Physiotherapy Evaluation and Intervention in the Acute Hemarthrosis: Challenging the Paradigm

Zourikian, N.; Forsyth, Angela

doi:10.1002/9781119979401.ch30

Cited by 6 publications

(6 citation statements)

References 50 publications

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“…Indeed, many treatment variations exist in the practise of R.I.C.E., where these elements are combined to address swelling. The use of ice is not an effective method to achieve control of haemarthrosis-related swelling [56]. In a systematic review of controlled trials of ice in soft-tissue injury, Bleakley et al [59] found, "little evidence to suggest that the addition of ice to compression had any significant effect."…”

Section: Discussionmentioning

confidence: 99%

The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?

et al. 2012

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Repeated haemarthroses and the consequences of blood in the joint contribute to blood induced joint disease (BIJD) in people with haemophilia (PWH). Prevention of bleeding, through medical management, is the standard of care in developed countries, but is not universally available due to financial and other barriers. Ice application, as part of R.I.C.E. (Rest, Ice, Compression, Elevation) or alone, is commonly recommended as an adjunct treatment to decrease bleeding, pain, tissue metabolism, oedema, and inflammation. This article will review evidence regarding local cooling by commonly used ice application methods, to decrease the temperature of the skin and intra-articular (IA) joint space and the resultant effects on haemostasis and coagulation. The general literature was reviewed for articles in English describing temperatures achievable in the skin and IA space using clinically relevant ice protocols, and the effect of cooling on haemostasis and coagulation. The literature demonstrates that typical methods of ice application can cool both the skin and IA space. Published, general literature studies have also consistently demonstrated that experimental cooling of blood and/or tissue, both in vitro and in vivo in humans and in animal models, can significantly impair coagulation and prolong bleeding. In PWH with acute haemarthrosis, ice application has potential to increase haemorrhage morbidity by further impairing coagulation and haemostasis. Ice has not been shown to improve overall outcome, stop bleeding nor swelling from haemarthrosis. Although ice can help manage acute, haemarthrosis-related pain, there are other available interventions that will not impair coagulation and haemostasis.

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Section: Discussionmentioning

confidence: 99%

The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?

et al. 2012

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“…The application of ice following a soft tissue injury is believed to help manage acute hemarthrosis-related pain by decreasing nerve conduction velocity, reducing edema formation through proinflammatory response reduction, and inducing vasoconstriction, thereby reducing blood flow to the injured tissue. 28 However, Forsyth et al have recently suggested that any decrease in intra-articular temperature could interfere with coagulation in the presence of acute tissue lesions (in vitro) in both in animals and human subjects with normal hemostasis. 29 , 30 Furthermore, applying ice actually delays healing by preventing macrophages from releasing insulin-like growth factor (IGF-1) within the damaged muscle or joint.…”

Section: Management Of Acute Hemorrhagic Episodesmentioning

confidence: 99%

Optimal management of hemophilic arthropathy and hematomas

Lobet¹,

Hermans²,

Lambert³

2014

JBM

140

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Hemophilia is a hematological disorder characterized by a partial or complete deficiency of clotting factor VIII or IX. Its bleeding complications primarily affect the musculoskeletal system. Hemarthrosis is a major hemophilia-related complication, responsible for a particularly debilitating chronic arthropathy, in the long term. In addition to clotting factor concentrates, usually prescribed by the hematologist, managing acute hemarthrosis and chronic arthropathy requires a close collaboration between the orthopedic surgeon and physiotherapist. This collaboration, comprising a coagulation and musculoskeletal specialist, is key to effectively preventing hemarthrosis, managing acute joint bleeding episodes, assessing joint function, and actively treating chronic arthropathy. This paper reviews, from a practical point of view, the pathophysiology, clinical manifestations, and treatment of hemarthrosis and chronic hemophilia-induced arthropathy for hematologists, orthopedic surgeons, and physiotherapists.

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“…The management of acute bleeding episodes is based on the concept of the RRICE regime (Replacement therapy, Rest, Ice, Compression and Elevation). Application of ice following a soft tissue injury is believed to decrease nerve conduction velocity, reduce oedema formation and induce vasoconstriction . However, there is no definite consensus within the literature regarding blood flow changes in response to ice application ; for example, Forsyth et al .…”

Section: Treatment: Physiotherapy and Sports Therapy (S Lobet)mentioning

confidence: 99%

“…Application of ice following a soft tissue injury is believed to decrease nerve conduction velocity, reduce oedema formation and induce vasoconstriction . However, there is no definite consensus within the literature regarding blood flow changes in response to ice application ; for example, Forsyth et al . recently suggested that reductions in intra‐articular temperature could interfere with coagulation in the presence of acute tissue lesions .…”

Section: Treatment: Physiotherapy and Sports Therapy (S Lobet)mentioning

confidence: 99%

Managing Haemophilia for Life: 4th Haemophilia Global Summit

et al. 2014

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Summary The 4th Haemophilia Global Summit was held in Potsdam, Germany, in September 2013 and brought together an international faculty of haemophilia experts and delegates from multidisciplinary backgrounds. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored global perspectives in haemophilia care, discussing practical approaches to the optimal management of haemophilia now and in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance and potential to influence haemophilia care globally. In this supplement from the meeting, Jan Astermark reviews current understanding of risk factors for the development of inhibitory antibodies and discusses whether this risk can be modulated and minimized. Factors key to the improvement of joint health in people with haemophilia are explored, with Carlo Martinoli and Víctor Jiménez‐Yuste discussing the utility of ultrasound for the early detection of haemophilic arthropathy. Other aspects of care necessary for the prevention and management of joint disease in people with haemophilia are outlined by Thomas Hilberg and Sébastian Lobet, who highlight the therapeutic benefits of physiotherapy and sports therapy. Riitta Lassila and Carlo‐Federico Perno describe current knowledge surrounding the risk of transmission of infectious agents via clotting factor concentrates. Finally, different types of extended half‐life technology are evaluated by Mike Laffan, with a focus on the practicalities and challenges associated with these products.

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Physiotherapy Evaluation and Intervention in the Acute Hemarthrosis: Challenging the Paradigm

Cited by 6 publications

References 50 publications

The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?

The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?

Optimal management of hemophilic arthropathy and hematomas

Managing Haemophilia for Life: 4th Haemophilia Global Summit

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