myositis ossificans

[arunja]

Myositis ossificans is due to the rupture of the capillaries in muscle which later develop in the form of calcium deposition over the muscle. Its common especially after an elbow # . X ray reveals a cotton wool like appeareace. The most common muscle to get affected is the Quadriceps. Never do any massage or tissue mobilisation in elbow. My suggestion is that, make the patient to do more active movmnts within the availiable ROM.

[mageshanand]

Hi guys

I absolutely agree with arunja, you should not do any movements at all until the inflammation subsides, but arunja literature says that for the MO to re absorb, it takes around an year,

and i have come across a study in which Iontophoresis with 2 percent acetic acid was tried, it was a case description and that guy has had a good relief with excellent reabsorption !, but what you have to consider is that, he had this lesion following a sports injury but yours is head injury the etiology is quite different, so you might want to consider IO only if you feel that your patient will be a suitable candidate for it.

cheers

[physiobob]

Posttraumatic Heterotopic Ossification

To give more of an overview of this issue it is important to show that there are at least 3 forms of myositis ossificans although commonly as physio's we only discuss the traumatic, sports injury type. Below is a more thorough outline of the various forms of heterotrophic ossification

Background: In 1918, Dejerine and Ceillier first described heterotopic ossification (HO) in paraplegic patients injured in World War I, referring to the process as paraosteoarthropathy. HO has been defined as the formation of mature lamellar bone in soft tissues. The process involves true osteoblastic activity and bone formation. HO has been reported in cases of brain injury, spinal cord injury, stroke, poliomyelitis, myelodysplasia, tabes dorsalis, carbon monoxide poisoning, spinal cord tumors, syringomyelia, tetanus, and multiple sclerosis. This condition also has been reported after burns and total hip replacement.

Several terms have been used to describe the condition, including heterotopic ossification, ectopic ossification, and myositis ossificans. HO usually involves the large joints of the body (eg, hips, elbows, shoulders, knees). Excessive bone formation may result in significant disability by severely limiting the range of motion (ROM) of these joints (see Image 1).

The following 3 categories of HO have been described:

* Myositis ossificans progressiva is a rare metabolic bone disease in children with progressive metamorphosis of skeletal muscle to bone and is characterized by an autosomal dominant pattern of genetic transmission.

* Myositis ossificans circumscripta without trauma is a localized soft tissue ossification after neurologic injury or burns. This process also is referred to as neurogenic HO.

In relation to your original question some USA stastics showed:

An association has been cited between spasticity and HO. The incidence is higher in a spastic extremity; 84% of patients with HO had spasticity, and 54% of patients with HO had no spasticity. HO is seen in the elbow in 4% of patients with traumatic brain injury (TBI); however, if fracture or dislocation is associated with brain injury, the incidence of HO rises to 89%.

Patients with brain injuries are at greater risk for developing HO if they have significant spasticity or increased muscle tone in the involved extremity, duration of unconsciousness longer than 2 weeks, long-bone or associated fractures, and decreased ROM. Therefore, the risk of development of HO in a patient with brain injury increases as the severity of injury, length of immobilization, and duration of coma increase.

* Traumatic myositis ossificans occurs from direct injury to the muscles. Fibrous, cartilaginous, and osseous tissues near bone are affected. The muscle may not be involved.

Pathophysiology: The specific cause and pathophysiology of HO remain unclear. HO may be due to an interaction between local factors (eg, the pool of available calcium in adjacent skeleton, soft tissue edema, vascular stasis tissue hypoxia, mesenchymal cells with osteoblastic activity) and an unknown systemic factor or factors. The basic defect in HO is the inappropriate differentiation of fibroblasts to bone-forming cells. Early edema of connective tissue proceeds to tissue with foci of calcification and then to maturation of calcification and ossification.


The typical Sport (post trauma) myositis ossificans is summarised below

Definition: Myositis ossificans is an unusual condition that often occurs in athletes who sustain a blunt injury that causes deep tissue bleeding. A typical story is a soccer player who is kicked forcefully in the mid-thigh, and develops pain and significant bruising.

The soft-tissues that were injured in the traumatic event initially develops a hematoma, and subsequently develop the myositis ossificans. The word myositis ossificans means that bone forms within the muscle, and this occurs at the site of the hematoma. No one knows exactly why this occurs in some people.

The common concern when abnormal bone is seen on a x-ray is that there is a tumor within the soft-tissues. Fortunately, myositis ossificans has some typical clues that usually make it easily differentiated from a tumor. If there is any question about the diagnosis, repeat x-rays will be obtained several weeks later to ensure the bone mass is a typical myositis ossificans.

Treatment of myositis ossificans consists of:

* Rest

* Immobilization

* Anti-Inflammatory Medication

Rarely is surgical excision of the myositis ossificans warranted. If the myositis ossificans is removed before it is "mature," it will likely return. Therefore, most surgeons wait between 6 and 12 months before even considering removal. Furthermore, there is a chance of return even when removed very late. Generally, myositis ossificans is only removed surgically if it interferes with joint motion or if it is irritating a nerve

Hope this information helps our understanding and therefore treatment choices