Ossifying myositis

Ossifying myositis is a pathological disease affecting the muscular tissues. Consider the causes of the disease, symptoms, diagnosis and treatment.

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

Basic forms of myositis:

• Ossifying - occurs after trauma, but can be congenital, is characterized by the deposition of calcification in the muscles.
• Polymyositis is an inflammatory muscle disease caused by cytomegalovirus and the Coxsackie virus.
• Infectious (nemnoy) - occurs with bacterial and viral lesions, venereal diseases.
• Purulent - can appear as a result of chronic osteomyelitis or septicopyemia.
• Dermatomyositis - not only the muscular tissues are affected, but also the skin.
• Parasitic - occurs when a toxic-allergic reaction of the body to parasitic infection.

Ossifying myositis causes deformity of the limbs, and the appearance of severe pain, which leads to a decrease in mobility. In addition, the compaction of muscle sites occurs. At the initial stages, pathology provokes an inflammatory process in the muscle, which causes swelling, redness of the skin and painful sensations. Through time, the scar becomes ossified and leads to densification. When trying to palpate, you can find quite hard areas that are not different from bone. It is these fate that deform the limb due to the fusion with the bones.

As a rule, ossification occurs in the muscles of the hip and shoulder muscles. In the pathology of the brachial muscle, movements in the elbow joint are limited until complete immobilization. When the middle head of the quadriceps muscle of the femur deforms, the knee joint is affected.

Ossifying myositis has several forms, consider each of them:

• Traumatic - this form is characterized by rapid progression and the formation of a solid component within the muscle, which is taken for biopsy for sarcoma. 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 traumatization of large nerve trunks. As a rule, it affects the knee and hip joints.
• Progressing myositis - may begin to develop during the period of intrauterine fetal formation, but manifests itself in the first year of life of the child. Most often occurs in boys. It causes stiffness of the muscles, limitation of movements and changes in posture.

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Causes of ossifying myositis

The causes of ossifying myositis lie in the pathological physiological processes of denervation of muscle fibers. The disease can develop due to the effects of various kinds of toxic substances. Toxic myositis occurs with alcoholism and drug dependence. Taking certain medications is also capable of causing unstable muscle damage. But the exact pathogenesis of the disease is not known. Osisifits can be formed within several weeks, and 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 medium and mild severity occurs after various injuries, hypothermia, muscle cramps, intense physical exertion. The risk of developing myositis occurs in people of a certain profession - musicians, drivers, PC operators. Prolonged loads on certain muscle groups and uncomfortable body position provoke pathology.

[3], [4], [5], [6], [7]

Symptoms of ossifying myositis

Symptoms of ossifying myositis are of an increasing nature. Often, the disease occurs in young men and in 50% of cases due to injuries and mechanical damage. Foci of inflammation are localized in skeletal muscles, an advantage in its deep divisions. Less often the inflammatory process begins near the periosteum. As a rule, ossifying myositis affects the hips, buttocks, upper and lower extremities, shoulder area.

Consider the main symptoms that manifest as the disease progresses:

• On the affected surface there is a soft swelling, which when palpated in consistency resembles a dough.
• After a time, the affected tissues begin to thicken due to ossification. As a rule, during this period the disease is identified and treatment begins.
• The ossification node is surrounded by muscle masses, which, due to degenerative processes, have become like jellies. Perhaps the growth of fibrous tissue and the replacement of the knot with a formed bone, permeated with fibrous tissue and cysts.

The clinical picture of the disease depends entirely on the nature of the damage that caused myositis. If the vessels are damaged and the injury is serious, then the symptomatology is progressing. Within a month on the damaged limb there is swelling and soreness, which indicate an inflammatory process. In this case, the patient is waiting for a surgical intervention in the first months after the detection of pathology. If the ossifying myositis appears against the background of secondary microtrauma, then the disease proceeds asymptomatically, the only complaint of the patient is a small swelling in the lesion.

