We present what we believe to be the first reported case of atraumatic hemarthrosis of a patient not on antiplatelet or anticoagulation after H. After an extensive publication search there was only one case report of atraumatic hemarthrosis after hirudotherapy, but the patient was on coumadin as well. It did not note any intraarticular side effects from this therapy. A meta-analysis summarizing the use of Hirudo medicinalis, the medicinal leech, for osteoarthritis reported adverse reactions being more cutaneous in nature with localized itching, cellulitis, and mild bleeding. As the use of leeches in modern medicine is increasing the most common adverse reactions from leech therapy include infection, cutaneous bleeding, and allergic reactions. In regards toВ treatment of osteoarthritis it is thought that the hyaluronidase allows the anti-coagulants, vasodilators, and anesthetics to reach the deep tissues and the joint space providing anti-inflammatory effects and pain relief. It is suggested that hirudotherapyвЂ™s mechanism of action includes a wide range of secretions that ultimately eliminate micro-circulation disorders, restore vascular permeability of tissues, eliminate hypoxia, and improve the bioenergetic status of the organism. Today, it is used to stimulate blood circulation after plastic surgery, heal wounds, and relieve the pain associated with osteoarthritis.В A single bite of the leech, Hirudo medicinalis, releases 100 different bioactive materials.В A small example of these materials are anti-coagulants like hirudin and factor Xa inhibitors, vasodilators like acetylcholine and histamine like substance, and hyaluronidase that increases intestinal viscosity and antibiotic action. With the advent of modern medicine, hirudotherapy initially had a decline but now over the last few decades has had a resurgence. Then in the 19th century, leeches were used for treatment of hematomas, hemorrhoids, headaches, and abscesses. Initially it was used for bloodletting and вЂbalancing the biological humorsвЂ™.

Hirudotherapy, the use of leeches in medical treatment, began as early as 200-130 BC.

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