Case report 529
Myositis ossificans circumscripta of the psoas muscle due to overuse in an adolescent gymnast Julio Javier Masquijo and Federico Sartori Myositis ossificans is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. The purpose of this article is to report the case of myositis ossificans circumscripta (MOC) of the psoas muscle due to overuse in an adolescent gymnast. A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. Initial plain radiographs were initially interpreted as negative, and laboratory values were normal. MRI imaging demonstrated a circumscribed mass with associated oedema in the psoas muscle. Computed tomography-guided percutaneous biopsy was performed and histology confirmed the diagnosis of MOC. Conservative treatment was initiated with rest and anti-inflammatory drugs (indomethacin). The patient had a resolution of pain and function after 3 months of conservative treatment. At 6 months’ follow-up, MRI demonstrated complete resolution of the lesion and she
Introduction Myositis ossificans (MO) is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. It is more common in men and usually affects adolescents and young adults [1]. Although it may occur at any site, the usual areas involved are those most susceptible to injury, typically the thigh (quadriceps femoris and adductor muscles), elbow (flexor muscles) and buttocks (gluteal muscles), and less often the shoulder and calf [2,3]. MO can be classified into three types [4]: (a) MO progressiva or fibrodysplasia progressiva; (b) traumatic myositis ossificans circumscripta (MOC); and (c) MOC without history of trauma. Traumatic MOC can be produced by a local acute or chronic repetitive trauma. Occurrence in the psoas muscle is rare [5–11] with no reports of this condition produced by overuse. The purpose of this article is to report the case of MOC of the psoas muscle due to overuse in an adolescent gymnast. The patient and her family were informed that data from the case would be submitted for publication and they gave their consent.
Case description A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. She was involved in an intensive gymnastic training programme. She had been undergoing 1060-152X © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
gradually returned to her sports activity. At last follow-up she was asymptomatic. MOC is a rare lesion in the paediatric-adolescent population. To our knowledge, this is the first report of MOC in the psoas muscle produced by overuse. MRI is very sensitive in detecting oedema during the acute phase of the lesion. Conservative treatment should be considered, especially at the early stage of the disease. Spontaneous resolution can be expected in most cases. Level of Evidence: IV. J Pediatr Orthop B 23:529–532 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Pediatric Orthopaedics B 2014, 23:529–532 Keywords: adolescent, myositis ossificans circumscripta, overuse, psoas Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina Correspondence to Julio Javier Masquijo, MD, Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, CP5000, Argentina Tel: + 54 351 4269201; fax: + 54 351 4269201; e-mail: [email protected]
training 6 days a week for more than 4 h during the last 2 months. Physical examination demonstrated a normal gait with full active and passive range of motion. There was right hip pain on performance of the straight legraising test, and severe pain occurred upon passive stretching at 10° of the right hip extension. Neurological exam was completely normal. Standard anteroposterior and lateral radiographs were initially interpreted as negative (Fig. 1), and laboratory values were normal. Physical therapy was indicated but 1 month later she continued to have pain. MRI demonstrated a circumscribed mass of 35 mm in length with peripheral calcification, and associated oedema (Fig. 2). Detailed retrospective review of the initial radiographs showed a subtle mass in the right psoas. Computed tomography (CT)-guided percutaneous biopsy was performed and histology confirmed the diagnosis of MOC. Conservative treatment was initiated with rest and antiinflammatory drugs (indomethacin 75 mg every 12 h). Clinical follow-up showed complete pain relief and normal mobility of the hip and lumbar spine after 3 months. Control MRI demonstrated complete resolution of the lesion after 6 months (Fig. 3), and she gradually returned to her sports activity. At last follow-up she was asymptomatic.
