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There are many ways hemophilia can affect the musculoskeletal system.

We'll begin with the obvious. Bleeding into a muscle inhibits the normal contraction and extension through swelling and can also cause permanent hematomas however these rarely cause any permanent problems with functionality.

Similarly, swelling from bleeding into the joint areas can also limit the mobility of the joint.

Loss of mobility from either of these situations can cause atrophy of the musculature if the mobility and use of the muscles is for an extended period of time.

Frequent bleeding into the joints also can cause secondary damage beyond the swelling. With blood filling the joint area your body will react in order to reduce swelling, it will release enzymes into the joints in order to break down the blood for re-absorption. Unfortunately these same enzymes will also break down the cartilage in the joint and over repeated exposure lead to hemoarthritis.

Extreme cases can leave some joints without any cartilage at all, leading to decreased mobility, ossification, and even fusion of the joint. These again will most likely result in muscle atrophy due to decreased mobility and functionality.

Joint swelling can also cause some stretching of ligaments and tendons.

As you can see, there are many ways that hemophilia can potentially affect the musculoskeletal system. (Probably many more than even mentioned here.) Luckily the treatments for hemophilia have dramatically reduced the extent and frequency that these affects are seen today.

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