Management Approach for Myositis Ossificans
The management of myositis ossificans should focus on rest, ice, compression, and elevation (RICE) as initial therapy, with gentle painless range-of-motion exercises to restore mobility and appropriate padding to protect the affected area from additional trauma. 1
Diagnosis
- Diagnosis is based on radiographic evidence of a calcified mass along with a history of recent trauma to the affected area 1
- Ultrasound can be used at an early stage to reveal the 'zone phenomenon,' which is highly suggestive of myositis ossificans 2
- X-rays are of significant diagnostic value for confirming the diagnosis 3
- Complete examination should include assessment of muscle strength and function 4
- Distinguish true muscle weakness from pain-limited movement 5
Initial Management
Acute Phase
- Implement RICE therapy immediately after injury to minimize hematoma formation 1
- Rest the affected area
- Apply ice to reduce inflammation
- Use compression to limit swelling
- Elevate the affected limb to reduce edema
Early Rehabilitation
- Begin gentle, painless range-of-motion exercises to help restore mobility once acute pain subsides 1
- Consider non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin to suppress bone proliferation 3, 2
- Avoid aggressive stretching or manipulation that could exacerbate the condition 6
Advanced Management
For Persistent or Severe Cases
- Consider joint mobilization and eccentric strengthening exercises in the rehabilitation program 6
- Protect the affected area with appropriate padding to prevent additional trauma 1
- For cases with significant functional limitation, surgical excision may be considered after the ossification has matured (typically 9-12 months after initial presentation) 3
Surgical Considerations
- A less-invasive surgical approach with minimal trauma is recommended when excision is necessary 3
- Application of bone wax to fresh bone wounds may help prevent hematocele formation 3
- Post-operative administration of NSAIDs (e.g., indomethacin) can help suppress bone proliferation 3
Monitoring and Follow-up
- Regular radiographic assessment to monitor the maturation of heterotopic bone formation 6
- Continuous evaluation of range of motion and functional status 4
- Progressive rehabilitation program focusing on restoration of full function 6
Special Considerations
- Non-traumatic forms of myositis ossificans can occur and may present diagnostic challenges, but have similar radiological and histopathological characteristics to traumatic forms 7
- Complete maturation of heterotopic bone formation may take up to 9 months 6
- Return to athletic competition should only be permitted after achieving full pain-free range of motion and normal strength 6