Ultrasound, bleeds, joints and sport


Bianca Da Silva is Head of Department, Paediatric Physiotherapy, John Hunter Children’s Hospital, Newcastle, NSW.

My first day at WFH 2024 World Congress consisted of a full day ultrasound workshop at the Professional Development Day, with the focus on teaching how to detect the presence or absence of a bleed (largely in the joint spaces) using point-of-care ultrasound (PoCUS), which is used routinely in some Haemophilia Treatment Centres in the United States of America.

PoCUS is done at the bedside (i.e., point of care) by using portable ultrasound equipment to support a clinical assessment, with the idea that pain can be used in early identification to detect the presence or absence of a bleed. It does not replace current imaging that Haemophilia Treatment Centres are currently using such as ultrasound, CT or MRI that are performed by radiologists. It was demonstrated that it can also be used in the clinical setting to monitor the progression of a bleed, and how to use doppler imaging to assist with clinical decision making in whether a person with a bleeding disorder can consider returning to sporting activity.

Bianca having an ultrasound of her ankle

There was a particular focus on hands-on practice and teaching, with a number of skilled haematologists and physiotherapists/physical therapists teaching small groups how to use different musculoskeletal placements of the ultrasound transducer to identify bony and soft tissue landmarks, and how it would theoretically look in the presence of a bleed. There was also discussion about the results of a recent pilot study performed by the University of California San Diego, where patients were trained to be able to remotely perform joint self-images using a portable ultrasound device guided by a clinician utilising Telehealth. This demonstrates a possibility and future direction for the use of ultrasound in haemophilia care.

Bianca checking ankles of a volunteer with another physiotherapist

And then the Congress sessions began! There were different tracks/streams at the conference including medical, PWBD (people with bleeding disorders), MSK (musculoskeletal), dental, psychosocial, WGBD (women and girls with bleeding disorders), nurses and lab sciences. As a physiotherapist, I largely attended the musculoskeletal track, however there were a number of interesting sessions across the conference that regrettably I was unable to attend. This further reinforces the diversity of topics and different areas to consider in management of haemophilia as a person with a bleeding disorder or a clinician involved in patient care.

Group of people in front of a conference poster

L-R: Dr Janis Chamberlain, Bianca Da Silva and Jaime Chaise with their poster, ‘Out of the joint and into the muscle’

An additional highlight during the conference was the optimising musculoskeletal management for people with bleeding disorders session. During this session, attendees were able to work in small groups with a haematologist, orthopaedic surgeon and physiotherapist/physical therapist supporting each group as case studies were discussed, and then a greater discussion was conducted as a larger group. The ability to brainstorm and discuss cases with different clinicians from around the world was extremely valuable.

The final session on game changing health: bridging new treatment, sports and everyday living was uplifting. It reinforced the importance of working closely with people with bleeding disorders to support them to achieve their desired goals. Hazri Aris and Clive Smith shared their experiences and physical endeavours including their challenges, and reflected on the future and changes to treatments and what this may mean for people with bleeding disorders.

Aguero P, Barnes RFW, Flores A, von Drygalski A. Teleguidance for patient self-imaging of hemophilic joints using mobile ultrasound devices: a pilot study. Journal of Ultrasound in Medicine 2023 Mar; 42(3):701-712. https://doi.org/10.1002/jum.16084

Bianca Da Silva was assisted by funding from HFA and the Dr Ho MSK Scholarship, John Hunter Children’s Hospital, to attend the WFH 2024 World Congress.

Photos: Bianca Da Silva

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