Myositis ossificans - Revision history

Rossdonaldson1 at 01:42, 10 May 2019

2019-05-10T01:42:13Z

← Older revision		Revision as of 01:42, 10 May 2019
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	*Plain radiograph showing peripheral soft tissue calcifications		*Plain radiograph showing peripheral soft tissue calcifications
	**Early radiographs may be non-diagnostic		**Early radiographs may be non-diagnostic
	*Biopsy may be required if concern for malignancy, calcified peritendonitis/bursitis, etc<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22.</ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		*Biopsy may be required if concern for malignancy, calcified peritendonitis/bursitis, etc<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

	==Management==		==Management==

Rossdonaldson1: /* References */

2019-05-10T01:34:27Z

References

← Older revision		Revision as of 01:34, 10 May 2019
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	[[Category:Orthopedics]] [[Category:Trauma]]		[[Category:Orthopedics]] [[Category:Trauma]]
			[[Category:Sports Medicine]]

ClaireLewis at 14:34, 22 September 2016

2016-09-22T14:34:26Z

← Older revision		Revision as of 14:34, 22 September 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:Orthopedics]] [[Category:Trauma]]

Mholtz at 02:33, 2 September 2016

2016-09-02T02:33:58Z

← Older revision		Revision as of 02:33, 2 September 2016
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	==Background==		==Background==
	~~Myositis ossificans (MO), also~~ known as heterotopic calcification~~, is a condition of benign~~ bone deposition within soft tissues, most often skeletal muscle. ~~The condition can arise~~ secondary to one larger traumatic event or repeated small ~~trauma~~ and will be localized to a single muscle or group of muscles involved in the trauma. Alternatively, the condition can be generalized, widespread, progressive and unrelated to trauma. The latter of which is generally considered to be hereditary and has a separate pathophysiology and treatment approach than what is discussed here. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref> Ropper AH, et al. Chapter 48. Diseases of Muscle. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. </ref>		*Also known as heterotopic calcification
			*Benign bone deposition within soft tissues, most often skeletal muscle.
			*Usually arises secondary to trauma (either one larger traumatic event or repeated small traumas) and will generally be localized to a single muscle or group of muscles involved in the trauma.<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref> Ropper AH, et al. Chapter 48. Diseases of Muscle. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. </ref>
			**Alternatively, can be generalized, widespread, progressive and unrelated to trauma - this is thought to be a hereditary form with a separate pathogenesis and treatment
			*Pathophysiology not completely understood - may be related to inappropriate differentiation of mesenchymal cells into chondrocytes and osteoblasts in the setting of trauma/inflammation<ref> Kan L, et al. Dysregulation of local stem/progenitor cells as a common cellular mechanism for heterotopic ossification. Stem Calls. 2009;27(1):150-156. </ref>

	~~===Pathophysiology===~~		[[File:MyositisOssificans.png\|thumbnail\|Plain radiograph taken two months after injury demonstrates irregular calcification located along muscle on medial aspect of right thigh. Diagnosis was myositis ossificans]]
	~~The pathophysiology~~ of myositis ossificans is not completely understood but likely involves inappropriate differentiation of mesenchymal stem cells into chondrocytes and osteoblasts in the setting of inflammation. <ref> Kan L, et al. Dysregulation of local stem/progenitor cells as a common cellular mechanism for heterotopic ossification. Stem Calls. 2009;27(1):150-156. </ref>

	==Clinical Features==		==Clinical Features==
	~~Patients often present with reports~~ of pain ~~lasting longer than expected following a~~ trauma ~~to the hip or thigh muscles with associated decreased~~ range of motion~~. Often there is a palpable~~ painful mass within 2 weeks of ~~the~~ initial trauma.		*Length of pain out of proportion to trauma
	Typical scenario involves blunt soft tissue injury to the thigh such as with football players who then present with protracted pain and stiffness with a palpable mass in the thigh. Alternatively, those who experience repeated minor trauma such as horseback riders or shooters (rifleman or marksman) may develop pain decreased range of motion in their thighs or deltoid respectively.<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref><ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref>[[File:MyositisOssificans.png\|thumbnail\|Plain radiograph taken two months after injury demonstrates irregular calcification located along muscle on medial aspect of right thigh. Diagnosis was myositis ossificans]]		*Decreased range of motion
			*Palpable, painful mass (generally forms within 2 weeks of initial trauma)