Discussion MO is a benign self-limiting condition in which a mass of heterotopic bone forms within the soft tissues. The exact DOI: 10.1097/BPB.0000000000000096
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
530 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 6
Fig. 1
Anteroposterior and lateral radiographs (initially interpreted as negative) show a subtle mass in the right psoas.
mechanism of injury in overuse is not known. It is believed that overuse causes accumulation of anaerobic metabolic waste products and lactic acid, leading to muscle vulnerability [12,13]. Continuation of the activity can cause microtrauma and microscopic muscle damage [12–14]. Its repetitive character, especially in endurance sports, results in diminished perfusion and further muscle damage, thereby initiating an inflammatory reaction [12,13]. This seems to be enough to encourage the differentiation of the fibroblasts into osteoblasts with the development of MO [15]. There are no typical features that differentiate between children-adolescents and adults in terms of clinical– radiological presentation and/or evolution. The classic radiographic features of MO have been reviewed previously [3]. Aside from soft-tissue swelling and oedema, the first changes are noted at 3–4 weeks. Flocculant
densities similar to callus arise within the mass and periosteal reaction occurs in ∼ 60% of cases. At 6–8 weeks a lacy pattern of new bone is sharply circumscribed by a cortex around its periphery. By 4–6 months the lesion usually gives the appearance of mature lamellar bone and may begin to show absorption. Although CT has been proposed as a useful diagnostic tool, the best imaging modalities are conventional radiography and MRI [16]. The MRI patterns of MOC are typical but not pathognomonic. In some cases, the differential diagnosis from an infection or a malignant tumour remains difficult. The MRI findings in MO vary according to the stage of the disease [17]. Early lesions tend to be inhomogeneous and show increased signal intensity centrally on T2-weighted images probably related to the increased cellularity here. Fluid–fluid levels resulting from haemorrhage and surrounding soft tissue and even bone marrow oedema may be observed. Curvilinear and irregular areas of decreased
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Myositis ossificans circumscripta of the psoas due to overuse Masquijo and Sartori 531
Fig. 2
(a) Coronal and (b) sagittal T2-weighted images demonstrate right psoas mass high signal intensity with associated oedema and enhancement.
Fig. 3
Follow-up MRI. (a) Coronal and (b) sagittal T2-weighted images show complete resolution of the lesion.
signal corresponding to calcification are noted later on, although these are better visualized on CT. Chronic lesions tend to be well defined, possess a border of low signal and contain fatty marrow. In our patient, the MRI
showed soft-tissue swelling adjacent to the iliopsoas with some calcification seen mainly at the periphery of the mass. This is different from tumours, which tend to develop more dense calcification centrally [18].
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
532 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 6
There are few reports in which the development of MOC is caused by overuse. Defoort et al. [15] reported the case of a female swimmer with MOC of the triceps due to overuse. The patient was treated with rest and antiinflammatory drugs, and obtained complete resolution after 6 months. Antao [19] reported an MOC under the rectus femoris in a 23-year-old soccer player. He complained of hip pain during exercise and was treated with vigorous massage for a period of 3 months by an osteopath. The mass was excised through an anterior approach, and after 2 years the patient was asymptomatic. Gast et al. [20] and Webner et al. [21] reported similar cases during running races, and Cetin et al. [22] reported a case of MOC in the adductor muscle in a soccer player treated conservatively. The conservative approach does have a definite role in the treatment of this condition. Treatment should consist of symptomatic support with anti-inflammatory drugs and relative rest, especially at the early stage of the disease [15]. This is to diminish the pain due to muscle inflammation and surrounding perilesional oedema. Although indomethacin was used in this case, it has not been validated for the prevention and treatment of MOC [23]. Other authors have proposed the use of extracorporeal shock wave therapy [24,25] or bisphosphonates [26]. Surgical excision should only be considered in cases of persistent painful masses, associated with muscle weakness and a significant loss of joint motion and/or doubtful diagnostics [11,18,27]. MOC is a rare lesion in the paediatric-adolescent population. To our knowledge, this is the first report of MOC in the psoas muscle produced by overuse. MRI is a very sensitive technique in detecting oedema during the acute phase and sometimes can exclude a malignant process. Conservative treatment should be considered especially at the early stage of the disease. Spontaneous resolution can be expected in most cases.
Acknowledgements
4 5 6
7
8
9
10 11
12
13 14 15
16
17 18 19 20
21 22 23
24
Conflicts of interest
There are no conflicts of interest.
25
References
26
1 2 3
Jaffe HL. Tumours and tumourous conditions of the bones and joints. Philadelphia: Lea and Febiger; 1958. pp. 526–527. Jones BV, Ward MN. Myositis ossificans in the biceps femoris causing sciatic nerve palsy. A case report. J Bone Joint Surg 1980; 62B:506–507. Norman A, Dorfman HD. Juxtacortical circumscribed myositis ossificans: evolution and radiographic features. Radiology 1970; 96:301–306.
