Ossifying myositis

Ossifying myositis is a pathological disease affecting muscle tissue. Let's consider the causes of the disease, symptoms, diagnosis and treatment.

Myositis is a group of inflammatory diseases affecting skeletal muscles. The main symptom of the pathology is localized muscle pain, which intensifies with movement and palpation. Ossifying myositis is a partial ossification of the muscle. The disease is a rare form of polymyositis, which develops after injuries, sprains and ligament ruptures, fractures and dislocations. Myositis can develop against the background of fibromyositis, that is, when damaged muscle fibers are replaced by connective tissue.

The main forms of myositis:

• Ossifying - occurs after injuries, but can also be congenital, characterized by the deposition of calcifications in the muscles.
• Polymyositis is an inflammatory muscle disease caused by cytomegalovirus and Coxsackie virus.
• Infectious (non-purulent) – occurs with bacterial and viral infections, venereal diseases.
• Purulent – may appear as a result of chronic osteomyelitis or septicopyemia.
• Dermatomyositis – not only muscle tissue is susceptible to damage, but also the skin.
• Parasitic – occurs as a result of the body’s toxic-allergic reaction to a parasitic infection.

Ossifying myositis causes deformation of the limbs and severe pain, which leads to decreased mobility. In addition, muscle areas become compacted. In the initial stages, the pathology provokes an inflammatory process in the muscle, which causes swelling, redness of the skin and painful sensations. Over time, the scar ossifies and leads to compaction. When attempting palpation, one can detect fairly hard areas that are indistinguishable from bone. It is these areas that deform the limb due to fusion with the bones.

Ossification usually occurs in the thigh and shoulder muscles. In case of shoulder muscle pathology, movements in the elbow joint are limited to complete immobilization. In case of damage to the middle head of the quadriceps muscle of the thigh, the knee joint is subject to deformation.

Ossifying myositis has several forms, let's look at each of them:

• Traumatic - this form is characterized by rapid progression and the formation of a solid component inside the muscle, which is mistaken for sarcoma during biopsy. It is because of errors in the process of diagnosis and treatment that the disease causes a number of serious complications.
• Trophoneurotic – develops due to trauma to large nerve trunks. As a rule, it affects the knee and hip joints.
• Progressive myositis – can begin to develop even during the period of intrauterine formation of the fetus, but manifests itself in the first year of the child’s life. Most often occurs in boys. Causes muscle stiffness, limited movement and changes in posture.

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Causes of myositis ossificans

The causes of ossifying myositis are rooted in pathological physiological processes of muscle fiber denervation. The disease can develop due to exposure to various toxic substances. Toxic myositis occurs with alcoholism and drug addiction. Taking certain medications can also cause unstable muscle damage. But the exact pathogenesis of the disease is unknown. Ossificates can form over several weeks or even years.

Very often the disease occurs against the background of osteomyelitis, erysipelas, cystitis with stones in the bladder. Various viral diseases, bacterial and fungal infections also provoke myositis. Myositis of moderate and mild severity occurs after various injuries, hypothermia, muscle cramps, intense physical activity. The risk of developing myositis occurs in people of certain professions - musicians, drivers, PC operators. Long-term loads on certain muscle groups and an uncomfortable body position provoke pathology.

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Symptoms of myositis ossificans

Symptoms of ossifying myositis are progressive. The disease often occurs in young men and in 50% of cases due to injuries and mechanical damage. Foci of inflammation are localized in the skeletal muscles, mainly in their deep sections. Less often, the inflammatory process begins near the periosteum. As a rule, ossifying myositis affects the thighs, buttocks, upper and lower extremities, and shoulder area.

Let's look at the main symptoms that appear as the disease progresses:

• A soft swelling appears on the affected surface, which, when palpated, resembles dough in consistency.
• Over time, the affected tissues begin to thicken due to ossification. As a rule, during this period, the disease is detected and treatment begins.
• The ossification node is surrounded by muscle masses that have become jelly-like due to degenerative processes. It is possible for fibrous tissue to grow and for the node to be replaced by formed bone permeated with fibrous tissue and cysts.

The clinical picture of the disease depends entirely on the nature of the injury that caused myositis. If the vessels are damaged and the injury is serious, the symptoms are progressive. Within a month, swelling and pain appear on the injured limb, indicating an inflammatory process. In this case, the patient will undergo surgery in the first months after the pathology is detected. If ossifying myositis appears against the background of secondary microtraumas, the disease is asymptomatic, the patient's only complaint is a slight swelling in the lesion.

Ossifying traumatic myositis

Ossifying traumatic myositis is an extraskeletal ossification of muscle tissue after injuries. The disease occurs due to acute and chronic injuries, i.e. as a result of dislocations, bruises, sprains, fractures, frequently repeated minor trauma (in athletes and people of certain professions).

The shoulder muscles (due to posterior dislocations of the forearm), as well as the adductor and quadriceps muscles of the thigh, and the gluteus medius are subject to ossification. This pathology very often appears in football players on the outer surface of the thigh due to bruises. Less often, ossifying traumatic myositis develops in the shoulder girdle, muscles of the lower leg and forearm. Regular reduction of dislocations, traumatic operations and a number of other reasons contribute to the development of ossifying myositis.

