title: Hemophilic arthropathy of shoulder joints: clinical, radiographic, and ultrasonographic characteristics of seventy patients.
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.
authors.affiliation: Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yeu-Chin
authors.initials: YC
authors.lastname: Chen
authors.forename: Liang-Cheng
authors.initials: LC
authors.lastname: Chen
authors.forename: Shin-Nan
authors.initials: SN
authors.lastname: Cheng
authors.forename: Ru-Yu
authors.initials: RY
authors.lastname: Pan
authors.forename: Shin-Tsu
authors.initials: ST
authors.lastname: Chang
authors.forename: Tsung-Ying
authors.initials: TY
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D004185:Disability Evaluation; D005260:Female; D006395:Hemarthrosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D012785:Shoulder Joint; D018709:Statistics, Nonparametric; D014463:Ultrasonography