Heterotopic Ossification
Original Editors - Bruce Tan from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Heterotopic Ossification (HO) refers to the formation of lamellar bone inside soft tissue structures where bone does not normally exist. This process can occur in structures such as the skin, subcutaneous tissue, skeletal muscle, and fibrous tissue adjacent to bone. In more rare forms, HO has also been described in the walls of blood vessels and intra-abdominal sites such as the mesentery.[1]
Research suggests four factors which contribute to formation of heterotopic bone: 1) inciting event (usually trauma), 2) a signal from the site of injury, 3) a supply of mesenchymal cells whose genetic machinery is not fully committed, 4) an environment which is conducive to the continued formation of new bone.[1] These factors are discussed more indepth in the Etiology/Causes section.
HO was fisrt described by by Patin in 1692 while working with children diagnosed with myositis ossificans progressiva.[2] It was not until 1918 when Dejerine & Ceillier detailed the anatomical, clinical, and histological features of ectopic bone formation in soldiers who sustained spinal injuries during World War I.[3]
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
Clinical signs and symptoms of HO may appear as soon as 3 weeks or up to 12 weeks after initial musculoskeletal trauma, spinal cord injury, or other precipitating event.[4]
Findings which may suggest the presence of HO are as follows:[3]
- joint swelling and warmth (initial phase)
- joint pain
- palpable mass, firm (late stage)
- decreased ROM of effected joint
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Etiology/Causes[3][edit | edit source]
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
- Kennedy MA, Sama AE, Sigman M. Tibiofibular syndesmosis and ossification. case report: sequelae of ankle sprain in an adolescent football player. Journ of Emer Med 2000; 18: 233-240.
- Bovo G, Romano F, Perego E, Franciosi C et al. Heterotopic mesenteric ossification ("intraabdominal myositis ossificans"): a case report. International Journal of Surgical Pathology 2004; 12: 407-409.
- Brower RS, Vickroy NM. A case of psoas ossification from the use of BMP-2
for posterolateral fusion at L4–L5.Spine 2008; 18: 653-655.
Resources
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Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol 2005; 34: 609-619.
- ↑ Bossche LV, Vanderstraeten G. Heterotopic ossification: a review. J Rehabil Med 2005; 37: 129-136.
- ↑ 3.0 3.1 3.2 Pape HC et al. Current concepts in the development of hetetrotopic ossification. Journ Bone and Joint Surg 2004; 86: 783-787.
- ↑ Shehab D, Elgazzar AH, Collier BD. Heterotopic ossification. Jour of Nuclear Medicine 2002; 43: 346-353.
