Myositis Ossificans Traumatica of the Hand

Case Note Note de cas

Myositis ossificans traumatica of the hand

Manish Chadha, MS(Ortho); Anil Agarwal, MS(Ortho)

yositis ossificans usually affects from a local osteopath for the initial palmar flexion. Both pronation and Myoung active adults.1 Occurring 3–4 weeks, following which the elbow supination were restricted to 0°–40°. predominantly in muscles, a similar lesion and wrist were mobilized. The pain and There was a mild Volkmann’s ischemic may occasionally be found in subcuta- swelling gradually diminished over contracture with a positive Volkmann’s neous tissues, tendons, fascia and perios- 8 months, but there was restriction of sign. Distal pulses were well palpable. teum. The occurrence of traumatic movement in the elbow and wrist joints. Anteroposterior and lateral radi- myositis ossificans in tissues of the hand On presentation, we noted some ographs of the elbow (Fig. 1) and wrist is uncommon. We report a rare case of swelling in the elbow region and on the (Fig. 2) revealed ossification around the traumatic myositis ossificans occurring in dorsum of the wrist. The local tempera- elbow and dorsal to the carpals and extensor tendon sheaths of the hand and ture was not increased and there was no metacarpals in the location of the exten- the wrist region in a 10-year-old boy. erythema. A bony, hard mass was palpa- sor tendon sheaths suggestive of trau- ble over the lateral aspect of the elbow matic myositis ossificans. There also was Case report and the dorsum of the wrist, which was a suspicion of an epiphyseal injury to the continuous with the parent bone. There lower end of the ulna. A 10-year-old boy presented with a his- was minimal local tenderness. Both the Considering the significant trauma that tory of injury to the left upper limb supracondylar ridges were indistinct and was subsequently treated by massage, a 8 months earlier. He had fallen from a rounded. Active range of elbow move- diagnosis of posttraumatic myositis ossifi- tree and sustained a closed injury to the ment was 60°–90°. Movement at the cans was made. This was confirmed by left elbow and wrist. He received massage wrist ranged from 10° dorsiflexion to 20° subsequent histopathological examination.

FIG. 2. Anteroposterior (left) and lateral (right) radiographs showing soft-tissue ossification over the dor- FIG. 1. Anteroposterior (left) and lateral (right) radiographs of the sum of the wrist suggestive of myositis ossificans in the elbow showing ossification in the soft tissues over the lateral aspect extensor tendon sheaths. The distal end of the ulna of the elbow joint. shows evidence of a probable epiphyseal injury.

Department of Orthopaedics, University College of Medical Sciences and Guru Teg Dahadur Hospital, Delhi, India

Accepted for publication May 16, 2006

Correspondence to: Dr. Manish Chadha, C-A/16, Tagore Garden, New Delhi-110027, India; [email protected]

Discussion metabolism plus an excess of calcium of this entity in most cases is conservative. brought to the injured part by the hyper- However, intractable pain due to com- Most cases of osteitis ossificans reported emia of the injury. Radiographically, dif- pression of neural tissue and limitation of in the literature are of a nontraumatic ferentiation between calcification and function may require aggressive treatment myositic mass arising in the soft tissues of ossification in a tendon is almost impossi- with surgery.4 the hand which mimic a neoplasm. Our ble. Exact differentiation is possible only patient had traumatic myositis ossificans by histopathological examination. Competing interests: None declared. in extensor tendon sheaths of the hand The differential diagnosis includes and wrist, a rare site for myositis. foreign-body granuloma, giant cell tumour References Rothberg2 coined the term “tendonitis of soft tissue (osteoclastoma), atypical ossificans traumatica” a collective name fibroxanthoma and pseudosarcomatous 1. Mirra JM. Bone tumors: clinical, radio- given to calcification and ossification in or fibromatosis (nodular fasciitis). Pseudo- logic, and pathologic correlations. Philadel- around tendons. This distinct entity is malignant myositis ossificans, a rare non- phia: Lea and Febiger; 1989. p. 1550-75. usually the result of a single traumatic traumatic form of myositis ossificans, can 2. Rothberg AS. Tendinitis ossificans trau- injury and the heterotrophic new bone sometimes involve the hand. It presents matica. Am J Surg 1942;58:285-8. formation is considered to have no con- as a benign soft-tissue tumour exhibiting nection to bone, periosteum or muscle. sarcoma-like features in the central area 3. Kwittken J, Branche M. Fasciitis ossificans. It is believed that mesodermal tissues and is associated with mature bone in the Am J Clin Pathol 1969;51:251-5. respond by reactive proliferation to a periphery.4 4. Kusuma S, Lourie GM, Lins RE. Myositis traumatic stimulus.3 New bone formation Because of the self-limiting and ossificans of hand. J Hand Surg [Br] 1999; is the result of increased vascularity and benign nature of myositis, the treatment 24:128-30.

E22ine-10 J can chir, Vol. 50, No 6, décembre 2007