MYOSITIS OSSIFICANS
By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.
Severe blunt trauma causing an intramuscular hematoma may result in delayed ossification. Severe muscle injuries, especially in the quadriceps may be accompanied by bone that grows within the muscle during the healing process. Following muscle injuries the body is supposed to lay down new muscle cells and scar tissue to heal the area. In myositis ossificans abnormal bone growth develops within the muscle tissue causing a firm mass within the muscle itself. This can become painful affecting an athlete’s ability to return to sports. It may limit the muscle’s overall flexibility and predispose it to further problems. This can include further strains to the muscle. The muscle will generally be weaker than the unaffected side. The condition is rarely without symptoms. X-rays are necessary to make the diagnosis. Bone tumors must be ruled out. The appearance of the bone on x-rays may help to distinguish a tumor from myositis ossificans. MRIs may be necessary for further evaluation. When myositis ossificans develops aggressive rehabilitation protocol is necessary to improve flexibility to the muscle. Concentric and eccentric exercises are also necessary to maximize the muscle strength, hopefully preventing further injury. Surgery is indicated when the bone mass continues to be painful and interferes with joint movement and muscular activity. The mass may rarely impinge upon the nerves creating nerve compression and the symptoms associated with it. Surgery must be delayed for 6-24 months during which time the mass has matured.
X-RAYS:
Round mass with distinct outer margin. Center is usually radiolucent.
PROGNOSIS:
Over time the volume of heterotopic bone usually diminishes. Recovery of normal muscle function in the presence of myositis ossificans is usually delayed. Indomethacin (strong nonsteroidal anti-inflammatory) may be of benefit in diminishing the volume of bone and lessening the pain associated with the condition.
MYOSITIS is an inflammation of the muscle usually caused by overuse. Shin splints are a form of this where the muscle starts pulling away from the bone causing inflammation to develop at the muscle-bone junction.
CAUSES:
Inflammation of muscle is usually caused by overuse. Especially common in people who are performing in activity they are not accustomed to. Also common in athletes in the early part of a training season. It is also common in athletes in the early part of a training season.
SYMPTOMS: Symptoms include pain with activity, tenderness and occasionally swelling over the injury site. Symptoms worsen over time then start to preclude sports.
TREATMENT:
- Rest, ice and compression of the muscle.
- The decrease in training intensity or stopping the activity if the pain is moderate to severe.
- Shoe gear changes may be necessary.
- Physical therapy may be needed which would include stretching and strengthening exercises to prevent recurrence.
- Surgery is rarely necessary unless an underlying cause cannot be treated conservatively.