Myositis Ossificans

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Myositis Ossificans
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Myositis Ossificans

• Myositis ossificans results from a complication
  of a contusion injury and occurs when part of of
  the hematoma is replaced with bone. This
  condition can occur anywhere in the body but more
  commonly occurs in the quadriceps.
• The bone deposits may occur as a separate piece
  or pieces of bone lying entirely within the
  muscle or attached to the bone (exostosis).

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Myositis Ossificans

• These calcium deposits are thought to be caused
  by periosteal cells that invade the hematoma
  following the injury.
• This causes a partial avulsion of muscle fibers
  from the periosteum.

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Mechanism of Injury and Presentation

• Usually caused by injuries that result in a
  severe contusion or chronic contusion injuries.
• Patient will first present with severe pain at
  first usually with a contusion and a palpable
  mass within the muscle.

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Signs and Symptoms

• Bruising

• Pain
• Palpable mass in muscle

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  Examination and Evaluation

•             History
• How did it occur?
• When did it occur?
• What type of pain do you have?
• Does the pain change at different times?
• Is there any other sensation rather than pain?
• Is there any swelling? If so, was swelling
  immediate or did it come later?

•      Observation
•   Look at how the athlete moves.
• Look for swelling, contusion, and ecchymosis.
• Check for a palpable mass within the muscle. Mass
  usually shows up within 2-3 weeks.

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Examination and Evaluation

•          Palpation
• Palpate along the muscle and around the contused
  area to feel for a calcium deposit.

•      Special Test
• Manual Muscle Testing- assess the strength of the
  athlete you are testing.
• Check Range of Motion-check the athletes range
  of motion to see if calcium deposit is decreasing
  ROM.

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Referral/Diagnostic Procedure

• Plain Film Radiographs
• MRI

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Rehabilitation and Protection

• Range of Motion Exercises
• Stretch
• Protective covering over the injured area.

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Treatment

• Heat
• Massage
• Ultrasound
• If the condition is painful and restricts
  motion, the calcium deposit may be removed after
  one year with much less likelihood of its return.
  Too-early removal of the formation may cause it
  to return.

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Questions

• What is myositis ossificans?
• a. contusion
• b. calcium deposit
• c. an avulsion fracture
• d. inflammed muscle
• Myositis ossificans is result of
• a. repetitive contusions
• b. severe hematoma
• c. untreated contusion
• d. all the above

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Questions

• Myositis ossificans is caused by ____ cells that
  invade a hematoma.
• a. osteoblastic
• b. osteoclastic
• c. periosteal
• d. none of the above
• A palpable mass in the muscle will be seen
  _____.
• immediately
• never
• 4-6 weeks
• 2-3 weeks

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Questions

• Calcium deposits should only be removed under
  what condition(s)?
• a.condition is severely painful
• b. motion is restricted
• c. mass is too large
• d. contusion has been resolved

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Sources

• Arnheim, Daniel D. Prentice, William E. (1999)
  Principles of Athletic Training. 10th edition.
  pg. 571. Boston McGraw Hill Press
• Bosher, James M. Thibodeau, Gary A.(1994)
  Athletic Injury Assessment. pg.520
• Larson,Christopher M. MD Louis C. Almekinders,
  MD Spero G. Karas, MD William E. Garrett, MD,
  PhD (February 2002). The Physician and
  Sportsmedicine. Vol.30 No.2 Evaluating and
  Managing Muscle Contusions and Myositis
  Ossificans . http//www.physsportsmed.com/issues/
  2001/12_01/moeller.htm
• Prentice, William E.(2003) Therapeutic Modalities
  for Sports Medicine and Athletic Training. 5th
  edition. pg.120-121
• Ruane, Joseph J., DO Thomas A. Rossi, MD(April
  1997). The Physician and Sportsmedicine. Vol.26
  No.4 When Groin Pain Is More Than 'Just a
  Strain' Navigating a Broad Differential
  http//www.physsportsmed.com/issues/2001/12_01/moe
  ller.htm