Dislocation of the knee joint - S83.2
Fresh meniscus tear - S83.3
Fresh rupture of articular cartilage of the knee joint - S83.4
Sprain, rupture and strain of the external internal collateral ligament - S83.5
Sprain, rupture and strain of the anterior posterior cruciate ligament of the knee joint - S83.6
Sprain, rupture and overstrain of other and unspecified elements of the knee joint - S83.7
Injury to multiple structures of the knee joint
S84 Nerve injury at calf level
- S84.0
Injury to the tibial nerve at the level of the leg - S84.1
Injury of the peroneal nerve at the level of the leg - S84.2
Injury of cutaneous sensory nerve at the level of the leg - S84.7
Injury of several nerves at the level of the leg - S84.8
Injury to other nerves at the level of the leg - S84.9
Injury of unspecified nerve at the level of the leg
S85 Injury to blood vessels at the level of the leg
- S85.0
Popliteal artery injury - S85.1
Injury of tibial anterior posterior artery - S85.2
Injury of the peroneal artery - S85.3
Injury of the great saphenous vein at the level of the leg - S85.4
Injury of the small saphenous vein at the level of the leg - S85.5
Popliteal vein injury - S85.7
Injury of several blood vessels at the level of the leg - S85.8
Injury to other blood vessels at the level of the leg - S85.9
Injury of unspecified blood vessel at the level of the leg
S86 Injury to muscle and tendon at shin level
- S86.0
Injury of the calcaneal [Achilles] tendon - S86.1
Injury to another muscle and tendon of the posterior muscle group at the level of the lower leg - S86.2
Injury to the muscle and tendon of the anterior muscle group at the level of the lower leg - S86.3
Injury to the muscle and tendon of the peroneal muscle group at the level of the lower leg - S86.7
Injury of several muscles and tendons at the level of the leg - S86.8
Injury to other muscles and tendons at the level of the leg - S86.9
Injury to unspecified muscles and tendons at the level of the leg
S87 Crushed leg
- S87.0
Knee crush injury - S87.8
Crushing of another and unspecified part of the leg
S88 Traumatic amputation of the lower leg
- S88.0
Traumatic amputation at the level of the knee joint - S88.1
Traumatic amputation between the knee and ankle joints - S88.9
Traumatic amputation of lower leg at unspecified level
S89 Other and unspecified injuries of the leg
- S89.7
Multiple leg injuries - S89.8
Other specified injuries of the leg - S89.9
Unspecified lower leg injury
Symptoms
If the volume of blood spilled into the joint capsule is small, there may be no external signs at all. A person only experiences pain and discomfort - by analogy with the treatment of arthrosis or osteoarthritis of the knee, and is also forced to limit mobility. External symptoms appear if more than 40-50 ml of blood has spilled into the cavity:
- the joint swells and increases in volume;
- bruises are noticeable;
- It becomes very painful to move your leg.
Knee swelling? Fix the limb and go to a rheumatologist-orthopedic surgeon
Codes according to ICD 10
Contusion of the knee joint
In the International Classification of Diseases, 10th revision (ICD-10), more than 66 codes are devoted to injuries and other pathological conditions of the knee joint, reflecting the category and name of each individual nosology.
The codes are arranged in specialized groups that allow you to find the category of the disease and determine the type of nosology.
Note, at present, not all doctors adhere to the clear ICD-10 classification, which affects statistics, disease prevention planning and the allocation of free medicines for the treatment of the most common ones.
Groups of knee joint diseases that can be found in ICD-10, including knee joint injuries:
- G57 – Damage to peripheral nerve endings (G57.3-G57.4) . The codes characterize the dysfunction of the lateral and median popliteal nerve. Often this pathology occurs with a severe bruise or fracture of the knee. We should not exclude tumor formations that block the work of nerve cells at the site of their development.