Ossifying traumatic myositis

Ossifying traumatic myositis is an extra-skeletal ossification of the muscle tissue after the traumas suffered. The disease occurs due to acute and chronic injuries, that is, as a result of dislocations, bruises, sprains, fractures, often recurring minor traumatization (in athletes and people of certain professions).

Ossification is affected by the shoulder muscles (because of the posterior dislocations of the forearm), as well as the adductor and quadriceps muscles of the thigh, the middle gluteus muscle. This pathology very often appears in football players on the outer surface of the thigh due to bruises. Less often ossifying traumatic myositis is formed in the humeral girdle, the muscles of the lower leg and forearm. Regular dislocation of the dislocations, traumatic operations and a number of other causes contribute to the development of ossifying myositis.

• The first symptoms appear 2-3 weeks after the injury. In the area of damaged muscle, painful sensations, 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 near the joint, it limits movement in it. In some cases, ossification of the muscles takes place simultaneously with the ossification of other tissues, which can cause ankylosis.
• The detection of a traumatic form of the disease is a differentiated diagnosis. The pathology of the muscle tissue must be separated from the possible ossification of the capsule of the joint and ligaments, hematomas, pathologies of non-traumatic origin, fibroids, synovia and other diseases.
• The treatment of any injuries begins with the immobilization of the damaged limb and the imposition of a plaster bandage for 10 days. This is necessary in order 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 is waiting for a surgical intervention, and complete removal of the formed bone along with the capsule. The prognosis of traumatic myositis is favorable, since the disease does not cause irreversible movement of the joints.

Progressing ossifying myositis

Progressing ossifying myositis is a hereditary disease, that is, congenital. The ailment is characterized by a long progressive course, which leads to disruptions in the work of the musculoskeletal system and can lead to disability of patients even of childhood.

Munchmeyer's syndrome or progressive ossifying myositis is most often diagnosed in male patients. Symptoms of the disease can manifest immediately after birth or at an early age, causing a gradual ossification of the muscle tissue. When palpation of damaged areas, tissue density is felt, but painful sensations do not arise. Myositis leads to an unnatural position of the body, restricts the movement of the joints or completely immobilizes them.

• Treatment does not bring proper effectiveness. But there are a number of recommendations that prevent the disease from progressing. Patients should follow a special diet with minimal calcium in food. As for the surgical intervention, many doctors consider this to be meaningless, and in some cases also dangerous, since the operation can provoke an increase in ossification.
• If the disease has an uncomplicated course, anti-inflammatory and desensitizing agents, various biostimulants and vitamins are used for treatment. With complicated form of myositis, therapy is carried out with hormonal preparations and steroids. A very important rule of treatment is the rejection of any intramuscular injections, since they can become new foci of ossification.

Ossifying myositis of hip

Ossifying myositis of the thigh is a pathological process that causes loss of elasticity of the muscular tissues. The disease has a long progressive course, that is, ossification is formed within a few months and may not be felt. Various injuries, dislocations and stretching cause damage to the muscle fibers and myositis. To date, there are three forms of ossifying myositis of the thigh:

• Ossificate is connected to the hip bone by means of a jumper.
• Periostal form - ossicitis contacts the femur.
• The ossification has a wide base, and part of the ectopic bone protrudes into the thickness of the quadriceps muscle.

Most often, the lesion is limited to the middle third of the thigh, but can spread to the proximal third. Diagnose the disease in a couple of weeks, and even a month after the injury. The patient complains of swelling, which becomes painful, and the skin above it hot to the touch. For diagnosis, an x-ray study is used that shows the degree of deformation of the muscle tissue and hip bone.

If the disease is detected at an early stage, then the treatment is an immobilization of the joint and conservative therapy. But even with complicated forms of ossifying myositis of the femur, no surgical treatment is performed. The whole therapy is reduced to taking medications and physiotherapy.