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	~~The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain~~ radiograph showing peripheral calcifications ~~consistent with the diagnosis. However, early~~ radiographs may be non-~~specific showing an indeterminate lesion wherein an MRI and biopsy~~ may be ~~necessary. It is important to note that it can be difficult to distinguish MO from~~ malignancy ~~such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or~~ bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		*Plain radiograph showing peripheral soft tissue calcifications
			**Early radiographs may be non-diagnostic
			*Biopsy may be required if concern for malignancy, calcified peritendonitis/bursitis, etc<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22.</ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

	==Management==		==Management==
	~~===Thigh Contusion===~~		*Generally self-limited disease process (may take up to 1 year to resolve)<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref>
	As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		*Supportive care, including pain control and physical therapy, is the mainstay of treatment

	~~===Myositis Ossificans===~~
	~~Surgical management is rarely necessary as MO is often~~ self-limiting and self-resolving. Management is focused on minimizing symptoms and maintaining function of the involved muscle group. Range of motion and strengthening exercises can be used to improve range of motion and function. MO may take ~~as long as~~ 1 year to ~~mature and~~ resolve.<ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref>

	==Disposition==		==Disposition==
	~~Patients benefit from~~ referral to sports medicine ~~specialist or orthopedist for core treatment.~~<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref>		*Discharge with referral to orthopedic surgery or sports medicine<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016.</ref>

	==See Also==		==See Also==
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	==External Links==		==External Links==


	==References==		==References==
	<references/>		<references/>

Rossdonaldson1: /* See Also */

2016-08-31T03:37:27Z

Rossdonaldson1: /* Differential Diagnosis */

2016-08-31T03:36:48Z

Differential Diagnosis

← Older revision		Revision as of 03:36, 31 August 2016
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Extremity trauma DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 03:35, 31 August 2016

2016-08-31T03:35:52Z

← Older revision		Revision as of 03:35, 31 August 2016
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	Myositis ossificans (MO), also known as heterotopic calcification, is a condition of benign bone deposition within soft tissues, most often skeletal muscle. The condition can arise secondary to one larger traumatic event or repeated small trauma and will be localized to a single muscle or group of muscles involved in the trauma. Alternatively, the condition can be generalized, widespread, progressive and unrelated to trauma. The latter of which is generally considered to be hereditary and has a separate pathophysiology and treatment approach than what is discussed here. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref> Ropper AH, et al. Chapter 48. Diseases of Muscle. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. </ref>		Myositis ossificans (MO), also known as heterotopic calcification, is a condition of benign bone deposition within soft tissues, most often skeletal muscle. The condition can arise secondary to one larger traumatic event or repeated small trauma and will be localized to a single muscle or group of muscles involved in the trauma. Alternatively, the condition can be generalized, widespread, progressive and unrelated to trauma. The latter of which is generally considered to be hereditary and has a separate pathophysiology and treatment approach than what is discussed here. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref> Ropper AH, et al. Chapter 48. Diseases of Muscle. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e. New York, NY: McGraw-Hill; 2014. </ref>

	==Pathophysiology==		===Pathophysiology===
	The pathophysiology of myositis ossificans is not completely understood but likely involves inappropriate differentiation of mesenchymal stem cells into chondrocytes and osteoblasts in the setting of inflammation. <ref> Kan L, et al. Dysregulation of local stem/progenitor cells as a common cellular mechanism for heterotopic ossification. Stem Calls. 2009;27(1):150-156. </ref>		The pathophysiology of myositis ossificans is not completely understood but likely involves inappropriate differentiation of mesenchymal stem cells into chondrocytes and osteoblasts in the setting of inflammation. <ref> Kan L, et al. Dysregulation of local stem/progenitor cells as a common cellular mechanism for heterotopic ossification. Stem Calls. 2009;27(1):150-156. </ref>

