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Hemophilic Arthropathy of Shoulder JointsClinical, Radiographic, and Ultrasonographic Characteristics of Seventy Patients
Yeu-Chin Chen, MD1; Liang-Cheng Chen, MD, MS1; Shin-Nan Cheng, MD, PhD1; Ru-Yu Pan, MD, PhD1; Shin-Tsu Chang, MD, MS, PhD1; Tsung-Ying Li, MD1
1 Division of Hematology/Oncology (Y.-C.C.), Hemophilia Care and Research Center (S.-N.C., R.-Y.P., and T.-Y.L), and the Department of Physical Medicine and Rehabilitation (L.-C.C., and S.-T.C.), No. 325, Section 2, Chenggong Road, Neihu 114, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. E-mail address for T.-Y. Li: doc31141@gmail.com
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Investigation performed at the Division of Hematology/Oncology, Hemophilia Care and Research Center, Department of Medicine, Department of Paediatrics, and the Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 03;95(7):e43 1-8. doi: 10.2106/JBJS.K.01646
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Abstract

Background: 

Although shoulder problems frequently occur in patients with hemophilia, systematic evaluation of shoulder joint damage in these patients has only rarely been reported.

Methods: 

The clinical, radiographic, and ultrasonographic characteristics of the shoulder joint were studied in a cohort of seventy consecutive patients with hemophilia. We collected information on age, disease severity, history of shoulder hemarthrosis, prophylaxis therapy, functional Oxford shoulder score, and crutch use. Both shoulders of each patient were evaluated with shoulder motion and visual analog pain scale scores as well as with radiography and ultrasonography.

Results: 

Sixty-six patients had hemophilia A, and four had hemophilia B. The median age was thirty-four years (range, ten to sixty-three years). Fifty-six shoulders in thirty-five patients had shoulder bleeds, and twenty-seven patients (38.6%) had shoulder pain or limited motion. As determined with radiographs, eighteen (25.7%) of the seventy patients had hemophilic shoulder arthropathy. A strong correlation between the functional Oxford shoulder score and the radiographic Pettersson score was also noted (r = 0.749, p < 0.001). The ultrasonographic abnormalities in the fifty-six hemarthrotic shoulders included chondromalacia (76.8%), osseous irregularity (60.7%), bicipital tenosynovitis (60%), partial-thickness rotator cuff tear (35.7%), and full-thickness rotator cuff tear (17.9%). Older age, the absence of any previous prophylaxis therapy, and higher frequency of crutch use were the most significant factors associated with shoulder bleeds.

Conclusions: 

Shoulder arthropathy is relatively common in patients with hemophilia. Rotator cuff tears were common in the present study, and there was a strong correlation between shoulder function and the radiographic severity of the arthropathy. Ultrasonography was useful for the evaluation of disorders of the soft tissues of the hemophilic shoulder.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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