BIOLOGY

INVESTIGATORY
PROJECT

TOPIC– MYOSITIS OSSIFICANS

 CERTIFICATE

This is to certify that this project entitled work done by S

MONIK RAJ of class XII- C in the academic year 2021-2022.A
genuine investigation has been carried out to investigate about
the subject matter and the related data collection and
investigation has been completed solely and sincerely for
practical held at KENDRIYA VIDYALAYA NO.1 AFS
TAMBARAM.

INCHAGRE MRS. SRI PRIYA [PGT BIOLOY]

INTERNAL EXAMINER EXTERNAL EXAMINER

PRINCIPAL
 ACKNOWLEDGEMENT

I take this to place record on my profound respect to

our principal Mrs. Syriac Mary for guiding light to
my success. I would like to thank my subject teacher
Mrs Nandhini R [PGT CHEM] who has guided ,
encouraged and supported me to do this project work
successfully. I am fortunate to receive the blessings
from my parents whose profound love was the source
of inspiration for my endeavours. I thank my friends
and classmates who helped me throughout the project.
 INDEX

S.no Topic Page

no
1) Introduction 5-7
2) Causes 8-9
3) Symptoms 10-12
4) Treatment 13-17
5) Case Study 18-19
6) Bibliography 20
 INTRODUCTION
Myositis ossificans (MO) is the most common form of
heterotopic ossification (HO), usually within large
muscles.
Some doctors view MO and HO as two points on the same
line. They are similar problems that cause pain, local signs
of inflammation, and loss of motion.
In both cases, bone forms in and around soft tissue (usually
muscle).

Myositis ossificans (MO) occurs after trauma to the muscle

or a brokenbone. New bone cells form between the torn
muscle fibers.
This happens most often around the elbow or thigh.
Children and young adults are affected most often.
Myositis ossificans comprises two syndromes
characterized by heterotopic ossification (calcification) of
muscle. The World Health Organization, 2020, has
grouped myositis ossificans together with fibro-osseous
pseudotumor of digits as a single specific entity in the
category of fibroblastic and myofibroblastic tumors
In the first, and by far most common type, nonhereditary
myositis ossificans (commonly referred to simply as
"myositis ossificans")calcifications occur at the site of
injured muscle, most commonly in the arms or in the
quadriceps of the thighs.
The term myositis ossificans traumatica is sometimes used
when the condition is due to trauma.Also myositis
ossificans circumscripta is another synonym of myositis
ossificans traumatica refers to the new extraosseous bone
that appears after trauma.
The second condition, myositis ossificans progressiva (also
referred to as fibrodysplasia ossificans progressiva) is an
inherited affliction, autosomal dominant pattern, in which
the ossification can occur without injury, and typically
grows in a predictable pattern. Although this disorder can
be passed to offspring by those afflicted with FOP, it is
also classified as nonhereditary, as it is most often
attributed to a spontaneous genetic mutation upon
conception.[citation needed]

Most (i.e. 80%) ossifications arise in the thigh or arm, and

are caused by a premature return to activity after an injury.
Other sites include intercostal spaces, erector spinae,
pectoralis muscles, glutei, and the chest. On planar x-ray,
hazy densities are sometimes noted approximately one
month after injury, while the denser opacities eventually
seen may not be apparent until two months have passed.
Myositis ossificans (MO) is the most common form of
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.
 CAUSES
Myositis ossificans (MO) occurs when bone or bone-like
tissue grows where it’s not supposed to. It most commonly
happens in your muscle after an injury — like when you
get hit hard in the thigh during a soccer game or maybe
after a car or bicycle accident.

About 80 percent of the time, these bony growths develop

in the muscles of your thigh or upper arm.

What causes this and who’s at risk?

MO is typically caused by direct trauma to the muscle, like
a knee to the thigh in rugby or landing hard on the ground
in a bike accident. If you develop a large contusion
(bruise) and a pool of blood forms a lump over the injury
(hematoma), bone may grow at the injury site. This is
responsible for 20 percentTrusted Source of MO cases.
Repeated minor trauma — sometimes seen on the inside
thighs of horseback riders — can also result in MO.
Fractures and surgery, especially hip replacement, are
other possible causes.