• The first symptoms appear 2-3 weeks after the injury. In the area of the damaged muscle, pain, swelling and a noticeably growing compaction increase. After 1-2 months, the compaction turns into bone and the pain subsides. Since the newly formed bone is located near the joint, it limits movement in it. In some cases, muscle ossification occurs simultaneously with the ossification of other tissues, which can cause ankylosis.
• Detection of the traumatic form of the disease is a differential diagnosis. Muscle tissue pathology must be separated from possible ossification of the joint capsule and ligaments, hematomas, pathologies of non-traumatic origin, fibromas, synoviomas and other diseases.
• Treatment of any injuries begins with immobilization of the injured limb and application of a plaster cast for 10 days. This is necessary to prevent the development of ossifying myositis. If this is not done, then 1-3 months after the injury, ossification will begin and conservative treatment will not help. In this case, the patient will undergo surgical intervention and complete removal of the formed bone along with the capsule. The prognosis for the traumatic form of myositis is favorable, since the disease does not cause irreversible disorders of joint movement.

Progressive ossifying myositis

Progressive ossifying myositis is a hereditary disease, i.e. congenital. The disease is characterized by a long progressive course, which entails disorders in the functioning of the musculoskeletal system and can lead to disability of patients even in childhood.

Munchmeyer syndrome or progressive ossifying myositis is most often diagnosed in male patients. Symptoms of the disease can appear immediately after birth or at an early age, causing gradual ossification of muscle tissue. When palpating damaged areas, the density of the tissue is felt, but there is no pain. Myositis leads to an unnatural body position, limits joint movement or completely immobilizes them.

• Treatment does not bring the desired effectiveness. But there are a number of recommendations that prevent the disease from progressing. Patients need to follow a special diet with a minimum calcium content in food. As for surgical intervention, many doctors consider it pointless, and in some cases dangerous, since the operation can provoke the growth of ossificates.
• If the disease has an uncomplicated course, anti-inflammatory and desensitizing agents, various biostimulants and vitamins are used for treatment. In complicated forms of myositis, therapy is carried out with hormonal drugs and steroids. An important rule of treatment is the refusal of any intramuscular injections, as they can become new foci of ossification.

Ossifying myositis of the thigh

Ossifying myositis of the thigh is a pathological process that causes loss of elasticity of muscle tissue. The disease has a long progressive course, that is, ossifications are formed over several months and may not make themselves known. Various injuries, dislocations and stretches cause damage to muscle fibers and myositis. Today, three forms of ossifying myositis of the thigh are distinguished:

• The ossificate is connected to the underlying femur by a bridge.
• Periosteal form - the ossificate contacts the femur.
• The ossificate has a wide base, and part of the ectopic bone protrudes into the thickness of the quadriceps muscle.

Most often, the extent of the lesion is limited to the middle third of the thigh, but can extend to the proximal third. The disease is diagnosed a couple of weeks or even a month after the injury. The patient complains of swelling, which becomes painful, and the skin above it is hot to the touch. X-ray examination is used for diagnosis, which shows the degree of deformation of muscle tissue and bones of the thigh.

If the disease is detected at an early stage, the treatment consists of joint immobilization and conservative therapy. But even with complex forms of ossifying myositis of the hip, surgical treatment is not performed. All therapy is reduced to taking medications and physiotherapy.

Diagnosis of ossifying myositis

Diagnosis of ossifying myositis is based on the typical clinical picture of the disease. The patient complains of dull aching pain, muscle weakness and discomfort when trying to palpate the affected area. Very often, palpation can reveal the presence of nodules and strands in the muscles. In addition, the presence of myositis is indicated by characteristic changes in the general blood test.

The examination process begins with a survey and examination, based on the results of which the doctor prescribes further laboratory and instrumental examinations. Let's consider the main stages of ossifying myositis diagnostics:

1. History taking and examination

The doctor asks the patient about the onset of the disease, past injuries and other pathologies of the body. After this, the patient is examined. The doctor visualizes the potential site of the lesion, examines the skin. If myositis has been progressing for a long time, it causes muscle atrophy, and the skin above this area has a sparse network of blood vessels, that is, it is pale. The affected muscle is palpated to assess the tone and identify painful points. Ossifying myositis is characterized by progressive muscle weakness, so the pain is moderate upon palpation, but the muscles are dense.

2. X-ray

The X-ray picture of ossifying myositis has a certain appearance. Thus, in the area of damaged muscle tissue, shadows of irregular shape are visible, which go along the growth of muscle fibers, can merge with bones or go isolated from them. It is this sign that indicates the presence of myositis and ossification.

3. Rheumatic tests

Rheumatic tests are tests that are needed to differentiate local and systemic rheumatic diseases. Rheumatic tests are needed to determine the etiology of the disease and exclude autoimmune diseases. In addition, this study allows you to determine the intensity of the inflammatory process. Rheumatic tests consist of such indicators as: •

C-reactive protein - an increased concentration of this substance indicates an inflammatory process in the body. This is a kind of marker of the acute phase of inflammation, it is detected during exacerbation of chronic myositis and infectious forms of the disease. This indicator is used not only for differential diagnostics, but also evaluates the effectiveness of treatment.

