1/26. Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/26. Unilateral osseous bridging between the arches of atlas and axis after trauma.STUDY DESIGN: This is a case report. OBJECTIVE: To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection. SUMMARY OF BACKGROUND DATA: Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin. methods: Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results. RESULTS: Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation. CONCLUSIONS: Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
3/26. Ossifying lipoma independent of bone tissue.A 46-year-old Japanese male was referred to a local hospital because of a firm, nontender mass on his neck. On physical examination, the tumor was soft, well demarcated, 3 x 2 cm in size and located in the submucosal region. It was entirely separate from the vertebrae. The resected tumor was shown to be a lipoma with focal ossification. Ossifying lipomas are rare, and the cases which are independent of bone even more so. A literature review revealed that ossifying lipoma independent of bone tissue has been reported in only 8 cases, and, interestingly, all of them occurred in the head and neck region.- - - - - - - - - - ranking = 1.0799456944945keywords = physical examination, physical (Clic here for more details about this article) |
4/26. Heterotopic ossification of the adductor longus muscle presenting as dyspareunia.dyspareunia after heterotopic ossification of the adductor longus is a rare complication. We describe a patient with symptomatic heterotopic ossification of the adductor muscle that developed years after sustaining a fracture of the inferior pubic ramus in association with an injury to the adductor longus muscle. The patient's pain was reduced and his dyspareunia resolved after excision of the adductor longus heterotopic ossification and subsequent physical therapy.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
5/26. Extensive ossification in a craniopharyngioma.A rare extensive ossification occurred in a suprasellar craniopharyngioma of a man who died at 21 years of age. The tumor produced headache, retarded physical and mental development, visual disturbances, and increased intracranial pressure. The neoplasm recurred after surgical and roentgenological treatments. Differentiation of multipotential mesenchymal cells or mesenchymal type cells within the tumor has been suggested as the mode of occurrence of bone in this craniopharyngioma.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
6/26. Continuous passive motion in the management of heterotopic ossification in a brain injured patient.We report a man admitted to inpatient rehabilitation 6 wk after traumatic brain injury, who presented with bilateral knee heterotopic ossification. In addition to conventional physical therapy, we applied a continuous passive motion device during 4 wk increasing the range of motion of the knees. On the basis of the limited current literature and this case, we suggest that the use of continuous passive motion devices for heterotopic ossification may be effective and safe and should be the subject of further study.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
7/26. Ossification of the ligamentum flavum in the cervicothoracic junction: case report on ossification found on both sides of the lamina.STUDY DESIGN: A case of ossification on both sides of the ligamentum flavum in the cervicothoracic junction is described. OBJECTIVES: To review the pathology associated with ossification of the ligamentum flavum in the spine and its incidence at the cervicothoracic junction. SUMMARY OF BACKGROUND DATA: The literature on the common sites for ossification of the ligamentum flavum is reviewed. No report described ossification on the outer surface of the ligament presenting as ossification nodules on the medial side of the apophyseal joint. methods: The clinical, radiographic, and pathologic features associated with ossification of the ligamentum flavum are presented. The ossified ligament grew into nodular masses on both surfaces: posterolaterally on the medial surface of the apophyseal joint and anteromedially on the undersurface of the lamina. The masses were connected by a film of elastic fibers from the remnant ligamentum flavum. RESULTS: The symptoms and physical signs of cervical myelopathy improved after laminectomy and removal of the ossified ligament. There was no recurrence. CONCLUSION: The reported case adds to the literature on the pathology associated with ossification of the spinal ligaments.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
8/26. Progressive osseous heteroplasia. A case report and review of the literature.Progressive osseous heteroplasia is a rare childhood disorder that is characterized by ectopic progressive ossification of skin, muscle, and connective tissue. We report a 5 year-old female patient with familial transmission. She developed cutaneous calcifications and ossifications within the first 2 months of life. Her father and father's aunt had subcutaneous nodules. At the age of 5 years, physical examination of the patient revealed ossified subcutaneous nodules and plaques on both upper limbs, the right side was predominantly affected. All the joints of the upper limbs were ankylosed except the left shoulder. biopsy specimens of the patient and her father revealed islands of bone in the reticular dermis and deep dermis, respectively. We suggest that all family members of progressive osseous heteroplasia patients are carefully investigated for ossified nodules because of autosomal dominant inheritance.- - - - - - - - - - ranking = 1.0799456944945keywords = physical examination, physical (Clic here for more details about this article) |
9/26. Pelvic injuries in child abuse.Three cases of child abuse are described in which pelvic injuries were prominent findings on radiologic examination: Two patients had pelvic fractures, and one was found to have heterotopic ossification of the soft tissues of the pelvis and thighs corresponding to extensive bruising in the pubic, genital, buttock, and thigh areas, resulting from physical and sexual abuse. These represent uncommon radiographic findings. Skeletal survey in cases of suspected child abuse should include the entire pelvis, and special attention should be paid to the ischiopubic rami the most common site of these rare pelvic injuries.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
10/26. Ossification of the transverse atlantal ligament associated with fluorosis: a report of two cases and review of the literature.STUDY DESIGN: Two cases of ossification of the transverse atlantal ligament (OTAL) are reported, and the literature is reviewed. OBJECTIVE: To report two cases of OTAL, which share fluorosis as a possible etiologic link. SUMMARY OF BACKGROUND DATA: OTAL, a rare phenomenon, may cause upper cervical canal stenosis and spastic quadriparesis. However, the incidence, etiology, and the best therapeutic options are currently unclear. methods: Two cases are reported. Included are pertinent history, physical examination, radiographic evaluation, nonsurgical interventions, and outcomes. The available literature is also reviewed. RESULTS: On systemic examination, these two cases were found to have ossification of many ligaments and interosseous membranes, i.e., the atlantal transverse ligament, posterior longitudinal ligament, and interosseous membranes of ribs, forearm, and leg. These findings were coupled with a history of high fluoride intake and dental fluorosis; the diagnosis of fluorosis was made. After 2 weeks of treatment with halo ring traction, and protection and stabilization with a hard cervical collar, the clinical symptoms significantly improved. CONCLUSION: The incidence of OTAL may be not as rare as has been thought. Although the complete etiology of OTAL is not known, fluorosis may be one of the etiologic factors related to OTAL, as well as the ossification of other ligaments and interosseous membranes. Nonsurgical treatment may be safe and effective.- - - - - - - - - - ranking = 1.0799456944945keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |