II. Pathophysiology

  1. Nonmalignant, soft tissue ossification (esp. quadriceps Muscles, brachialis Muscle, hip adductor Muscles)
  2. Sports-related Trauma to Muscle (or surgery-induced)
  3. Results in Hematoma that ossifies
    1. Fibroblasts differentiate into Osteoblasts, triggered by inflammation

III. Findings

  1. Presents 2 to 4 weeks after injury
  2. Most commonly affects the quadriceps femoris Muscle, brachialis Muscle and hip adductor Muscles
  3. Similar findings as with Quadriceps Contusion
  4. Prolonged, localized Muscle pain
  5. Affected joint is stiff with reduced range of motion, as are the adjacent joints

IV. Differential diagnosis

V. Imaging

  1. Bedside Ultrasound
    1. Preferred first-line study
  2. XRay
    1. May demonstrate ossifications at 3 to 4 weeks
  3. MRI
    1. Hyperintense mass
    2. T2 may demonstrate calcifications

VI. Management

  1. Anticipate a prolonged course of spontaneous resolution
  2. Maintain limb range of motion
  3. NSAIDs
  4. Activity restriction
  5. Consider surgical intervention if lesions persist at 12 months

VII. Prevention

  1. Early cold therapy
  2. Acetaminophen is preferred in first few days for pain after injury to decrease bleeding risk
  3. Start gentle, static Stretching after first 48 hours following injury

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Related Studies

Ontology: Myositis Ossificans (C0027122)

Definition (NCI) A disorder characterized by non-neoplastic bone formation in soft tissues. It usually follows blunt trauma and bleeding in the deep soft tissues.
Definition (MSH) A disease characterized by bony deposits or the ossification of muscle tissue.
Concepts Disease or Syndrome (T047)
MSH D009221
SnomedCT 44551007, 156720008, 203030008
English Muscle calcification, Myositis Ossificans [Disease/Finding], myositis ossificans, muscle calcification, myositis ossifican, ossificans myositis, muscular calcification, Muscular calcification, Myositis Ossificans, ossification of muscle (diagnosis), ossification of muscle, Ossification - muscle, Calcification - muscle, Myositis ossificans, Muscle ossification, Muscular ossification (disorder), Muscular ossification, muscle; ossification, myositis; ossificans, ossificans; myositis, ossification; muscle, Muscular ossification, NOS, Myisitis ossificans
Japanese 骨化性筋炎, コッカセイキンエン, コツカセイキンエン
Swedish Myositis ossificans
Czech myositis ossificans, Osifikující myozitida
Finnish Lihaksen luutumismuutos
Polish Zapalenie mięśni kostniejące, Kostnienie mięśni
Hungarian Myositis ossificans
Norwegian Myositis ossificans
Dutch myositis; ossificans, ossificans; myositis, ossificatie; spier, spier; ossificatie, myositis ossificans, Myositis ossificans
Spanish miositis osificante, osificación de músculo (trastorno), osificación de músculo, osificación muscular, Miositis osificante, Miositis Osificante
Portuguese Miosite ossificante, Miosite Ossificante
French Myosite ossifiante, Myosite ossifiante progressive diffuse, Maladie de Münchmeyer, Maladie de l'homme de pierre
German Myositis ossificans
Italian Miosite ossificante

Ontology: Heterotopic Ossification (C0029396)

Definition (MSH) The development of bony substance in normally soft structures.
Definition (CSP) development of bony substance in normally soft structures.
Concepts Pathologic Function (T046)
MSH D009999
SnomedCT 128491006
English Ossification, Ectopic, Ossification, Heterotopic, Ossification, Pathologic, Ossification, Pathological, Pathologic Ossification, Pathological Ossification, pathologic ossification, Heterotopic Ossification, OSSIFICATION PATHOL, PATHOL OSSIFICATION, Ossification, Heterotopic [Disease/Finding], heterotopic ossification, ectopic ossification, ossification heterotopic, Heterotopic ossification (finding), Heterotopic ossification (disorder), Ectopic Ossification, Heterotopic ossification, Ectopic ossification
Dutch ectopische ossificatie, Beenvorming, heterotope, Heterotope ossificatie, Ossificatie, heterotope, Ossificatie, pathologisch, Verbening, heterotope
German ektopische Ossifikation, Ossifikation, heterotope, Ossifikation, pathologische, Verknöcherung, pathologische
Italian Ossificazione ectopica, Ossificazione patologica, Ossificazione eterotopica
Portuguese Ossificação ectópica, Ossificação Heterotópica, Ossificação Patológica
Spanish Osificación ectópica, osificación heterotópica (hallazgo), osificación heterotópica (trastorno), osificación heterotópica, Osificación Heterotópica, Osificación Patológica
Swedish Benbildning, heterotop
Japanese イショセイコツカ, イショセイコッカ, 化骨-異所性, 異所性化骨, 化骨-病的, 異所性骨化, 異所的骨形成, 病的化骨, 骨化-病的
Czech osifikace heterotopická, osifikace patologická, Ektopická osifikace
Finnish Sidekudossyntyinen luutuminen
Polish Kostnienie heterotopowe, Kostnienie patologiczne
Hungarian Ectopiás ossificatio
Norwegian Heterotop forbeining, Heterotop ossifikasjon, Heterotop forbening, Patologisk forbeining, Patologisk ossifikasjon, Patologisk forbening
French Ossification pathologique, Métaplasie osseuse, Ossification ectopique, Ossification hétérotopique