Myositis ossificans

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Myositis ossificans (MO) is a benign process characterized by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes. Myositis ossificans is one of the skeletal “don’t touch” lesions.

There are some conditions that are related to, or share a similar name to, myositis ossificans 1:

myositis ossificans circumscripta: refers to new bone that usually appears after trauma

myositis ossificans progressiva: a rare, inherited disorder characterized by fibrosing and ossification of muscle, tendon and ligaments of multiple sites that are disabling and ultimately fatal

panniculitis ossificans: similar to MO but occurring in subcutaneous tissues

fibro-osseous pseudotumor of the digits: variant of MO occurring in the fingers and toes 

The remainder of this article focuses on the former. Myositis ossificans progressiva, panniculitis ossificans and fibro-osseous pseudotumor of the digits are discussed separately.

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Myositis ossificans

Dr Henry Knipe◉◈ and Dr Saqba Farooq et al.

Myositis ossificans (MO) is a benign process characterized by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes. Myositis ossificans is one of the skeletal “don’t touch” lesions.

There are some conditions that are related to, or share a similar name to, myositis ossificans 1:

myositis ossificans circumscripta: refers to new bone that usually appears after trauma

myositis ossificans progressiva: a rare, inherited disorder characterized by fibrosing and ossification of muscle, tendon and ligaments of multiple sites that are disabling and ultimately fatal

panniculitis ossificans: similar to MO but occurring in subcutaneous tissues

fibro-osseous pseudotumor of the digits: variant of MO occurring in the fingers and toes 

The remainder of this article focuses on the former. Myositis ossificans progressiva, panniculitis ossificans and fibro-osseous pseudotumor of the digits are discussed separately.

On this page:

Article:

Epidemiology

Clinical presentation

Pathology

Radiographic features

Treatment and prognosis

Differential diagnosis

See also

References

Images:

Cases and figures

Imaging differential diagnosis

Epidemiology

Most cases of myositis ossificans occur as a result of trauma, and thus, the primary demographic is young adults 1. Another group which is especially prone to myositis ossificans are paraplegics, usually without evidence of trauma 2.

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Clinical presentation

Typically presents as a painful, tender, enlarging mass, which in 80% of cases is located in large muscles of the extremities, often following recognized local trauma, although a definite traumatic event is not always recalled 1,3. In the case of paraplegics, recognized episodes of trauma are often absent, and the disease occurs particularly around the knees and hips 2.

Pathology

Myositis ossificans is essentially metaplasia of the intramuscular connective tissue resulting in extraosseous bone formation (without inflammation). 

It has a zonal organization 1:

peripheral, well-organized mature lamellar bone

intermediate osteoid region

central immature non-ossified cellular (fibroblasts) focus

Unfortunately, the histologically of myositis ossificans can appear similar to osteosarcoma, and thus, can lead to inappropriate management.

Radiographic features

The typical radiographic appearance of myositis ossificans is circumferential calcification with a lucent center and a radiolucent cleft (string sign) that separates the lesion from the cortex of the adjacent bone.

Plain radiograph

Calcification usually begins to become apparent on plain radiographs within 2-6 weeks, and the lesion reaches the classic well-circumscribed peripherally calcified appearance by two months. Over the following 4 or so months, they typically become smaller and denser 1,3.

The cleft between it and the subjacent bone may be difficult to see on plain radiographs.
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Sir same problem is in my left hip so the treatment is available ..give email address so I can send you report

TheAmitsing