Related Experiment Video
Updated: Dec 12, 2025
Measurements of Motor Function and Other Clinical Outcome Parameters in Ambulant Children with Duchenne Muscular Dystrophy
Published on: January 12, 2019
Muscle strength and joint health in children with hemophilia: a cross-sectional study
Necati Muhammed Tat1, Ayşe Merve Tat1, Filiz Can2
1Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University Faculty of Health Sciences, Konya.
Insights
Children with hemophilia experience joint damage and muscle weakness, particularly in the upper extremities. Early detection and rehabilitation are crucial for managing hemophilic arthropathy.
Area of Science:
- Pediatric Orthopedics
- Hematology
- Rehabilitation Medicine
Background:
- Hemophilia is a genetic bleeding disorder that can lead to joint damage (hemarthrosis) in children.
- The long-term effects of hemarthrosis on the musculoskeletal system in pediatric patients are not fully understood.
Purpose of the Study:
- To assess joint health in children with hemophilia (CwH).
- To investigate the impact of recurrent bleeding into joints (hemarthrosis) on the musculoskeletal system in CwH.
Main Methods:
- Evaluated 41 children (6-18 years) with hemophilia using the Hemophilia Joint Health Score (HJHS).
- Assessed pain, range of motion, and muscle strength (flexors/extensors) in knee, elbow, and ankle joints.
- Utilized Visual Analog Scale, goniometer, and digital dynamometer for measurements.
Main Results:
- Arthropathy was prevalent in knees (29), elbows (19), and ankles (18).
- Significant decreases in muscle strength were observed in elbows and ankles of affected limbs.
- Extension loss correlated strongly with HJHS scores, indicating joint damage severity.
Conclusions:
- Hemarthrosis appears to cause greater muscle strength loss in the upper extremities (elbows) compared to lower extremities (knees, ankles).
- Extension loss is a key indicator of hemophilic arthropathy.
- Comprehensive musculoskeletal evaluation and timely rehabilitation are recommended for CwH.
Background And Objectives:
We aimed to evaluate joint health in children with hemophilia (CwH) and to investigate the effects of hemarthrosis on the musculoskeletal system.
Method:
Forty-one CwH aged between 6-18 years participated in the study. Joint health status was evaluated according to Hemophilia Joint Health Score (HJHS). Pain intensity level was assessed in resting and in activity using Visual Analog Scale. Range of motion was measured with goniometer and muscle strength was assessed with digital dynamometer. Arthropathic joints were examined in three groups named knee, elbow and ankle.
Results:
Physical examination revealed arthropathy findings to be found in 29 knee, 19 elbow and 18 ankle joints. The median of flexion angle of the affected side were 120°, 122° and 12° for the knee, elbow and ankle and extension losses of these joints were 5°, 7° and 0, respectively. In CwH having knee and elbow arthropathy, index joint HJHS was found to be significantly higher than those with ankle arthropathy (p < 0.01). The flexor and extensor muscle strength significantly decreased in 11 CwH with unilateral elbow arthropathy compared to the non-arthropatic side (p < 0.05). In 15 CwH with unilateral ankle arthropathy decreased in the extensor muscle strength (plantarflexors) (p < 0.05). Extension loss showed a good correlation with index HJHS of elbow, knee and ankle joints, respectively. (rs= 0.599, 0.576, 0.606, p < 0.01). We observed that the muscle strength of elbow flexors/extensors and ankle extensors were significantly decreased compared to the non-arthropathic side. However this situation was not detected in knee joint despite having highest index HJHS.
Conclusion:
Our findings indicate that hemarthrosis may cause more muscle strength loss in the upper extremity than the lower extremity. Furthermore, extension loss was found to be an important parameter in physical examination of hemophilic arthropathy. Musculoskeletal system should be evaluated comprehensively at regular intervals and when necessary rehabilitative treatment should be planned.