Gonarthrosis of the knee joint
M17 – Gonarthrosis or arthrosis of the knee joint (M17.0-M17.9) . Classification codes reflect the clinical picture of the disease (bilateral or unilateral disease), as well as the etiological cause of the pathological condition. Code M17.3 characterizes post-traumatic gonarthrosis, the cause of which may be a bruise of the knee joint.- M22 - Lesions of the patella. It is known that damage to the patella occurs when force is directly applied to the sesamoid bone. In cases of subluxation or dislocation of the patella, there may be an indirect application of force (asynchronous contraction of the muscles of the anterior surface of the thigh). In any case, damage to the patella is impossible without bruising the knee, since the inflammatory process cannot be localized exclusively in front of the joint. Codes M22.0-M22.9 classify damage to the patella according to the cause, extent of the process and other features of inflammation of the patella.
- M23 – Intra-articular lesions of the knee. This category covers a variety of pathological processes occurring in the intra-articular bursa of the knee joint. M23.1-M23.3 – code for variants of meniscal lesions. M23.4 – presence of a free body in the joint cavity. In traumatology, this disease is called “articular mouse,” which is caused by a chronic inflammatory process of cartilage tissue. Also included in this category are complete and incomplete intra-articular comminuted fractures of the knee, because bone fragments with untimely and unqualified medical care can remain in the joint cavity and significantly reduce the quality of life. M23.5-M23.9 - codes describe all kinds of intra-articular lesions of the ligamentous apparatus of the knee.
Knee injury
M66 - Spontaneous rupture of the synovium and tendon. This category characterizes a violation of the integrity of soft anatomical structures due to impact, bruise or other reasons. Code M66.0 is classified as popliteal cyst rupture, and code M66.1 is classified as synovial rupture. Of course, a rare injury is characterized by a violation of the function and integrity of one anatomical structure, but in order to describe the patient’s condition in more detail, it is customary to consider each case separately.- M70 - Diseases of soft tissues associated with load, overload and pressure. This category describes diseases associated with the inflammatory process of various etiologies in the knee joint and not only. M70.5 - Other bursitis of the knee joint. This code means any inflammatory processes formed in the joint capsule of the knee.
- M71 – Other bursopathies. In this category there is code M71.2 describing a synovial cyst of the popliteal region or Baker's cyst, which most often occurs after a bruise or other injury to the knee joint and its structures.
- M76 - Enthesopathies of the lower limb, excluding the foot. In this category, the knee includes code M76.5 - Tendinitis of the patella region, which characterizes chronic and acute inflammation of the bursa and ligaments of the knee joint. The cause of this pathology is often an untreated inflammatory process resulting from a bruise, wound or other type of grass.
- Q74 - Other congenital anomalies (malformations) of the limb(s) . The code for the knee in this category is Q74.1 - Congenital anomaly of the knee joint. Even if surgical intervention was performed to correct this pathology, the issue of removing the diagnosis is decided exclusively by the medical commission of category 1 medical institutions, the highest accreditation.
Rupture of the knee joint ligaments
S80 - Superficial injury of the lower leg - hemarthrosis, hematoma, closed contusion. The most common category of traumatology. This category contains ICD 10 code S80.0 – Contusion of the knee joint. The coding does not provide an indication of the cause and duration of the disease; it only records the case and nature of the injury.- S81 – Open wound of the leg. In this category there is a code S81.0 - Open wound of the knee joint, which may coincide with the presence of a contusion or fracture of the knee, but in this case indicates the primary pathology that led to the presence of other associated symptoms. For example, with an open wound of the knee joint there will be signs of a bruise, but they will be secondary, since the bruise is caused by a violation of the integrity of the skin of the knee itself.
- S83 Dislocation, sprain and damage to the capsular ligamentous apparatus of the knee joint. S83.0-S83.7 – code for any pathological conditions of the knee that are associated with a violation of the integrity and function of the anatomical formations of the knee joint.
According to the above data, as well as the pathogenetic features of the course of each of the diseases of the knee joint, we can say that they all occur with certain signs of bruise.
The doctor must correctly assess the patient’s current condition based on complaints, the patient’s medical and life history, objective examination data and the results of functional diagnostics. Without a full examination, it is impossible to make a correct final diagnosis.
Subtleties of diagnosis
Often, an external examination is sufficient to diagnose hemarthrosis. The doctor will palpate and make sure that the patella is balling. Such a “floating” patella is never detected with ordinary bruises.
A puncture of the knee joint will help confirm the presence of blood in the cavity, but it is not enough to understand the nature of the damage. Therefore, patients are prescribed additional examination - MRI, CT or ultrasound.
