Thigh injuries in athletes

Bilateral deltoid myositis ossificans in a weightlifter using anabolic steroids

A 40-year-old male weightlifter presented with a 6-month history of a painless mass in the right deltoid. He had no history of trauma to the shoulder other than an arthroscopic rotator cuff repair a few weeks earlier. Physical examination showed a firm, nontender mass located longitudinally and coinciding with the deltoid, measuring 12×14×4 cm. There was no limitation in range of motion or functioning. Magnetic resonance imaging (MRI) and computed tomography (CT) scans suggested a lobulated, heterogeneous mass with multiple areas of calcification that raised suspicion for soft tissue sarcoma vs myositis ossificans. Marginal resection of the soft tissue mass was performed, and pathologic studies confirmed the diagnosis of xanthogranulomatous myositis ossificans with dystrophic calcifications and central cystic degeneration. At 2-week follow-up, the patient had improved range of motion and pain, but he noted a second soft tissue mass in the left deltoid. The MRI and CT scans showed a 10.5×16×3.4-cm linear, lobulated lesion with multiple calcifications, similar in appearance to the contralateral deltoid. The patient admitted to frequently injecting anabolic steroids into his deltoids. Because the patient was asymptomatic on the left side and the MRI appearance of the left deltoid mass was similar to that of the myositis ossificans seen on the right side, the patient opted for nonsurgical treatment. This is a rare case of myositis ossificans occurring bilaterally in the deltoids after repeated injections of anabolic steroids. There is currently no known association between anabolic steroids and myositis ossificans. This condition often mimics malignant neoplasms, illustrating the necessity of resection for diagnostic confirmation.

Diagnosis and management of quadriceps strains and contusions

Injuries to the quadriceps muscle group occur frequently in sports and athletic activities. Muscle strains and contusions constitute the majority of these injuries. The clinical presentation and assessment of quadriceps strains and contusions are reviewed along with discussion of appropriate imaging used in diagnosis. Treatment protocols for acute injuries are reviewed including rehabilitation techniques frequently utilized during recovery. Special consideration is given to discussing the criteria for return to sports for athletes after injury. Myositis ossificans is a potentially disabling complication from quadriceps contusions and risk factors, prevention, and treatment are reviewed.

Traumatic myositis ossificans as a result of college fraternity hazing

We present a case of a 20-year-old college student who had myositis ossificans traumatica develop after a fraternity hazing. The patient was struck repeatedly on both of his thighs while standing at attention, and he presented with bilateral thigh pain and stiffness 6 weeks after the incident. Physical examination revealed 130 degrees flexion of his right knee and 50 degrees flexion of his left knee, which had a firm end point. Radiographs showed extensive new bone located adjacent to the anterior and lateral aspects of his left femur with less involvement of his right thigh. Magnetic resonance imaging revealed considerable edema involving much of the rectus femoris and vastus lateralis of both thighs. The patient was treated with physical therapy and indomethacin for pain and inflammation control. At his 1.5-year followup, the patient's left knee flexion had improved to 130 degrees . Nonoperative treatment with careful followup resulted in a favorable outcome in this patient despite considerable formation of bilateral thigh myositis ossificans traumatica.

Tackler's bony spur in sumo wrestlers: a report of two cases

We examined two sumo wrestlers who had tackler's bony spur. In football players, these spurs are secondary to subperiosteal hematoma formation from repeated direct blows by an opponent or from ill-fitting shoulder pads. The initial charge of sumo wrestling is similar to a tackle in American football. Our two patients had had repeated direct blows by opponents on the initial wrestling charge. The tackler's bony spurs of our two patients were located on the lateral aspect of the humeral shaft just distal to the deltoid insertion, and there was no involvement of the anterior mass of the brachialis muscles or elbow. We consider that tackler's bony spurs are sometimes, but not often, seen in sumo wrestlers.

Predicting a recovery time from the initial assessment of a quadriceps contusion injury

Six quadriceps contusion tests were evaluated for inter-rater reliability and ability to predict the recovery time of 100 injured rugby players. All subjects were treated with a standardised and disciplined treatment program incorporating cryokinetics and modified training. Muscle firmness ratings, thigh circumference and passive knee flexion range of movement (ROM) measurements, and the unilateral palpation, brush-swipe and tap tests were all found to have substantial to excellent reliability (range: 0.66-1.00). Multiple regression analysis demonstrated that 64 per cent of the variance in the time taken to return to full training could be accounted for by an equation involving the uninjured-injured difference in knee range, relative firmness rating of the injured muscle, difference in circumferences at the suprapatellar border, being able to play on following injury and the time delay before starting treatment.

Heterotopic ossification in unidentified skeletal remains

Heterotopic ossification is a benign, ectopic bone growth that develops in muscle and other soft tissue. The exact cause is poorly understood, but it is a rarely serious complication of soft tissue trauma. Its most common form, myositis ossifications traumatica, occurs as a secondary complication of direct muscle injury. However, other forms are less common and can result from specific pathologic conditions, such as spinal cord trauma and metabolic disorders. In patients who have had spinal cord injury and subsequent paraplegia, heterotopic ossification often results in ankylosis of the hip and a loss in range of motion. Ectopic ossification occurs below the injury site, and, although the specific muscle groups can vary, it usually involves those for which the origin and insertion involve the anterior pelvis and proximal femur. In dried bone, heterotopic ossification can appear as a smooth, irregularly shaped benign tumor of mature bone, extending from the surface but not invading the cortical bone. These tumors range in size from a few millimeters to several centimeters. Because heterotopic ossification is often associated with specific types of injuries, it has a unique anthropological use in forensic cases.

Emergency department evaluation and treatment of hip and thigh injuries

This article reviews the clinical and diagnostic evaluation of patients with injuries to the hip and thigh. The history and physical examination, appropriate imaging strategies, complications and associated injuries, analgesia, treatment, and appropriate patient disposition are emphasized.