What is it? Myo-muscle Itis-inflammation Ossificans-ossification BUT MYOSITIS OSSIFICANS DOESNT IMPLY MS INFLAMMATION!! Then what is it?....

Defn:

A benign tumour-like lesion characterized by osteoid & heterotopic bone formation in soft tissues or even beneath the periosteum.

CLASSIFICATION
Myositis ossificans traumatica
Post traumatic Localised to soft tissues affected by trauma Common 75%

Myositis ossificans progressiva

Congenital Soft tissues all over the body involved Rare

SYNONYMS- MYOSITIS OSSIFICANS

TRAUMATICA Pseudomalignant osseous tumour Ossifying hematoma Extraosseous localised non-neoplastic bone & cartilage formation Localised myositis ossificans

MYOSITIS OSSIFICANS TRAUMATICA

CAUSES:

Hematoma & periosteal stripping due to

1. Trauma - simple blow (contusion) -dislocation (injury during reduction) - avulsion (periosteal stripping in children) Fracture-short period of immobilisation

2. Massage: Immediately after injury, spread of hematoma

PATHOPHYSIOLOGY
Structures involved muscles, ligaments, tendons, fascia, periosteum Zone phenomena (Ackermann) 1. Central highly cellular- fibroblasts highly mitotic 2. Fibroelastic tissue 3. Mature well oriented bone

PATHOPHSYSIOLOGY CONTD.

Peculiar alteration in ground substance of connective tissue- proliferation of mesenchymal cells & metaplasia .Based on locationextraosseous, periosteal,parosteal

PATHOPHYSIOLOGY CONTD.
Degenerated & necrosed tissues are cleared off by macrophages

Fibroblasts invade & proliferate(fibrosarcoma)

Sarcoplasmic nuclei proliferate & sarcoplasm production increases(only in ms)

PATHOPHYSIOLOGY CONTD.
Cluster of nuclei in sarcoplasmic mass (giant cell tumour or myosarcoma)

Ground substance-hyaline change and encloses mesenchymal cells

Mesenchymal cells show metaplasia to form osteoblasts

Mineralisation and bone formation

This process begins at the periphery & gradually progresses toward the centre. Hence zone phenomenon. Ossification resorption may disappear by osteoclastic

When myositis ossificans is not removed it gets covered by a cartilagenous cap due to ms action (post traumatic osteochondroma)

Acute stage-pain swelling tenderness. Active & passive movt painful

Later-pain reduces & well circumscribed indurated painless mass

Clinical features
Stretching of ms difficult-inelasticity & ms action difficultobstruction Hard mass may persist or undergo complete regression or post traumatic osteochondroma

CLINICAL FEATURES CONTD. Muscles commonly affected:

Brachialis anticus Quadratus femoris Adductors in thigh (Prussian disease) Deltoid

Joints involved

Elbow Ankle Knee(Pellegrini Stieda disease) Shoulder Hip

MYOSITIS OSSIFICANS PROGRESSIVA

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Rare congenital condition evident in childhood associated with disorders like Microdactyly, Brachydactyly, Klippel Feil etc. Starts as solitary firm mass in upper back(trapezius, lattissimus dorsi) but later other masses in soft tissues all over body Ossification takes place months or years later IP joints of foot & thumb as well as joints of spine may fuse Only lab finding raised ESR

MYOSITIS OSSIFICANS

Myositis ossificans in the brachialis ms anteriorly & in the triceps ms posteriorly.

A.Involvement of brachialis ms 5 m after dislocation of elbow

MYOSITIS OSSSIFICATION
RECURRENCE AFTER SXZ

B.Osseous mass was excised 9 m later.microscopi cally bone was mature

C.Large mass of myositis ossificans in brachialis

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