How does blood get into the joint capsule? Expert - about the mechanism of development of hemarthrosis:
Knee contusion (Knee contusion)
At the first aid stage, it is necessary to ensure that the limb is at rest, give it an elevated position, and apply cold to reduce swelling and the severity of hemorrhages. The victim is taken to the emergency room. Treatment of bruises is symptomatic, usually carried out on an outpatient basis and generally follows the same scheme.
Conservative therapy
In the absence of hemarthrosis or synovitis, it is enough to limit physical activity. Patients are given a sick leave certificate, recommended to walk less and give the leg an elevated position at rest. While walking (if this gives a positive effect), you can use an elastic bandage, but only for fixation, without applying it too tightly, so as not to disrupt the blood supply to the area of injury.
When at rest, the bandage must be removed. In the first days, cold should be applied to the leg (a heating pad with cold water or an ice pack wrapped in a towel). From the third day you can use dry heat. Under no circumstances should you warm your leg in hot water - this will increase swelling and can provoke the development of hemarthrosis.
Urine therapy is strictly contraindicated. Firstly, this method is unscientific and does not bring practical benefit, but it can cause irritation and the appearance of pustular skin lesions. Secondly, applying compresses to the area of the knee joint in some cases causes the development of recurrent synovitis, and sometimes even severe “urinary” arthritis.
For severe injuries and moderate bruises of the knee, accompanied by hemarthrosis or synovitis, a plaster splint is applied, it is recommended to limit the load, and analgesics and UHF are prescribed. For hemarthrosis and synovitis, puncture of the knee joint is indicated, during which fluid is removed and the joint is washed with a solution of novocaine. If necessary, the puncture is repeated after a few days.
Physiotherapeutic treatment
After relief of acute phenomena and removal of the splint, rehabilitation measures are carried out to restore range of motion, strength and muscle tone. Physical therapy is prescribed, which helps speed up the rehabilitation process, prevent muscle atrophy and the occurrence of contractures. When treating a knee injury, the following physiotherapeutic techniques are used:
- SMV therapy - an electromagnetic field stimulates local blood circulation, makes it possible to reduce the time for swelling to resolve, and reduce inflammation;
- laser therapy – exposure to infrared laser stimulates blood circulation, activates local metabolic processes, and reduces pain;
- Ultrasound therapy is effective in the treatment of post-traumatic synovitis, eliminates swelling, accelerates metabolism, and has a positive effect on the course of biochemical processes;
- inductothermy – improves metabolic rates, prevents the development of pathological changes in cartilage tissue, eliminates swelling and pain.
Surgery
Surgeries for knee bruises are rarely used and are performed routinely in a trauma hospital.
- In case of intense hemarthrosis and intense arching pain, arthroscopic revision and sanitizing lavage of the joint can be performed. In some cases, surgical hemostasis is performed during knee arthroscopy.
- During the treatment of professional athletes, damaged hyaline cartilage is sometimes treated: exfoliated fragments are cut off, then the surface of the cartilage is polished.
After the manipulation, a plaster cast is applied, UHF and other physiotherapeutic procedures are prescribed, and after immobilization is stopped, the patient is referred to exercise therapy.
Treatment tactics for hemarthrosis
First of all, it is necessary to quickly remove blood and synovial fluid from the cavity through puncture. The procedure is carried out under local anesthesia under aseptic conditions, after which special drugs are administered orally - anti-inflammatory, analgesic and hemostatic. Sometimes, as in the treatment of osteoarthritis of the knee, arthroscopy may be necessary if the damage to the internal structures is large.
If the blood volume is less than 20-30 ml, you can do without a puncture: the clots will gradually dissolve on their own. If the manipulation is carried out, the patient is given a pressure bandage, and the joint is immobilized using a plaster or splint. For a week, it is recommended to use crutches to walk so as not to rely on the affected leg. At the end of this period, as in the treatment of arthrosis, rehabilitation measures are indicated - physiotherapy, massage and exercise therapy.
