What Is Myositis Ossificans and How Is It Treated?

Myositis ossificans are abnormal bony deposits in muscle tissue. They can develop either from trauma, repetitious micro-trauma, or can be hereditary. Although the exact reason they develop is not yet fully understood, they are a result of trauma to muscle tissue, such as a football player getting hit hard in the thigh during a game, that cumulates in a big bruise which then follows an inflammatory pattern that can cascade into gradual bone formation. This process is divided into three stages: early (0-4 weeks following injury), intermediate (4-8 weeks following injury), and mature (greater than 8 weeks). The ossificans are self-limiting, meaning, that they are not a problem unless they cause the patient intolerable pain or are encroaching on blood vessels or nerves. If pain is felt, it often diminishes as the ossifican matures. Sometimes joint range of motion is lost.

Diagnosis of myositis ossificans is difficult, as the ossificans show up differently depending on the stage of their development. Magnetic resonance imaging (MRI) is the gold standard for their detection, but is costly. Computerized tomography (CT Scan) is good for detection in earlier stages and x-rays are able to detect an ossifican in its mature stage. The biggest concern at the earliest stage of development is to differentiate between a developing ossifican and a malignant tumor.

Treatment is initially non-surgical in nature and the emphasis is decreasing pain and lost motion and increasing function. Conservative treatment is very successful, often because the ossifican reabsorbs or becomes no longer painful once it matures. The best treatment, however, is prevention of ossifican development in the first place with proper care following a traumatic event to muscles. The current recommendation following soft tissue injury is rest for about three to seven days combined with ice, compression, and elevation. Ice should be applied in 15 to 20 minute increments every 30 to 60 minutes, along with assisted movement through the joints range of motion. Once the relative rest period has occurred there should be a slow and graduated return to exercise. If conservative treatment fails, surgery is an option. Surgery is limited to patients with intractable pain or ossificans that are significantly encroaching on important vascular or neural structures.

References: Walczak, B., DO et. al. Review Article: Myositis Ossificans. Journal of the American Academy of Orthopedic Surgery . October, 2015. Vol 23, No 10. Pp. 612-622.

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