• Antistreptolysin-O is an antibody that is produced when there is a streptococcal infection in the body. It helps to detect rheumatism and rheumatoid arthritis.
• Rheumatoid factor - increased values of these antibodies indicate autoimmune pathologies, rheumatoid seropositive arthritis or dermatomyosis. The analysis is carried out before treatment and after the main therapy.
• Myositis-specific autoantibodies are markers for the detection of dermatomyositis, polymyositis and inclusion body myositis. The most common antibodies are: Anti-Jo-1 – in 90% of patients with myositis, Anti-Mi-2 – in 95% of patients with dermatomyositis and Anti-SRP – in 4% of patients with myositis.

4. Morphological study

This type of diagnostics is a biopsy. That is, taking a biopsy for careful examination. The main goal of the study is to identify structural degenerative changes in muscle and connective tissues surrounding the vessels. The main indications for biopsy are infectious myositis, polyfibromyositis and polymyositis.

But, as a rule, of all the above-described diagnostic methods for identifying ossifying myositis, X-ray, computed tomography and radioisotope examination of the affected muscle tissue are used.

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Treatment of ossifying myositis

Treatment of ossifying myositis is the responsibility of such doctors as a therapist, rheumatologist and neurologist. The initial examination is carried out by a therapist, and then, depending on the etiology of the disease, he gives a referral to other specialists. If ossifications were detected at an early stage, then physiotherapeutic procedures (electrophoresis, ultrasound and others) are used for treatment to dissolve ossifications and relieve pain.

The treatment does not take place in a hospital, but the patient must regularly go for examinations and procedures prescribed by the doctor. The basis of treatment is bed rest, that is, it is necessary to ensure complete rest for the affected area of the body. The patient is prescribed a special diet, which consists of fruits, cereals and vitamins E, B. At the same time, spicy, salty, fried and fatty foods, as well as alcohol, are strictly prohibited.

• If myositis is caused by parasites, then anthelmintic drugs are prescribed; in case of bacterial infection, antibiotics and serums are prescribed.
• The purulent form of the disease requires surgical treatment - opening the abscess, installing drainage and washing the wound with antiseptic agents.
• If the cause of the disease is autoimmune, the patient is prescribed immunosuppressants and glucocorticosteroids. In particularly severe cases, cytapheresis and plasmapheresis are performed, that is, extracorporeal detoxification techniques.

Ossifying myositis can be treated conservatively only in the early stages; in all other cases, surgery is performed. This is due to the fact that at the initial stages of the disease, calcifications are absorbed under the influence of various medications. Non-steroidal anti-inflammatory drugs (Nimesulide, Ketonal, Diclofenac), vasoactive therapy, and pain relievers and muscle spasms can be used for treatment.

Prevention of ossifying myositis

Prevention of ossifying myositis is based on maintaining a balanced diet, an active lifestyle, but without excessive physical activity, and timely treatment of any diseases. Let's consider the main preventive recommendations for ossifying myositis:

• A balanced diet prevents inflammation in muscle tissue. For these purposes, it is recommended to consume fatty polyunsaturated acids, which are found in fish. Also useful are products with a high content of salicylates (potatoes, beets, carrots). The diet should include easily digestible proteins (soy, almonds, chicken), calcium-rich products (fermented milk products, currants, celery) and cereals, which are rich in magnesium.
• Drinking regimen is of great importance in the prevention of various myositis. It is necessary to drink at least two liters of water per day. In addition to water, it is recommended to replenish the water balance with green tea, various fruit drinks and compotes. If swelling occurs due to excessive drinking, then rosehip decoction should be taken to eliminate it.
• As for physical activity, when preventing ossifying myositis, it is necessary to spend more time outdoors. It is also recommended to harden the body, alternate rest and physical activity, and monitor posture. And swimming, cycling, and gymnastics reduce the risk of developing ossification of muscle tissue

To prevent myositis, it is necessary to exclude a sedentary lifestyle, hypothermia and exposure to drafts. Long-term loads on one muscle group are dangerous. By eliminating all these factors and adhering to preventive measures, you can protect your body not only from ossifying myositis, but also from a number of other pathologies.

Prognosis of ossifying myositis

The prognosis of ossifying myositis depends entirely on the stage at which the disease was detected and how the treatment was carried out. With timely and adequate therapy, the prognosis is favorable. The prognosis also depends on the rate of ossification, which is different for everyone. The pathological process can last for years, affecting all muscle structures. But the most interesting thing is that ossification does not spread to the eye muscles, heart, diaphragm, larynx and tongue.

If ossifying myositis has a congenital pathological character, then most patients die before reaching the age of ten. This is due to the fact that the muscles of the abdominal wall and intercostal muscles undergo ossification, which entails a violation of the breathing process. Severe ossification leads to limited movements of the spine and all large joints. If ossification affects the muscle tissues of the lower jaw, then the patient has difficulty chewing and swallowing food, breathing normally. Unfortunately, treatment has not been developed for this form of the disease, so the prognosis is unfavorable.