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Occasionally after a thigh contusion (ie. dead leg), the hematoma(blood filled bruised area) calcifies and this is known as ‘’myositis ossificans’’. The injury is usually as a result of impact which causes damage to the sheath that surrounds the bone called the periostium, as well as to the muscle. Bone can grow within the muscle due to calcification of the injured area which becomes painful as a result. In myositis ossificans , osteoblasts replace some of the fibroblasts in the healing hematoma one week after the injury and lay down new bone over a number of weeks. Fibroblasts are cells which are normally involved in tissue healing and repair, whereas osteoblasts are cells that are involved in bone. After approximately six or seven weeks the bone growth ceases. At this stage often a palpable lump can be felt. Slow resorbtion of the boney mass then occurs, but a small amount of bone may remain and mature.
Why some contusions calcify is not fully understood. Incidence rates are estimated at between 9% and 20% in athletes with thigh contusion. The more severe the contusion the more likely the development of myositis ossificans, with intramuscular (within the muscle) contusions being more susceptible than intermuscular (between muscles) contusions(King, 1998). Inappropriate treatment of the injury is also seen as a factor in its development. The use of heat following the injury on the affected muscle, or massaging the area too early may increase the risk of developing the condition. In quadriceps injury (common dead leg) the risk of myositis ossificans development is increasingly high if the contusion results in prone(lying face down) knee flexion of less than 45 degrees two to three days after injury. Also the incidence of this condition seems to be higher in quadriceps injuries where there is also swelling around the knee.
Symptoms that you may be developing myositis ossificans include an increase in morning pain and pain with activity, remaining several weeks after the initial injury. Patients also often complain of night pain. On palpation the area develops a characteristic ‘’woody feel’’. Initial improvement of range of motion during the weeks following the injury ceases and there is a subsequent deterioration.
Treatment may include local electrotherapy to reduce muscle spasm, along with painless range of motion exercises. Shockwave therapy has also shown some promise. Indomethacin which reduces new bone formation is prescribed as a preventative measure in high-risk presentations(King, 1998). Corticosteroid injections are definitely not to be used in this condition. Surgery is only used where bone tissue has matured within the muscle. This involves removal of the matured bone tissue.
Eddie O Grady is a Physical Therapist specialiasing in the treatment of back pain, neck pain and sports injuries. He has clinics in Killerisk, Tralee and John Street, Dingle. Phone 086-7700191 for appointment.