The doctor will decide whether a puncture is necessary. It all depends on the volume of blood in the joint cavity
Publications in the media
Frequency - 60–84% of the total number of injuries to the knee joint. Causes : trauma: a jump or fall from a height onto straight legs, a quick turn of the body with a fixed foot, a sharp rotation of the foot and lower leg outward or inward in a position of flexion in the knee joint, quickly standing up after a long squatting position.
Pathomorphology • Types of damage to the meniscus •• Tears of the meniscus or its parts from the place of attachment to the joint capsule •• Tears of the meniscus itself in its various parts, transchondral, longitudinal like a hand-held watering can, transverse, horizontal, flap, various combinations of these injuries • There are tears of the internal and external menisci. Ruptures of both menisci are possible, but damage to the internal meniscus most often predominates • A rupture of the internal meniscus is often combined with damage to the internal collateral ligament and anterior cruciate ligament - an unfortunate triad. Clinical picture • The acute period lasts 4–5 weeks •• Pain without precise localization, swelling of tissues in the joint area •• Fluid in the joint cavity: synovitis, hemarthrosis •• Restriction of movements in the joint, sometimes joint blockade. The most convincing symptoms of meniscus damage are revealed later, when all acute effects of the injury subside • Chronic stage. Typical signs of meniscus damage appear •• Pain in the projection of the joint space on the side of the injury, intensifying with palpation with simultaneous rotation of the tibia in the opposite direction •• Symptom of joint blockade - fixation of the tibia at an angle of 130° when moving in the knee joint - a sign of infringement of the torn part of the meniscus between articular surfaces of bones. Sometimes the blockade is accompanied by a characteristic click or crunch •• Atrophy of the quadriceps muscle and Chaklin's symptom - flattening and tension of the sartorius muscle when extending the leg •• Baikov's symptom - increased pain with passive extension of the leg after preliminary compression of the joint space from the sides •• McMurray's symptom - intensification pain when rotating the shin bent at a right angle outward or inward indicates damage to the lateral or medial meniscus, respectively •• Turner's symptom is a violation (decrease or increase) of sensitivity along the inner surface of the knee.
Research methods • X-ray of the knee joint with contrast reveals foreign bodies in the joint cavity, changes in the articulating bones • MRI • Arthroscopy of the knee joint. Differential diagnosis • Acute period •• Rupture of the capsule and ligamentous apparatus •• Bruises •• Intra-articular fractures • Chronic stage •• Meniscopathy •• Meniscosis •• Meniscus cyst. Treatment • Acute stage - plaster immobilization for up to 3 weeks, diagnostic and therapeutic puncture of the knee joint, physiotherapy (UHF in an oligothermic dosage, magnetic therapy, Bernard currents, after removing the plaster cast - phonophoresis with hydrocortisone, exercise therapy) • Chronic stage - surgical treatment: suturing the meniscus , sectoral and paracapsular resection of the meniscus, total meniscectomy. In the postoperative period - a plaster splint for 7-10 days, UHF, magnetic therapy, exercise therapy. Working capacity is restored after 6–8 weeks. According to indications, arthroscopic operations are performed.
ICD-10 • M23.6 Other spontaneous ruptures of knee ligament(s) • M23.8 Other internal lesions of the knee
Why is hemarthrosis dangerous?
If blood is not removed from the cavity in a timely manner, the disease can cause complications. Blood saturates the joint and clots form in it. Even if they resolve over time, adhesions may remain in their place - the cartilage surface is deformed and will no longer be smooth. Due to unevenness, the cartilage in certain areas will wear away - sooner or later treatment for arthrosis will be required.
And if in case of hemarthrosis the problem can be solved by puncture followed by rehabilitation, then in case of osteoarthrosis, long-term therapy will be required, for example, an annual course of intra-articular injections of Noltrex. Injections of this synthetic drug relieve pain for 9-15 months, replacing the missing synovial fluid. They must be done at regular intervals to maintain results. Today this is one of the most effective ways to combat arthrosis. If hemarthrosis is treated in time, the knee can remain healthy.
Another danger of this disease is purulent arthritis. Since pathogenic bacteria multiply especially intensively in the blood, there is a high risk of infection. That is why do not ignore a swollen knee: consult with an orthopedist and follow all the instructions for hemarthrosis that are likely to help you avoid arthrosis.