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Joint Damage

Joint Damage. The Affects of Bleeds on a Joint & How to Treat Joint Damage. A joint is the place where two or more bones come together. At the end of each bone there is a smooth layer of tissue called cartilage which protects the bones and acts like a shock absorber.

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Joint Damage

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  1. Joint Damage The Affects of Bleeds on a Joint & How to Treat Joint Damage

  2. A joint is the place where two or more bones come together. • At the end of each bone there is a smooth layer of tissue called cartilage which protects the bones and acts like a shock absorber. • Surrounding the entire joint is a tough elastic casing called the synovial capsule. Lining the inside of the synovial capsule is the synovial membrane which contains many small blood vessels and also makes the synovial fluid. • The synovial membrane has three functions. • To lubricate the joint • To feed the cartilage with nutrients • To remove fluid and debris from the joint • Joints are supported by tendons, muscles and also ligaments. Tendons attach muscles to bones, ligaments connect bones and cartilage, which prevents bones in a joint from moving the wrong way. Joints 101What is a joint, how does it work & what is it’s purpose?

  3. How & Why Bleeds Affect a Joint • The synovial membrane has a very large number of blood vessels which is one of the reasons why joint bleeding is so common in individuals with hemophilia. • During a bleed, blood will flow from the blood vessels that are in the synovial membrane into the joint capsule. If the bleeding is not stopped the joint capsule will fill with the blood. • As the blood is reabsorbed into the tissue surrounding the joint, the tissues will swell, which stretches ligaments and tendons and causes damage to the joint. • When the blood is reabsorbed it also causes the synovial membrane to thicken, which means more blood vessels and more of a risk of future bleeds. • Recurring bleeds in the joints causes the synovial membrane to produce enzymes which causes more joint swelling. There is also an increase of iron deposits in the joints. • Overtime the recurring bleeds will destroy the synovial membrane replacing it with scar tissue. • Recurring bleeds also lead to erosion of the cartilage. The enzymes and iron deposits not only affect the synovial membrane, but they also break down the cartilage at the end of the bones. The cartilage will eventually become rough and uneven causing arthritis to develop.

  4. The number one cause for joint damage is repeated bleeding into a single joint which is often called… A “target joint” Target joints are most commonly located at the knee, elbow and ankle. The definition of a “target joint” is one in which recurrent bleeds have occurred on four or more occasions during previous 6 months or in which 20 lifetime bleeding episodes have occurred.

  5. Managing Bleeds The best chances of reducing joint damage is by treating a bleed early and aggressively. It is extremely important to recognize the signs of a bleed as soon as possible in order to begin treatment. Symptoms of a Bleed • a bubbling or tingling feeling in the joint • an “aura” or unusual sensation when the joint begins to bleed • Stiffness, pain or swelling in the joint • The skin around the joint feels warm • The joint is unable to bear any weight Responding to a Bleed • Treat with factor product as soon as possible • Follow up with R.I.C.E. to help with pain, reduce further swelling and prevent further damage • Rest – Use the joint as little as possible • Ice – Put ice on affected joint to reduce swelling and pain. You can use a bag of ice, a bag of frozen vegetables or an ice pack product. Do not apply ice directly to the skin. Apply ice 5 minutes on, 10 minutes off. Repeat. Cryocuff also works very well. • Compression – Put pressure on the joint by wrapping with some form of a wrap, ACE bandage, etc. • Elevation – Keep the joint higher than the rest of the body to help blood flow away from the joint, as a result reducing the swelling and pain.

  6. Ways to Treat Joint Damage Reoccurring bleeds into the same joint can cause the synovial membrane surrounding the joint to thicken and become inflamed causing the synovial fluid to no longer lubricate the cartilage. This causes a condition called synovitis, which causes problems ranging from pain and loss of motion to arthritis. • Synovectomy– a procedure where excess synovial tissue is removed. A thin layer of healthy tissue grows back after the procedure and usually fewer bleeds are experienced afterwards. • Radionuclide Synovectomy – radioactive material called Phosphorus 32 is injected into the joint. The lower levels of radiation emitted by the Phosphorus 32 slow down the growth of new synovial cells that would cause more thickening. This is usually an outpatient procedure. • Arthroscopic Synovectomy – a small metal tube is inserted through 2 or 3 very small incisions in the joint. The excess synovial membrane is removed through this tube. This procedure may be effective in reducing the number of bleeds and improving or maintain the range of motion. However, removal of all the excess synovial tissue is more difficult than with open surgery. • Open Synovectomy – surgically opening the joint through an incision in order to clearly access the joint to find and remove all damaged tissue. Due to the incision and the joint capsule being opened up recovery time is longer and some loss of motion may occur. • Arthrodesis – fusion of the bone to control pain and bleeding, usually in ankles. Arthrodesis uses staples, screws or bone grafting to fuse the joint correctly. • Total Joint Replacement – surgery where the joint is removed and replaced with an artificial joint made of metal, ceramic or plastic. The knee, hip and shoulder are typically the best candidates for this procedure.

  7. Preventing Joint Damage & Maintaining Healthy Joints It is easier to prevent joint damage than to repair it after it has already happened. Some things that can be done to help prevent damaged joints are: • Treat with factor as soon as a bleed occurs • Rest to allow the bleeding to stop • Elevation to lower the blood pressure and allow the blood to drain away from the joint • Anti-inflammatory drugs to reduce swelling • Electrical stimulation of the muscles around the joint to avoid wasting of the muscles while the joint is recovering • Active physical therapy to regain movement in the joint and avoid the formation of fibrous build-ups in the joint The only way to completely prevent joint damage is to prevent bleeds into the joints with prophylactic factor replacement therapy (taking factor on a scheduled basis to prevent bleeds instead of an “on demand” basis once a bleed is already taking place).

  8. Sources • http://www.hemophilia.ca/en/bleeding-disorders/hemophilia-a-and-b/the-complications-of-hemophilia/joint-damage/ • http://www.thereforyou.com/managing-hemophilia/joint-problems/about-joints.html • http://en.wikipedia.org/wiki/Synovial_membrane • http://www.changingpossibilities-us.com/LifeWithInhibitors/TheNeedForSpeed.aspx Thank you for your attention. If you have any additional questions in regards to joint damage that were not covered, please contact us at Axiom Therapeutics.

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