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MYOSITIS
OSSIFICANS
(Post traumatic ossification/sterners tumor) VINKAL SARAAN
B.P.T
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 Myo – muscle

 Ossify – bone formation

 Bone formation with in a muscle secondary to blunt trauma.

 The condition occur in young active males due trauma to the muscle
and soft tissues(hematoma in the muscle-collection of blood outside the
blood vessel).

 Essentially metaplasia (reversible change in which one adult cell type )

of the intramuscular connective tissue resulting in extra osseous bonne
formation.
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 Quadriceps ,brachialis ,gluteal ,and deltoid are the muscles usually .

involved (other sites – pectoralis muscle )

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TYPES OF MYOSITIS OSSIFICANS

 1. NON HEREDITARY MYOSITIS OSSIFICANS.

 2. MYOSITIS OSSIFIANS PROGRESSIVA (fibrodysplasia

ossificans progressive)
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1. NON HERIDITARY MYOSITIS OSSIFICANS

 Conditions occur in children (due to periosteum is loosely

attached around bones) and in young active male due to trauma
to the muscle and soft tissue (hematoma in muscle) , massage
following fracture can also aggravate.
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PATHOPHYSIOLOGY
 Bone morphogenetic protein stimulate stem cells
in soft tissue to form osteoblasts.
 Organization of hematoma

 Fibroblastic hypoplasia

 Osteoid formation
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Clinical presentation

 Pain

 Tenderness

 Swelling

 Decreases ROM.
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INVESTIGATION
 X RAY – mineralization occur about 3 weeks after injury.

-peripheral bone formation with central lucent area may appear as

DOTTED VEL PATTERN.

 CT SCAN – Mineralization progresses to form “egg shell

calcification”.

 Increased ESR and serum alkaline phosphate.

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TREATMENT

 Rest

 Activity modification

 No passive range of motion , they may stimulate ossification reaction

and lead to recurrence.

 Limb should be rested with the knee in extension / elbow in 90 degree

of flexion until local reaction has subside.

 Avoid heat and massage.

 NSAIDS and low dose radiation.

 Surgery is indicated if lesion is mature (may take up to 1 year).

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Differential Diagnosis.

 Parosteal osteosarcoma.

 Soft tissue sarcoma including malignant

fibrous histiocytoma.
 Synovial sarcoma.
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2. MYOSITIS OSSIFICANS PROGRESSIVA

 Rare autosomal dominant disorder.

 Skeletal malformation and progressive.

 Fibrosing and ossification of muscle , tendon, and

ligament of multiple sites often in the upper
extremities and back that is disabling and ultimately
fatal.
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 Heterozygous mutation in the glycine – serine.

 Painful lumps and stiffness in the adjoining joint ,

lumps decreases in the few weeks but joint mobility
reduction persists.

Exacerbating factors for ossification at new site

 Minor trauma , biopsy of lumps , dental treatment,
excision of masses.
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 Most common sites.

Sternocleidomastoid , paraspinal muscle , shoulder and pelvic

girdle muscle.

 Spared muscles

Abdominal muscles , extra ocular muscles , muscles of facial

expressions , diaphragm and tongue muscle.

Ossification progresses from proximal to distal.

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CLINICAL FEATURES
 Ossification in muscles and fibrous tissue.
 Kyphoscoliosis : restricted shoulder and pelvic girdle movement.
 Short hallux valgus

INVESTIGATION.
 Hemogram, ESR .
 ECG findings may be abnormal.
 Spirometry : restrictive pattern.
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TREATMENT
 Pain medication.

 Gentle occupation and physical therapy.

PREVENTION.
 Avoid falling

 Avoid IM injection since these can cause bone to grow.

 Never stretch the joint outside of their normal ROM.

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