27
Paterson DC. Myositis ossificans circumscripta, report of four cases without history of injury. J Bone Joint Surg Br 1970; 52:296–301. Thorseth K. A case of traumatic myositis ossificans in the iliopsoas muscle. Acta Orthop Scand 1968; 39:73–75. Matsuda Y, Iwafuchi M, Ohsawa Y, Uchiyama M, Naitoh S, Ohtani T, et al. A case of pseudomalignant myositis ossificans in the psoas muscle. J Jpn Soc Pediatr Surg 1994; 30:288–295. Petropoulos AS, Sferopoulos NK. Post traumatic myositis ossificans of the iliopsoas muscle. Apropos of a case with review of the literature. Rev Chir Orthop Reparatrice Appar Mot 1997; 83:747–751. Ceccarelli F, Morici F, Berti L, Giannini S. Circumscribed myositis ossificans of the iliopsoas muscle. Description of a case followed-up after 1 and 14 years. Chir Organi Mov 2004; 89:151–159. Sirvanci M, Ganiyusufoglu AK, Karaman K, Tezer M, Hamzaoglu A. Myositis ossificans of psoas muscle: magnetic resonance imaging findings. Acta Radiol 2004; 45:523–525. Kim SW, Choi JH. Myositis ossificans in psoas muscle after lumbar spine fracture. Spine (Phila Pa 1976) 2009; 34:E367–E370. Lee KT, Lin YM, Lee CH, Huang KC. Myositis ossificans circumscripta in the psoas muscle with femoral neuropathy. Formosan J Musculoskeletal Disord 2013; 4:22–25. Miller AE, Davis BA, Beckley OA. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options. Arch Phys Med Rehabil 2006; 87:286–290. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med 2003; 33:145–164. Toumi H, Best TM. The inflammatory response: friend or enemy for muscle injury? Br J Sports Med 2003; 37:284–286. Defoort S, Arnout NA, Debeer PD. Myositis ossificans circumscripta of the triceps due to overuse in a female swimmer. Int J Shoulder Surg 2012; 6:19–22. Hanquinet S, Ngo L, Anooshiravani M, Garcia J, Bugmann P. Magnetic resonance imaging helps in the early diagnosis of myositis ossificans in children. Pediatr Surg Int 1999; 15 (3–4):287–289. Quek ST, Unger A, Cassar-Pullicino VN, Roberts SN. A self limiting tumour. Ann Rheum Dis 2000; 59:252–256. Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. Am J Roentgenol 1991; 157:1243–1248. Antao NA. Myositis of the hip in a professional soccer player. A case report. Am J Sports Med 1988; 16:82–83. Gast W, Hagena FW, Pforringer W, Remberger K. Multilocular myositis ossificans-damage caused by excessive stress in performance sports? Sportverletz Sportschaden 1987; 1:59–63. Webner D, Huffman GR, Sennett BJ. Myositis ossificans traumatica in a recreational marathon runner. Curr Sports Med Rep 2007; 6:351–353. Cetin C, Sekir U, Yildiz Y, Aydin T, Ors F, Kalyon TA. Chronic groin pain in an amateur soccer player. Br J Sports Med 2004; 38:223–224. Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 2007; 21:317–331. Torrance DA, Degraauw C. Treatment of post-traumatic myositis ossificans of the anterior thigh with extracorporeal shock wave therapy. J Can Chiropr Assoc 2011; 55:240–246. Buselli P, Coco V, Notarnicola A, Messina S, Saggini R, Tafuri S, et al. Shock waves in the treatment of post-traumatic myositis ossificans. Ultrasound Med Biol 2010; 36:397–409. Ben Hamida KS, Hajri R, Kedadi H, Bouhaouala H, Salah MH, Mestiri A, et al. Myositis ossificans circumscripta of the knee improved by alendronate. Joint Bone Spine 2004; 71:144–146. Bronfen C, Touzet P, Peuchmaur M, Prieur AM, Rigault P. Non-traumatic myositis ossificans in a child. Review of the literature apropos of a case mimicking malignant tumor. Rev Chir Orthop Reparatrice Appar Mot 1993; 79:229–234.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Myositis ossificans circumscripta of the psoas muscle due to overuse in an adolescent gymnast Julio Javier Masquijo and Federico Sartori Myositis ossificans is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. The purpose of this article is to report the case of myositis ossificans circumscripta (MOC) of the psoas muscle due to overuse in an adolescent gymnast. A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. Initial plain radiographs were initially interpreted as negative, and laboratory values were normal. MRI imaging demonstrated a circumscribed mass with associated oedema in the psoas muscle. Computed tomography-guided percutaneous biopsy was performed and histology confirmed the diagnosis of MOC. Conservative treatment was initiated with rest and anti-inflammatory drugs (indomethacin). The patient had a resolution of pain and function after 3 months of conservative treatment. At 6 months’ follow-up, MRI demonstrated complete resolution of the lesion and she
