Hemophillia A

Recurrent hemarthroses Mechanoreceptor disturbance Chronic Hemophilic Arthropathy 1. Excessive growth within the epiphyseal plate of bone In the developing skeleton 2. Capsular fibrosis 3. Joint contracture 4. Muscle arthrophy 5. Ankylosing Stabilazer muscle weakness (Quadriceps, triceps. Hip ekstensor muscle) Angular deformity Flexion deformity

Joint inflammation

Limited mobility

Propriopception deficit

Muscle Atrophy

Delaying muscular reflex Activity around the joint Reduce joint protection And joint support

Muscle weakness

Decrease stress absorption

Joint instability

Decrease joint protection

Leg Length Discrepancy

Increase of joint bledding Muscle imbalance Increase of further joint damage

Abnormal posture and gait pattern

Mobilizer muscle tightness (flexor wrist and finger, Calf , hamstring,ilipsoas

Functional Scoliosis

Paralumbal Muscle spasm on concave side

Paralumbal Muscle weakness on convex side

IL6.Hemophillia A Recurrent intra-articular bleeding Deposition of iron (hemosiderin) in the synovium Exposure the cartilage to whole blood Induce synoviocyte Hypertrophy ( in the villi) Neovascularization In the subsynovial lays Attract of cytokines Production of Catabolic mediator (IL1. TNF) Inhibition of proteoglican synthesa Increase of proteoglican release Chronic synovitis Destruction of Carticular cartilage Loss of matrix (proteogliycan Content) Hemophillic Arthropathy .