Although larger muscles of the upper arm and thigh are

most commonly affected, MO can also occur in fat or
connective tissue like tendons, ligaments, and fascia.
Sports injuries or accidents usually initiate MO.
Adolescents and young adults in their 20s are most
likely to develop MO. It’s rare for children 10 and under to
get the condition. People who have paraplegia are also
prone to MO, but usually with no evidence of trauma.
When a muscle is injured or bruised, bony tissue can be
deposited into the bruise during the healing process. While
the exact cause of this reaction is unknown, athletes who
subject the area to repetitive trauma before it is able to
fully heal are more likely to have calcification and bony
formation in the injured muscle. Additionally, not taking
measures to reduce inflammation in the muscle after the
initial injury also leads to in an increased risk of
developing myositis ossificans. Calcification typically
occurs 2-4 weeks after the initial muscle injury and the
bone fully matures by 3-6 months.

A contusion (or bruise) is caused by a direct blow or

impact to a muscle. The muscle is crushed against the
underlying bone. Although the exact cause of myositis
ossificans is not completely understood, it is believed that
it may develop if a contusion is caused to re-bleed during
recovery. This can occur if someone returns to activity too
soon, or through over-vigorous massage or stretching of
the quadriceps muscle.
 SYMPTOMS
Most contusions, strains, and hematomas will start to feel
better after a few days or weeks with RICE therapy: rest,
ice, compression, and elevation.

But with MO, your pain will increase and your range of
motion in the affected leg or arm will get worse within one
to two weeks after your initial injury.
The injury site will swell and feel warm or hot to the
touch. You may feel a lump in the muscle. Pain and
tenderness can be severe, but will be limited to the injured
muscle. Your movement in that limb will be limited. It’s
unlikely you’ll have a fever.
Unlike other typical muscle strains or injuries, people with
myositis ossificans may notice that their pain worsens with
time instead of getting better.

Someone with this condition may also notice changes in

the affected muscle, including:
 warmth
 swelling
 a lump or bump
 decreased range of motion
Persistent pain in previously injured muscle. While
muscles can take months to get back to full strength
following a strain or a bruise, typically, after 2-3 weeks
there should be continued improvement in pain and
performance. If pain, range of motion, and strength have
not begun to improve or get worse at a month after the
injury, the cause could be myositis ossificans. In addition
to pain, swelling or a hard bump are signs of myositis
ossificans.

Myositis ossificans is characterised by an unusually slow

recovery from a contusion injury. Pain and range of
movement often improve in the first few weeks after an
injury, however, as bone is gradually formed in the muscle,
the pain and muscle stiffness worsen. Night pain and
increased pain in the morning may also be present. Other
symptoms include:
 swelling/inflamation
 stiffness
 weakness
 numbness
Because MO is not considered to have arisen until actual
bone formation (calcification) has occurred, MO is
generally not diagnosed until a minimum of 2 weeks after
an injury, as this is the least amount of time it takes for
bone formation to occur and to be seen on plain x-ray.
Often it takes 3-6 weeks for the bone calcification to show
up and MO is not officially diagnosed until the bone
formation is seen on x-ray or other investigation. By the
time bone formation has occurred, symptoms may include
a palpable lump in the muscle, range of motion that is
more restricted than it should be, weakness of the muscle,
and ongoing pain. Leading up to the bone formation, the
symptoms of MO present initially as the typical symptoms
of a muscle injury, and include pain, a limited range of
motion, weakness, and bruising in the area or down the
limb. A lump in the muscle felt earlier than 2-3 weeks
post injury is likely a hematoma, which is the pooling of
blood from the injury.

At the time that most muscle injuries should be improving,

those with MO show no improvement in their pain or
range of motion. A palpable mass may be felt in the
muscle and they may be limited in the function of their
limb, including walking with a limp if the injury is in their
lower extremity. Patients with MO may develop significant
pain after using the muscle, or may have pain during the
night or upon waking up. Most patients experience normal
initial rehabilitation and show improvement in their
symptoms early on in their recovery but then this
improvement either halts or deteriorates as the bone forms.
 TREATMENT

Myositis ossificans usually resolves on its own. Taking

pain relievers, such as naproxen or ibuprofen, can help
relieve discomfort.

