Post-traumatic Myositis Ossificans

Fig. 23.1

15-year-old-male soccer player 8 days after direct contusion on the thigh. Axial ultrasound shows an ill-defined area of hyperechogenicity (arrows) within the vastus intermedius muscle consistent with contusion

Fig. 23.2

15-year-old-male soccer player 8 days after direct contusion on the thigh. (a) Lateral radiograph of the left thigh shows a subtle laminar increased density (arrows) in the left vastus intermedius; (b) Axial ultrasound image shows irregular outlined muscle lacerations separated by hypoechoic fluid (arrows), consistent with muscle contusion and areas of haematoma. (c) Sagittal fat-suppressed T2-weighted MRI shows diffuse muscle edema and multiple heterogeneous fluid collections within the vastus intermedius muscle

Fig. 23.3

(a, b) 15-year-old-male soccer player 4 weeks after direct contusion on the thigh Axial and sagittal ultrasound images showed extensive hyperechoic rim (arrows) with posterior shadowing related to ossification in vastus intermedius muscle in keeping with myositis ossificans

Fig. 23.4

15-year-old-male soccer player 4 weeks after direct contusion on the thigh Lateral radiograph of the left thigh shows extensive ossification (arrows) of the vastus intermedius

Fig. 23.5

15-year-old-male soccer player 14 weeks after direct contusion on the thigh. Lateral radiograph of the left thigh shows extensive ossification (arrows) of the vastus intermedius

At week 8, he underwent five weekly sessions of radial extracorporeal shockwave therapy (ESWT) of 100 impulses at 2.5–3.5 bar over every square centimeter of the mass using the Storz Medical MASTERPULS^® MP100. The player felt less pain and his range of motion improved from 90 to 110^° after two sessions of ESWT. He then started gradual active and passive exercises and intermittent ultrasound therapy. The swelling and pain gradually subsided and the range of motion increased as he underwent the later three sessions of ESWT. At 12 weeks, his knee could move fully and he could start jogging. He was allowed more sports specific exercises and gradually returned to normal training by the 16th week.

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