Intraneural bleeding of the ulnar nerve in a haemophilic patient: Case report and guide to orthopaedic management

than 90% of bleeding episodes in patients with haemophilia occur in the musculoskeletal system, of which most episodes occur in the joints. Haematoma formation in muscles, with the development of pseudotumours, may compromise neurovascular structures. The incidence of chronic compressive peripheral neuropathies due to extrinsic causes is low. Acute nerve compression due to intraneural bleeding in patients with haemophilia is a rare entity. We report on acute ulnar nerve compression due to intraneural bleeding, accompanied by median nerve symptoms and present a practical guide to the orthopaedic management of these patients.

[1]  A. I. d'Young Conservative physiotherapeutic management of chronic haematomata and haemophilic pseudotumours: case study and comparison to historical management , 2009, Haemophilia : the official journal of the World Federation of Hemophilia.

[2]  J. Mahlangu,et al.  Guideline for the treatment of haemophilia in South Africa. , 2008, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[3]  A. Çakcı,et al.  A prospective series of musculoskeletal system rehabilitation of arthropathic joints in young male hemophilic patients , 2008, Rheumatology International.

[4]  J. Oldenburg,et al.  Inhibitor Development in Patients with Hemophilia A after Continuous Infusion of FVIII Concentrates , 2005, Annals of the New York Academy of Sciences.

[5]  M. Walsh,et al.  Retrospective audit of a continuous infusion protocol for haemophilia A at a single haemophilia treatment centre , 2005, Haemophilia : the official journal of the World Federation of Hemophilia.

[6]  I. Scharrer,et al.  Management of haemophilic patients with inhibitors in major orthopaedic surgery by immunadsorption, substitution of factor VIII and recombinant factor VIIa (NovoSeven®): a single centre experience , 2004, Haemophilia : the official journal of the World Federation of Hemophilia.

[7]  E. Rodríguez‐Merchán Orthopaedic surgery in persons with haemophilia. , 2003, Thrombosis and Haemostasis.

[8]  B. Kaymak,et al.  Concomitant compression of median and ulnar nerves in a hemophiliac patient: a case report. , 2002, Joint, bone, spine : revue du rhumatisme.

[9]  E. Rodríguez‐Merchán Orthopaedic surgery of haemophilia in the 21st century: an overview , 2002, Haemophilia : the official journal of the World Federation of Hemophilia.

[10]  F. Rosendaal,et al.  Definitions in Hemophilia , 2001, Thrombosis and Haemostasis.

[11]  C. Rothschild,et al.  Multicenter Retrospective Study on the Utilization of FEIBA in France in Patients with Factor VIII and Factor IX Inhibitors , 1997, Thrombosis and Haemostasis.

[12]  N. D. de Bosch,et al.  Hematomas Within the Iliopsoas Muscles in Hemophilic Patients: The Latin American Experience , 1996, Clinical orthopaedics and related research.

[13]  A. Giles,et al.  The Canadian Hemophilia Registry as the basis for a national system for monitoring the use of factor concentrates , 1995, Transfusion.

[14]  S. Schulman,et al.  Monoclonal purified F VIII for continuous infusion: stability, microbiological safety and clinical experience. , 1994, Thrombosis and haemostasis.

[15]  C. Dumontier,et al.  Entrapment and Compartment Syndromes of the Upper Limb in Haemophilia , 1994, Journal of hand surgery.

[16]  W. Greene Synovectomy of the ankle for hemophilic arthropathy. , 1994, The Journal of bone and joint surgery. American volume.

[17]  L. Hoyer,et al.  Factor VIII inhibitors: structure and function in autoantibody and hemophilia A patients. , 1994, Seminars in hematology.

[18]  S. Schulman,et al.  Stability of factor VIII concentrates after reconstitution , 1994, American journal of hematology.

[19]  S. Arkin,et al.  Recombinant Factor VIII for the Treatment of Previously Untreated Patients with Hemophilia A: Safety, Efficacy, and Development of Inhibitors , 1993 .

[20]  S. Arkin,et al.  Recombinant factor VIII for the treatment of previously untreated patients with hemophilia A. Safety, efficacy, and development of inhibitors. Kogenate Previously Untreated Patient Study Group. , 1993, The New England journal of medicine.

[21]  S. Schulman,et al.  Adjusted dose continuous infusion of factor VIII in patients with haemophilia A , 1992, British journal of haematology.

[22]  H. Pettersson,et al.  Twenty‐five years' experience of prophylactic treatment in severe haemophilia A and B , 1992, Journal of internal medicine.

[23]  R. Duthie,et al.  Peripheral nerve lesions in hemophilia. , 1991, The Journal of bone and joint surgery. American volume.

[24]  E. Ikkala,et al.  Haemophiliacs with factor VIII inhibitors in Finland: prevalence, incidence and outcome , 1990, British journal of haematology.

[25]  R. Ljung,et al.  Diagnostic Symptoms of Severe and Moderate Haemophilia A and B A Survey of 140 Cases , 1990, Acta paediatrica Scandinavica.

[26]  G. Brindley,et al.  Hemophilia presenting as compartment syndrome in the arm following venipuncture. A case report and review of the literature. , 1989, Clinical orthopaedics and related research.

[27]  G. Crawford,et al.  Ulnar nerve palsy in a haemophiliac due to intraneural haemorrhage. , 1984, British medical journal.

[28]  W. Hathaway,et al.  Comparison of continuous and intermittent factor VIII concentrate therapy in hemophilia A , 1984, American journal of hematology.

[29]  J. Hayden MEDIAN NEUROPATHY IN THE CARPAL TUNNEL CAUSED BY SPONTANEOUS INTRANEURAL HEMORRHAGE. , 1964, The Journal of bone and joint surgery. American volume.