Myositis ossificans and partial tear of quadratus femoris
Physical therapy for gluteal activation and hip flexor stretching.
1 month after initial visit the patient was seen again in the office for ultrasound to localize myositis ossificans and consider corticosteroid injection for symptom relief. The lesions was not well visualized due to depth of so injection was aborted.
The case was discussed with radiology, who recommended CT to further evaluate myositis ossificans and possible CT-guided injection for pain relief.
6 weeks after initial visit (6 months after initial injury), symptoms were mostly resolved
Myositis ossificans is a form of heterotopic ossification due to trauma or intramuscular hematoma. It is most commonly seen in the diaphysis of longs bones. Patients present with pain, tenderness, swelling and limited motion. A mass may be palpable and limited range of motion can be noted on physical exam. Xrays may show peripheral bone formation and a central lucent area. CT and MRI can also help with diagnosis. Initial treatment is rest with activity modification. Range of motion exercises can help. Surgery may be necessary if symptoms continue after 6 months. It is important to distinguish this type of lesion from cancer.
Moore, D. Myositis Ossficans. http://www.orthobullets.com/pathology/8042/myositis-ossificans. accessed 7/31/2015
Walker E, et al. Dilemmas in distinguishing between tumor and the posttraumatic lesion with surgical or pathologic correlation. Clin Sports Med. 2013 Jul;32(3):559-76
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