Introduction Myositis ossificans (MO) is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. It is more common in men and usually affects adolescents and young adults [1]. Although it may occur at any site, the usual areas involved are those most susceptible to injury, typically the thigh (quadriceps femoris and adductor muscles), elbow (flexor muscles) and buttocks (gluteal muscles), and less often the shoulder and calf [2,3]. MO can be classified into three types [4]: (a) MO progressiva or fibrodysplasia progressiva; (b) traumatic myositis ossificans circumscripta (MOC); and (c) MOC without history of trauma. Traumatic MOC can be produced by a local acute or chronic repetitive trauma. Occurrence in the psoas muscle is rare [5–11] with no reports of this condition produced by overuse. The purpose of this article is to report the case of MOC of the psoas muscle due to overuse in an adolescent gymnast. The patient and her family were informed that data from the case would be submitted for publication and they gave their consent.
Case description A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. She was involved in an intensive gymnastic training programme. She had been undergoing 1060-152X © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
gradually returned to her sports activity. At last follow-up she was asymptomatic. MOC is a rare lesion in the paediatric-adolescent population. To our knowledge, this is the first report of MOC in the psoas muscle produced by overuse. MRI is very sensitive in detecting oedema during the acute phase of the lesion. Conservative treatment should be considered, especially at the early stage of the disease. Spontaneous resolution can be expected in most cases. Level of Evidence: IV. J Pediatr Orthop B 23:529–532 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Pediatric Orthopaedics B 2014, 23:529–532 Keywords: adolescent, myositis ossificans circumscripta, overuse, psoas Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina Correspondence to Julio Javier Masquijo, MD, Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, CP5000, Argentina Tel: + 54 351 4269201; fax: + 54 351 4269201; e-mail: [email protected]
training 6 days a week for more than 4 h during the last 2 months. Physical examination demonstrated a normal gait with full active and passive range of motion. There was right hip pain on performance of the straight legraising test, and severe pain occurred upon passive stretching at 10° of the right hip extension. Neurological exam was completely normal. Standard anteroposterior and lateral radiographs were initially interpreted as negative (Fig. 1), and laboratory values were normal. Physical therapy was indicated but 1 month later she continued to have pain. MRI demonstrated a circumscribed mass of 35 mm in length with peripheral calcification, and associated oedema (Fig. 2). Detailed retrospective review of the initial radiographs showed a subtle mass in the right psoas. Computed tomography (CT)-guided percutaneous biopsy was performed and histology confirmed the diagnosis of MOC. Conservative treatment was initiated with rest and antiinflammatory drugs (indomethacin 75 mg every 12 h). Clinical follow-up showed complete pain relief and normal mobility of the hip and lumbar spine after 3 months. Control MRI demonstrated complete resolution of the lesion after 6 months (Fig. 3), and she gradually returned to her sports activity. At last follow-up she was asymptomatic.
