Traumatic myositis ossificans-physioscar

Traumatic myositis ossificans
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Traumatic myositis ossificans

Definition
Traumatic myositis ossificans is a reactive lesion occuring in the soft tissues and at times in the bone periosteum. It’s characterized by fibrous, osseous and cartilaginous proliferation of the subperiosteal hematoma. This is often later followed by metaplastic changes.

Causes 

Trauma
This features a definitive role within the causation of myositis ossificans. Injury to the muscles, ligaments, tendons, periosteum and bones leads to bleeding within the soft tissues which succesively may cause myositis.

Simple blow or repeated minor trauma
This could also produce to thanks to the repeated and constant soft tissue damage.

Dislocations and alvusion injuries
These are more prone to develop myositis than the fractues due to the violent stripping of the periosteum and damage of the violent stripping of the periosteum and damage to the muscles.

ILL- advised massage
This is far and away the most common cause for myositis. Vigorous and improper massage particularly the elbow joint by quacks, etc. Explains the frequent occurence of this problem in patients treated by traditional bonesetters and osteopaths.

Clinical features
In the acute stages, patient may complain of pain, swelling and loss of movements. On examination there may be tenderness. In the later stages, there’s is no pain and a bony hard lump could also be palpated. This may act as a mechanical block to the movement.

Remember

Areas commonly affected

  • Elbow joint common in young athlets
  • Ankle joint-(known as footballer’s ankle)
  • Knee-( known as pellegrini-stieda disease)
  • Shoulder
  • Hip
  • In head injuries it is more common
Investigations 
Radiography
Radiography  has little role within the acute stages, but within the later stages a bony growth could also be evidently seen.
radiography 3057768 960 720
Radiography
Treatment
Acute stages 
Conservative treatment is that the method of choice and consists of the following:
  • Immobilization of the party by splints, etc
  • Drugs: Calcitonin and non-steroidal anti-inflammatory drugs, Diphosphonate therapy ( NSAIDS)
  • physiotherapy: Active physiotherapy is inspired and passive stretching is avoided.
  • Manipulations is completed under anesthesia. It’s a double edged sword and has got to be done very carefully. Adhesions should snap abruptly and will not be broken gradually.
Late stages
  • Vigorous active ROM exercise using Roller skates, etc.
  • Gentle passive stretching
Chronic stages
Surgery is that the treatment of choice and consists of soft tissue release and excision of bony spur, when it’s well formed.
Post-surgery physiotherapy management
 
First 2 weeks
  • Hand elevation to prevent limb edema
  • Active exercises to the unaffected joints
  • Isometric exercises to the elbow muscles
After 2 weeks
  1. Thermotherapy to reduce pain and swelling
  2. Hydrotherapy
  3. Isometric to the elbow muscles
  4. Elbow mobilization is done as follows:
  5. Self assisted exercises for forearm supination and pronation by fixing the elbow by the sides of the trunk and placing the forearm on the thighs.
  6. Gentle passive stretching of the elbow are using appropriate adjunctive measures is commenced
  7. After 3 weeks all the above measures are often made more vigorous and PRE is started
  8. The patient should regain full functional activity by the highest of 6 weeks.
limb
Showing shortening limb
Remember 
The term myositis ossificans  could also be a misnomer because skeletal muscle is typically  not involved and inflammatory changes are rarely seen.
Myositis ossificans progressive is a different conditions and has  nothing to do with the traumatic one. It is a Congenital condition affecting all the skeletal muscles.

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