Myositis Ossificans

Myositis

ossificans results from a complication of

a contusion injury and occurs when part of of the
hematoma is replaced with bone. This condition
can occur anywhere in the body but more
commonly occurs in the quadriceps.
The bone deposits may occur as a separate piece
or pieces of bone lying entirely within the muscle
or attached to the bone (exostosis).

Myositis Ossificans
These

calcium deposits are thought to be

caused by periosteal cells that invade the
hematoma following the injury.
This causes a partial avulsion of muscle
fibers from the periosteum.

Mechanism of Injury and

Presentation
Usually

caused by injuries that result in a severe

contusion or chronic contusion injuries.
Patient will first present with severe pain at first
usually with a contusion and a palpable mass
within the muscle.

Signs and Symptoms

Bruising

Pain

Palpable

mass in muscle

Examination and
Evaluation
History
Observation
How did it occur?
Look at how the athlete
When did it occur?
moves.
Look for swelling,
What type of pain do you
contusion, and
have?
ecchymosis.
Does the pain change at
different times?
Is there any other sensation Check for a palpable mass
within the muscle. Mass
rather than pain?
usually shows up within 2Is there any swelling? If
3 weeks.
so, was swelling immediate
or did it come later?

Examination and Evaluation

Palpation

Special Test

Manual

Palpate

along the
muscle and around the
contused area to feel
for a calcium deposit.

Muscle Testingassess the strength of the

athlete you are testing.
Check Range of Motioncheck the athletes range
of motion to see if
calcium deposit is
decreasing ROM.

Referral/Diagnostic Procedure
Plain

Film
Radiographs

MRI

Rehabilitation and Protection

Range

of Motion Exercises

Stretch
Protective

area.

covering over the injured

Treatment
Heat
Massage
Ultrasound
* If the condition is painful
and restricts motion,
the calcium deposit may
be removed after one
year with much less
likelihood of its return.
Too-early removal of the
formation may cause it
to return.

Questions

What is myositis ossificans?

a. contusion
b.calciumdeposit
c. an avulsion fracture
d. inflammed muscle
2. Myositis ossificans is result of
a. repetitive contusions
b. severe hematoma
c. untreated contusion
d.alltheabove
1.

Questions
Myositis ossificans is caused by ____
cells that invade a hematoma.
a. osteoblastic
b. osteoclastic
c.periosteal
d. none of the above
4. A palpable mass in the muscle will be
seen _____.
3.

a.
b.
c.
d.

immediately
never
4-6 weeks
2-3weeks

Questions
5.

Calcium deposits should only be removed

under what condition(s)?
a.conditionisseverelypainful
b.motionisrestricted
c. mass is too large
d. contusion has been resolved

Sources

Arnheim, Daniel D.& Prentice, William E. (1999) Principles of Athletic

Training. 10th edition. pg. 571. Boston: McGraw Hill Press

Bosher, James M. & Thibodeau, Gary A.(1994) Athletic Injury Assessment.

pg.520
Larson,Christopher M. MD; Louis C. Almekinders, MD; Spero G. Karas, MD;
William E. Garrett, MD, PhD (February 2002). The Physician and
Sportsmedicine. Vol.30 No.2 Evaluating and Managing Muscle Contusions
and Myositis Ossificans .
http://www.physsportsmed.com/issues/2001/12_01/moeller.htm
Prentice, William E.(2003) Therapeutic Modalities for Sports Medicine and
Athletic Training. 5th edition. pg.120-121
Ruane, Joseph J., DO; Thomas A. Rossi, MD(April 1997). The Physician and
Sportsmedicine. Vol.26 No.4 When Groin Pain Is More Than 'Just a Strain':
Navigating a Broad Differential
http://www.physsportsmed.com/issues/2001/12_01/moeller.htm