Discussion MO is a benign self-limiting condition in which a mass of heterotopic bone forms within the soft tissues. The exact DOI: 10.1097/BPB.0000000000000096
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
530 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 6
Fig. 1
Anteroposterior and lateral radiographs (initially interpreted as negative) show a subtle mass in the right psoas.
mechanism of injury in overuse is not known. It is believed that overuse causes accumulation of anaerobic metabolic waste products and lactic acid, leading to muscle vulnerability [12,13]. Continuation of the activity can cause microtrauma and microscopic muscle damage [12–14]. Its repetitive character, especially in endurance sports, results in diminished perfusion and further muscle damage, thereby initiating an inflammatory reaction [12,13]. This seems to be enough to encourage the differentiation of the fibroblasts into osteoblasts with the development of MO [15]. There are no typical features that differentiate between children-adolescents and adults in terms of clinical– radiological presentation and/or evolution. The classic radiographic features of MO have been reviewed previously [3]. Aside from soft-tissue swelling and oedema, the first changes are noted at 3–4 weeks. Flocculant
densities similar to callus arise within the mass and periosteal reaction occurs in ∼ 60% of cases. At 6–8 weeks a lacy pattern of new bone is sharply circumscribed by a cortex around its periphery. By 4–6 months the lesion usually gives the appearance of mature lamellar bone and may begin to show absorption. Although CT has been proposed as a useful diagnostic tool, the best imaging modalities are conventional radiography and MRI [16]. The MRI patterns of MOC are typical but not pathognomonic. In some cases, the differential diagnosis from an infection or a malignant tumour remains difficult. The MRI findings in MO vary according to the stage of the disease [17]. Early lesions tend to be inhomogeneous and show increased signal intensity centrally on T2-weighted images probably related to the increased cellularity here. Fluid–fluid levels resulting from haemorrhage and surrounding soft tissue and even bone marrow oedema may be observed. Curvilinear and irregular areas of decreased
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Myositis ossificans circumscripta of the psoas due to overuse Masquijo and Sartori 531
Fig. 2
(a) Coronal and (b) sagittal T2-weighted images demonstrate right psoas mass high signal intensity with associated oedema and enhancement.
Fig. 3
Follow-up MRI. (a) Coronal and (b) sagittal T2-weighted images show complete resolution of the lesion.
signal corresponding to calcification are noted later on, although these are better visualized on CT. Chronic lesions tend to be well defined, possess a border of low signal and contain fatty marrow. In our patient, the MRI
showed soft-tissue swelling adjacent to the iliopsoas with some calcification seen mainly at the periphery of the mass. This is different from tumours, which tend to develop more dense calcification centrally [18].
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
532 Journal of Pediatric Orthopaedics B 2014, Vol 23 No 6
There are few reports in which the development of MOC is caused by overuse. Defoort et al. [15] reported the case of a female swimmer with MOC of the triceps due to overuse. The patient was treated with rest and antiinflammatory drugs, and obtained complete resolution after 6 months. Antao [19] reported an MOC under the rectus femoris in a 23-year-old soccer player. He complained of hip pain during exercise and was treated with vigorous massage for a period of 3 months by an osteopath. The mass was excised through an anterior approach, and after 2 years the patient was asymptomatic. Gast et al. [20] and Webner et al. [21] reported similar cases during running races, and Cetin et al. [22] reported a case of MOC in the adductor muscle in a soccer player treated conservatively. The conservative approach does have a definite role in the treatment of this condition. Treatment should consist of symptomatic support with anti-inflammatory drugs and relative rest, especially at the early stage of the disease [15]. This is to diminish the pain due to muscle inflammation and surrounding perilesional oedema. Although indomethacin was used in this case, it has not been validated for the prevention and treatment of MOC [23]. Other authors have proposed the use of extracorporeal shock wave therapy [24,25] or bisphosphonates [26]. Surgical excision should only be considered in cases of persistent painful masses, associated with muscle weakness and a significant loss of joint motion and/or doubtful diagnostics [11,18,27]. MOC is a rare lesion in the paediatric-adolescent population. To our knowledge, this is the first report of MOC in the psoas muscle produced by overuse. MRI is a very sensitive technique in detecting oedema during the acute phase and sometimes can exclude a malignant process. Conservative treatment should be considered especially at the early stage of the disease. Spontaneous resolution can be expected in most cases.
Acknowledgements
4 5 6
7
8
9
10 11
12
13 14 15
16
17 18 19 20
21 22 23
24
Conflicts of interest
There are no conflicts of interest.
25
References
26
1 2 3
Jaffe HL. Tumours and tumourous conditions of the bones and joints. Philadelphia: Lea and Febiger; 1958. pp. 526–527. Jones BV, Ward MN. Myositis ossificans in the biceps femoris causing sciatic nerve palsy. A case report. J Bone Joint Surg 1980; 62B:506–507. Norman A, Dorfman HD. Juxtacortical circumscribed myositis ossificans: evolution and radiographic features. Radiology 1970; 96:301–306.