Line 8:		Line 8:
	Patients often present with reports of pain lasting longer than expected following a trauma to the hip or thigh muscles with associated decreased range of motion. Often there is a palpable painful mass within 2 weeks of the initial trauma.		Patients often present with reports of pain lasting longer than expected following a trauma to the hip or thigh muscles with associated decreased range of motion. Often there is a palpable painful mass within 2 weeks of the initial trauma.
	Typical scenario involves blunt soft tissue injury to the thigh such as with football players who then present with protracted pain and stiffness with a palpable mass in the thigh. Alternatively, those who experience repeated minor trauma such as horseback riders or shooters (rifleman or marksman) may develop pain decreased range of motion in their thighs or deltoid respectively.<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref><ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref>[[File:MyositisOssificans.png\|thumbnail\|Plain radiograph taken two months after injury demonstrates irregular calcification located along muscle on medial aspect of right thigh. Diagnosis was myositis ossificans]]		Typical scenario involves blunt soft tissue injury to the thigh such as with football players who then present with protracted pain and stiffness with a palpable mass in the thigh. Alternatively, those who experience repeated minor trauma such as horseback riders or shooters (rifleman or marksman) may develop pain decreased range of motion in their thighs or deltoid respectively.<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref><ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref>[[File:MyositisOssificans.png\|thumbnail\|Plain radiograph taken two months after injury demonstrates irregular calcification located along muscle on medial aspect of right thigh. Diagnosis was myositis ossificans]]

			==Differential Diagnosis==

	==Evaluation==		==Evaluation==
	The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO from malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO from malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

	==Management==		==Management==
	===Thigh Contusion===		===Thigh Contusion===
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	==Disposition==		==Disposition==
	Patients benefit from referral to sports medicine specialist or orthopedist for core treatment.<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref>		Patients benefit from referral to sports medicine specialist or orthopedist for core treatment.<ref name=tintinalli> Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016. </ref>

	==See Also==		==See Also==

Jstevenson at 06:21, 30 August 2016

2016-08-30T06:21:24Z

← Older revision		Revision as of 06:21, 30 August 2016
Line 11:		Line 11:
	==Evaluation==		==Evaluation==
	The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO from malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO from malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>
			==Management==
	===Thigh Contusion===		===Thigh Contusion===
	As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

Jstevenson: /* Evaluation */

2016-08-30T06:19:26Z

Evaluation

← Older revision		Revision as of 06:19, 30 August 2016
Line 10:		Line 10:

	==Evaluation==		==Evaluation==
	The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO ~~form~~ malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO from malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>
	===Thigh Contusion===		===Thigh Contusion===
	As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

Jstevenson: /* Thigh Contusion */

2016-08-30T06:16:09Z

Thigh Contusion

← Older revision		Revision as of 06:16, 30 August 2016
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	The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO form malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		The diagnosis of myositis ossificans can be relatively straightforward with a good patient history of an inciting event and a plain radiograph showing peripheral calcifications consistent with the diagnosis. However, early radiographs may be non-specific showing an indeterminate lesion wherein an MRI and biopsy may be necessary. It is important to note that it can be difficult to distinguish MO form malignancy such as a soft-tissue sarcoma without a biopsy. Additional conditions to consider include soft-tissue abscess and calcifying peritendinitis or bursitis. <ref name=litreview> Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22. </ref><ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>
	===Thigh Contusion===		===Thigh Contusion===
	As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following ~~this~~ active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>		As soon as possible following injury the patient should have their knee painlessly held in 120 degrees of flexion with a brace or wrap and maintain this flexion for 24 hours. This can help minimize hematoma formation and subsequent MO. Following that, active painless range of motion exercises should begin. NSAIDs can be used for the first 48 to 72 hours only; beyond this NSAIDs can negatively affect healing. <ref name=contusion> Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24. </ref>

	===Myositis Ossificans===		===Myositis Ossificans===

← Older revision		Revision as of 03:37, 31 August 2016
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	==See Also==		==See Also==
			*[[Extremity trauma]]

	==External Links==		==External Links==