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MSK Case Presentation

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MSK Case Presentation

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  2. 19 yo Lacrosse Player • ~2 weeks ago, he was hit in his quadricep with a lacrosse stick. • Initial injury has improved some, but are has remained tender. • He returned to the field after 5 days. • Presents with pain, tenderness, warmth, focal swelling of his thigh. • New Development: He can palpate a new “lump” in the leg.

  3. Myositis Ossificans • Heterotopic bone formation in muscle in the setting of trauma. • Injury: Compression of muscle tissue against underlying bone with injury to the muscle, blood vessels, and periostium. • Seen radiographically about 2-4 weeks after initial hematoma.

  4. Myositis Ossificans • Bone will begin to grow 2-4 weeks after the injury and mature bone will be seen by 3-6 months. • Most common in athletic adults in the 2nd or 3rd decade • Usually in the setting of trauma. • Most common locations: Quadriceps, Brachialis, Deltoid.

  5. Myositis Ossificans • Why do some develop this lesion? • Not applying ice and compression immediately after the injury. • Intensive physiotherapy, massage, or heat too soon after the injury. • Returning to play too soon after injury.

  6. Major Differential Diagnosis • Osteosarcoma • Sunburst Appearance

  7. Radiological Comparison • Myositis ossificans • Calcification begins at the periphery and progresses toward the center. • Radiographic stabilization or improvement at 3 to 4 months • Osteosarcoma • Calcification begins at the center and progresses to the periphery. • Continued radiographic growth

  8. Clinical Comparison • Myositis Ossificans is favored with: • History of trauma to the affected site • Clinical improvement at 3 to 4 months • Most Important: Pain lessens with time • Pain with osteosarcoma is progressive and unrelenting.

  9. Myositis Ossificans • Treatment: Conservative • Rest, Immobilization, Ice • Things that decrease initial hematoma • Will usually resolve on its own • Surgery: Rarely indicated • Only if it interferes with joint movement or it irritates a nerve. • Usually wait 12 months for lesion to mature as shown by bone scan. • If removed before mature, it will likely recur

  10. References • Essentials of Physical Medicine and Rehabilitation, 1st edition • DeLee and Drez’s Orthopedic Sports Medicine, 2nd edition • www.bonetumor.org

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