27
Paterson DC. Myositis ossificans circumscripta, report of four cases without history of injury. J Bone Joint Surg Br 1970; 52:296–301. Thorseth K. A case of traumatic myositis ossificans in the iliopsoas muscle. Acta Orthop Scand 1968; 39:73–75. Matsuda Y, Iwafuchi M, Ohsawa Y, Uchiyama M, Naitoh S, Ohtani T, et al. A case of pseudomalignant myositis ossificans in the psoas muscle. J Jpn Soc Pediatr Surg 1994; 30:288–295. Petropoulos AS, Sferopoulos NK. Post traumatic myositis ossificans of the iliopsoas muscle. Apropos of a case with review of the literature. Rev Chir Orthop Reparatrice Appar Mot 1997; 83:747–751. Ceccarelli F, Morici F, Berti L, Giannini S. Circumscribed myositis ossificans of the iliopsoas muscle. Description of a case followed-up after 1 and 14 years. Chir Organi Mov 2004; 89:151–159. Sirvanci M, Ganiyusufoglu AK, Karaman K, Tezer M, Hamzaoglu A. Myositis ossificans of psoas muscle: magnetic resonance imaging findings. Acta Radiol 2004; 45:523–525. Kim SW, Choi JH. Myositis ossificans in psoas muscle after lumbar spine fracture. Spine (Phila Pa 1976) 2009; 34:E367–E370. Lee KT, Lin YM, Lee CH, Huang KC. Myositis ossificans circumscripta in the psoas muscle with femoral neuropathy. Formosan J Musculoskeletal Disord 2013; 4:22–25. Miller AE, Davis BA, Beckley OA. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options. Arch Phys Med Rehabil 2006; 87:286–290. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med 2003; 33:145–164. Toumi H, Best TM. The inflammatory response: friend or enemy for muscle injury? Br J Sports Med 2003; 37:284–286. Defoort S, Arnout NA, Debeer PD. Myositis ossificans circumscripta of the triceps due to overuse in a female swimmer. Int J Shoulder Surg 2012; 6:19–22. Hanquinet S, Ngo L, Anooshiravani M, Garcia J, Bugmann P. Magnetic resonance imaging helps in the early diagnosis of myositis ossificans in children. Pediatr Surg Int 1999; 15 (3–4):287–289. Quek ST, Unger A, Cassar-Pullicino VN, Roberts SN. A self limiting tumour. Ann Rheum Dis 2000; 59:252–256. Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. Am J Roentgenol 1991; 157:1243–1248. Antao NA. Myositis of the hip in a professional soccer player. A case report. Am J Sports Med 1988; 16:82–83. Gast W, Hagena FW, Pforringer W, Remberger K. Multilocular myositis ossificans-damage caused by excessive stress in performance sports? Sportverletz Sportschaden 1987; 1:59–63. Webner D, Huffman GR, Sennett BJ. Myositis ossificans traumatica in a recreational marathon runner. Curr Sports Med Rep 2007; 6:351–353. Cetin C, Sekir U, Yildiz Y, Aydin T, Ors F, Kalyon TA. Chronic groin pain in an amateur soccer player. Br J Sports Med 2004; 38:223–224. Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 2007; 21:317–331. Torrance DA, Degraauw C. Treatment of post-traumatic myositis ossificans of the anterior thigh with extracorporeal shock wave therapy. J Can Chiropr Assoc 2011; 55:240–246. Buselli P, Coco V, Notarnicola A, Messina S, Saggini R, Tafuri S, et al. Shock waves in the treatment of post-traumatic myositis ossificans. Ultrasound Med Biol 2010; 36:397–409. Ben Hamida KS, Hajri R, Kedadi H, Bouhaouala H, Salah MH, Mestiri A, et al. Myositis ossificans circumscripta of the knee improved by alendronate. Joint Bone Spine 2004; 71:144–146. Bronfen C, Touzet P, Peuchmaur M, Prieur AM, Rigault P. Non-traumatic myositis ossificans in a child. Review of the literature apropos of a case mimicking malignant tumor. Rev Chir Orthop Reparatrice Appar Mot 1993; 79:229–234.
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
