Case: A 37 year old female came into Scottsdale Sports Medicine Institute for an injury that occurred over 12 weeks ago while she was surfing. The cord of the board wrapped around her lower leg and pulled on her calf. She immediately experienced severe pain that she described as sharp as well as significant weakness, swelling and discoloration. She iced and took Ibuprofen the next day and assumed the bruising would dissipate as time wore on. As an avid surfer, she was eager to resolve the problem quickly and did not seek medical advice. After 2 weeks her pain was reduced, though the bruising was significant, she felt her injury was improving. However, the calf muscle that was injured began to harden as if it were flexed. Even in a relaxed state, her injured calf muscle was firm. She also began experiencing a new set of symptoms such as numbness and tingling directly over her calf muscle radiating throughout her lower leg.
We have all had bruises at some point, but what is difference between a bruise that will heal versus a bruise that changes into a new condition and does not improve? The answer: myositis ossificans traumatica, which is the development of a calcified, bony growth in a bruise. Though atypical, once an injury occurs, the rush of blood to the site is thought to interact with specific muscle cells (fibroblast cells) and turn them into bone formation cells (osteoblast cells).
- Restricted range of movement
- Pain and sensation changes in the muscle
- A hardening (or a hard lump) formation in the muscle
Diagnosis, Treatment and Prevention: In addition to a thorough and complete assessment by a medical provider, taking into consideration the history of a recent injury, the symptoms presented and with the use of imaging (x-ray, CT scan, bone scans, etc.,) the diagnosis of myositis ossificans traumatica is confirmed. Treatment includes physical therapy (therapeutic ultrasound/shock wave therapy to break up the bone growth) and for extreme cases surgical removal of the calcification. Though myositis ossificans traumatica is rare, it can happen and is best treated with a multidisciplinary medical approach. Be proactive and know the best steps to dealing with a bruise to avoid complications involve:
- Ice, ice and more ice immediately after
- Use of heat to absorb the bruise later on
- No deep tissue massage
- Monitor the injury
- Come in and see Dr. Carfagno to make sure you are ready to return to activities as quickly and safely as possible!
Disclaimer: Articles are based on real cases seen at Scottsdale Sports Medicine. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Please consult your medical professional for individualized healthcare.
Torrance, D. A., & deGraauw, C. (2011). Treatment of post-traumatic myositis ossificans of the anterior thigh with extracorporeal shock wave therapy. The Journal of the Canadian Chiropractic Association, 55(4), 240–246.
Simon, T., Guillodo, Y., Madouas, G., Saraux, A.(2016). Myositis ossificans traumatica (circumscripta) and return to sport: A retrospective series of 19 cases, Joint Bone Spine, Volume 83, Issue 4. Pages 416-420, ISSN 1297-319X, http://dx.doi.org/10.1016/j.jbspin.2015.07.013. http://www.sciencedirect.com/science/article/pii/S1297319X16000142