Myositis ossificans: Difference between revisions
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==Background== | ==Background== | ||
*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> | |||
[[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]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Length of pain out of proportion to trauma | |||
*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== | ||
*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== | ||
*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> | |||
*Supportive care, including pain control and physical therapy, is the mainstay of treatment | |||
==Disposition== | ==Disposition== | ||
*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/> | ||
[[Category:Orthopedics]] [[Category:Trauma]] | |||
[[Category:Sports Medicine]] |
Latest revision as of 01:42, 10 May 2019
Background
- 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.[1][2]
- 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[3]
Clinical Features
- Length of pain out of proportion to trauma
- Decreased range of motion
- Palpable, painful mass (generally forms within 2 weeks of initial trauma)
Differential Diagnosis
Extremity trauma
- Compartment syndrome
- Contusion
- Crush syndrome
- Degloving injury
- Fracture
- Laceration
- Myositis ossificans
- Open joint injury
- Peripheral nerve injury
- Rhabdomyolysis
- Tendon injury
- Vascular injury
Evaluation
- 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[1][4]
Management
- Generally self-limited disease process (may take up to 1 year to resolve)[1]
- Supportive care, including pain control and physical therapy, is the mainstay of treatment
Disposition
- Discharge with referral to orthopedic surgery or sports medicine[5]
See Also
External Links
References
- ↑ 1.0 1.1 1.2 Walczak BE, et al. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-22.
- ↑ 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.
- ↑ 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.
- ↑ Trojian TH. Muscle contusion (thigh). Clin Sports Med. 2013 Apr;32(2):317-24.
- ↑ Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016.