Clinical note
Bilateral and Recurrent Myositis Ossificans in an Athlete: A Case Report and Review of Treatment Options

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Abstract

Miller AE, Davis BA, Beckley OA. Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options.

An unusual case of recurrent myositis ossificans (MO) bilaterally in the hamstring muscles of a 47-year-old athlete secondary to trauma is presented with a review of the literature of current treatment options. MO is a common condition that occurs among athletes in association with muscle and/or tendon strain or contusion. After an extensive literature review, we believe this to be the first case reported of recurrent and bilateral MO in a nonsurgical setting from recurrent hamstring strains. Plain radiographs and physical examination revealed the appearance and chronology of this pathology. Treatment options to improve flexibility and decrease morbidity are discussed along with prophylaxis for future injury. Treatment of mobility and flexibility, rehabilitation goals and treatment with nonsteroidal anti-inflammatory drugs, bisphosphonates, and magnesium are discussed along with prophylaxis.

Section snippets

Case description

The patient—a male in his late forties—was a semiprofessional softball player whose chief complaint was left thigh pain for 1 month. He reported being among the fastest runners on the team. He presented to his primary care physician 1 month before evaluation in our sports clinic with a sudden onset of pain in the left thigh while playing softball and trying to stretch a single into a double. The pain was described as tightness posteriorly around his mid thigh not extending past his knee. He

Discussion

Calcification of soft tissues has been well described in the literature.3, 7 Traumatic MO is believed to result from an initial injury followed by prolonged macrophage invasion with osteogenic bone mediator release, resulting in osteogenesis.4, 19 This leads to progression of focal osteogenesis near the site of injury. This case demonstrates definite recurrent disease in multiple sites in an active athlete who suffered significant loss of athletic function as a result of MO. Our hypothesis is

Conclusions

MO is not an uncommon sequela of sports injuries. It is most likely to occur after contusions or strains, and is often of no major clinical consequence if treated appropriately. We report the case of an athlete who developed multiple sites of MO that significantly limited his athletic function. After a thorough review of the literature, we believe this is the first reported case of recurrent, bilateral MO occurring entirely as the result of multiple muscular strains of the lower extremities. MO

Acknowledgments

We thank Peter Cooperberg, MD, from the Department of Radiology, University of British Columbia, Vancouver, BC, Canada, for his contribution of images, and Pamela T. Prescott, MD, Division of Endocrinology, Clinical Nutrition and Vascular Medicine, University of California, Davis, CA, for her expertise in endocrinology.

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