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inflammation of muscle tissue

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/05 00:05:43」(JST)

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Myositis ossificans comprises two syndromes characterized by heterotopic ossification (calcification) of muscle.

Heterotopic Ossification Elbow1

Classification

In the first, and by far most common type, nonhereditary myositis ossificans (commonly referred to simply as "myositis ossificans", as in the remainder of this article), calcifications occur at the site of injured muscle, most commonly in the arms or in the quadriceps of the thighs.
- The term myositis ossificans traumatica is sometimes used when the condition is due to trauma.^[1]^[2]
The second condition, myositis ossificans progressiva (also referred to as fibrodysplasia ossificans progressiva) is an inherited affliction, autosomal dominant pattern, in which the ossification can occur without injury, and typically grows in a predictable pattern.

Presentation

The condition may sometimes be diagnosed from radiographs obtained for unrelated problems.

Most (i.e. 80%) ossifications arise in the thigh or arm, and are caused by a premature return to activity after an injury. Other sites include intercostal spaces, erector spinae, pectoralis muscles, glutei, and the chest. Hazy densities are sometimes noted approximately one month after injury, while the denser opacities eventually seen may not be apparent until two months have passed.

If the ossification is located in the adductor muscles, it is known as "Prussian's disease".

Pathophysiology of myositis ossificans traumatica: The specific cause and pathophysiology are unclear - it may be caused by an interaction between local factors (e.g., a reserve of available calcium in adjacent skeletal tissue or soft tissue edema, vascular stasis tissue hypoxia or mesenchymal cells with osteoblastic activity) and unknown systemic factors. The basic mechanism is the inappropriate differentiation of fibroblasts into bone-forming cells (osteoblasts). Early edema of connective tissue proceeds to tissue with foci of calcification and then to maturation of calcification and osifications

Prevention

Radiation therapy subsequent to the injury or as a preventive measure of recurrence may be applied but its usefulness is inconclusive.^[3]

Treatment

Treatment is initially conservative, as some patients' calcifications will spontaneously be reabsorbed, and others will have minimal symptoms. In occasional cases, surgical debridement of the abnormal tissue is required, although success of such therapy is limited.

Treatment of myositis ossificans:

Rest
Reduction
Immobilization
Anti-inflammatory drugs
Physiotherapy management

Surgical removal of the myositis ossificans is rarely warranted. If the myositis ossificans is excised before its maturation, it will likely reoccur. Consequently, most healthcare providers wait 6–12 months before considering excision. There is a chance of relapse even when removed in a mature state. In general, myositis ossificans is removed surgically if it limits the range of motion of the joint, irritates a nerve or lowers quality of life.

References

^ Sodl JF, Bassora R, Huffman GR, Keenan MA (January 2008). "Traumatic myositis ossificans as a result of college fraternity hazing". Clin. Orthop. Relat. Res. 466 (1): 225–230. doi:10.1007/s11999-007-0005-6. PMC 2505309. PMID 18196398.
^ Chadha M, Agarwal A (December 2007). "Myositis ossificans traumatica of the hand". Can J Surg 50 (6): E21–2. PMC 2386223. PMID 18067695.
^ http://emedicine.medscape.com/article/390416-overview

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English Journal

Image guided core needle biopsy of musculoskeletal lesions: are nondiagnostic results clinically useful?

Didolkar MM, Anderson ME, Hochman MG, Rissmiller JG, Goldsmith JD, Gebhardt MG, Wu JS.SourceDivision of Musculoskeletal Radiology, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
Clinical orthopaedics and related research.Clin Orthop Relat Res.2013 Nov;471(11):3601-9. doi: 10.1007/s11999-013-3170-9. Epub 2013 Jul 17.
BACKGROUND: The clinical utility of nondiagnostic core needle biopsies is not fully understood. Understanding the clinical and radiologic factors associated with nondiagnostic core needle biopsies may help determine the utility of these nondiagnostic biopsies and guide clinical decision making.QUEST
PMID 23861048

Myositis ossificans of the temporalis muscle: case report and review of the literature.

Schiff MJ, Meara DJ.SourcePGY-4 Chief Resident, Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Christiana Care Health System, Wilmington, DE. Electronic address: mschiff@christianacare.org.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.J Oral Maxillofac Surg.2013 Nov;71(11):1893-8. doi: 10.1016/j.joms.2013.05.002. Epub 2013 Jul 19.
Myositis ossificans, also known as traumatic myositis ossificans or myositis ossificans circumscripta, is the product of an unusual reactive process of mesenchymal stem cells within the muscle produced secondary to a traumatic insult or inflammatory process. In approximately 75% of cases, the proces
PMID 23871468

Quadriceps Traumatic Myositis Ossificans in a Football Player: Management With Intravenous Pamidronate.

Mani-Babu S, Wolman R, Keen R.SourceDepartment of Rheumatology and Sport and Exercise Medicine, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.Clin J Sport Med.2013 Oct 31. [Epub ahead of print]
: Myositis ossificans (MO) can be a significant complication of traumatic muscle contusion. Bisphosphates have been used in management of heterotopic ossification after spinal cord injury, but there is a lack of evidence with respect to MO in the sporting population. We present a case of a 14-year-o
PMID 24184852