Other things that a person can do at home include:

 resting the area
 icing the injury
 elevating the affected area
 gentle stretching
 wrapping the affected muscle with an elastic bandage
to reduce swelling

After the first 48 to 72 hours, a person can start physical

therapy to build up strength in the muscle.

Therapy should start with an assisted range of motion

exercises — this involves moving the joints slowly and
gently in all directions to see how far they will go — and
gradually progressing into full dynamic exercise as the
muscle regains strength.
If pain relievers, physical therapy, and other home care
measures are not effective in treating myositis ossificans,
surgical removal of the growth may be needed.
Surgery is usually only used in cases with:

 severe pain
 growths that interfere with nearby nerves, joints, or
blood vessels
 poor range of motion that makes it difficult to perform
daily activities

The doctor or surgeon may recommend delaying surgery

for a period to reduce the risk that myositis ossificans will
reoccur.
You may be able to prevent MO by properly taking care of
your injury in the first two weeks. You can reduce
inflammation by immobilizing the affected muscle with
slight compression, icing, and elevation.

Contusions and strains are vulnerable to additional trauma

during the first couple of weeks. Avoid heavy activity,
massage, and forceful stretching.
If MO has already been diagnosed, your treatment will be
similar to what you did right after the injury first occurred.
Physical therapy is generally conservative, as symptoms
and the size of the bony mass will shrink over time.

Home remedies
Some things you can do at home include:
  Rest: You don’t have to just lie there, but don’t stress
the muscle too much.
 Ice: Apply for 15 to 20 minutes at a time.
 Compression: Wrap an elastic bandage firmly around
your injury to minimize swelling and keep the area
stable.
 Elevation: Raise your injured limb above the level of
your heart to help drain excess fluid from the area.
 Non-painful stretching and strengthening: Gently
stretch the affected muscle and start doing
strengthening exercises when your doctor says it’s OK.
Don’t perform any movements to the point of pain.

Medications and orthotics

You can take nonsteroidal anti-inflammatory drugs
like ibuprofen (Advil) or naproxen (Aleve) to reduce pain
and swelling. Topical treatments like Biofreeze or Tiger
Balm can also help ease pain.

When your pain and movement allow you to get back to

sports, wear some padding or other protection on the
injured muscle to prevent additional damage.

Physical therapy and surgery

A physical therapist may use these methods to decrease
your pain, increase your mobility, and get you on the
playing field again:
  Passive range of motion and mobilization: This is
when a person or machine moves your body parts for
you.
 Active range of motion and mobilization: This is
when you use your own strength to move your body
parts.
 Ultrasound therapy: Sound waves can provide deep
heating to speed healing.
 Extracorporeal shock wave therapy (ESWT): High-
energy sound waves (shock waves) send a mechanical
forceTrusted Source to the injured muscle, helping it
heal more quickly.

If conservative treatments don’t relieve your pain and

restore your range of motion, you and your doctor may
consider surgery. Surgery happens after the bony mass has
stopped developing. The removal of the bone mass will
cure MO.

Outlook
With nonsurgical treatment, stiffness and
tenderness typically lastTrusted Source about one year.

It’s important to follow your physical therapist or doctor’s

instructions for increasing your:

 activity level
 range-of-motion exercises
  stretching
 strengthening

Doing too much too soon can worsen MO. But not
working to recover your range of motion when the doctor
says it’s safe may make your pain and stiffness last longer.
Small ossifications (bony masses) may resolve without any
long-term effects. Larger masses may end up needing
surgery. But once removed, the bone mass is unlikely to
return unless you injure that muscle again.
 CASE STUDY
The patient met with an accident and had 2 fractures
in the right elbow.The injury was treated with POP
for about 22 days.After the removal of POP the the
patient was called for physiotheraphy.And after
having about 20 sessions of physio there still no scope
of improvement and the range of motion of the right
was affected severely, and later a CT scan of the
affected elbow and blood work was done and the
doctors found out that the patient had Myositis
ossificans later he was given medications and again
after 3 months the physio.After having physio rehab
for about once in two days the range of motion started
to improve.
CT SCAN & X-RAY
 BIBLIOGRAPHY

https://www.physio-pedia.com/

https://www.sciencedirect.com/

https://en.wikipedia.org/wiki/Myo
sitis_ossificans

https://www.ncbi.nlm.nih.gov/

https://www.orthobullets.com/