Diagnosis of ossifying myositis

Diagnosis of ossifying myositis is based on a 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, during palpation, it is possible to determine 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 survey begins with a survey and examination, according to which the doctor appoints further laboratory and instrumental examinations. Let's consider the basic stages of diagnosis of ossifying myositis:

1. Anamnesis and examination

The doctor asks the patient about the onset of the disease, the transferred injuries and other pathologies of the body. After this, the patient is waiting for the examination. The doctor visualizes the potential site of the lesion, examines the skin. If the myositis progresses a long time, it causes muscle atrophy, and the skin above this area has a scanty grid of blood vessels, that is, pale. The affected muscle is probed to assess the tone and identify the painful points. Ossifying myositis is characterized by progressive muscular weakness, so when palpation the pain is moderate, but the muscles are dense.

2. X-ray

The radiological picture of the ossifying myositis has a definite form. So, 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. Revmoprobes

Revmoprobes are analyzes that are needed to differentiate local and systemic rheumatic diseases. Revmoprobes are needed to determine the etiology of the disease and exclude autoimmune diseases. In addition, this study allows you to establish 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 with exacerbation of chronic myositis and infectious forms of the disease. This indicator is used not only for differential diagnosis, but estimates the effectiveness of treatment.

• Antistreptolysin-O is an antibody that is produced by the presence of streptococcal infection in the body. It allows to reveal rheumatism and rheumatoid arthritis.
• Revmofaktor - increased values of these antibodies indicate autoimmune pathologies, rheumatoid seropositive arthritis or dermatomyosis. The analysis is performed before and after the main therapy.
• Myositis-specific autoantibodies are markers for the detection of dermatomyositis, polymyositis and myositis with inclusions. 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 diagnosis is a biopsy. That is, taking a biopsy for careful study. The main goal of the study is to identify structural degenerative changes in the muscular and connective tissues surrounding the vessels. The main indications for biopsy: infectious myositis, polyfibromyositis and polymyositis.

But, as a rule, of all the diagnostic methods described above, x-rays, computed tomography and a radioisotope study of affected muscular tissues are used to detect ossifying myositis.

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Treatment of ossifying myositis

Treatment of ossifying myositis is the responsibility of such physicians as a therapist, rheumatologist and neurologist. The initial examination is performed by the therapist, and then, depending on the etiology of the disease, gives direction to other specialists. If the ossification has been identified at an early stage, then physiotherapeutic procedures (electrophoresis, ultrasound and others) are used to dissolve ossitis and anesthetize.

Treatment does not take place in a hospital environment, but the patient must regularly go to the examination and the procedures prescribed by the doctor. The basis of treatment is compliance with bed rest, that is, it is necessary to ensure complete rest of 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, strictly prohibited, salted, fried and fatty foods, as well as alcohol.

• If myositis is caused by parasites, then prescribe anthelmintic medicines, with bacterial damage - antibiotics and serums.
• Purulent form of the disease requires surgical treatment - opening the abscess, installing drainage and washing the wound with antiseptic.
• With an autoimmune cause of the disease, the patient is prescribed immunosuppressors and glucocorticosteroids. In especially severe cases, cytherephy and plasmapheresis are carried out, that is, methods of extracorporeal detoxification

Ossifying myositis is susceptible to conservative treatment only in the early stages, in all other cases an operation is performed. This is due to the fact that at the beginning of the disease, calcinates dissolve under the action 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

The prevention of ossifying myositis is based on the observance of a balanced diet, an active lifestyle, but without excessive physical exertion and the timely treatment of any diseases. Let's consider the basic preventive recommendations for ossifying myositis:

• Full nutrition prevents inflammation in the muscle tissue. For these purposes, it is recommended to use fatty polyunsaturated acids, which are contained in fish. Also, foods high in salicylates (potatoes, beets, carrots) are useful. In the diet should be easily digestible proteins (soy, almonds, chicken), foods rich in calcium (sour milk, currants, celery) and cereals that are rich in magnesium.
• The drinking regime is very important in the prevention of various myositis. A day must drink at least two liters of water. In addition to water, it is recommended to fill the water balance with green tea, various fruit drinks and compotes. If due to abundant drink there is swelling, then to eliminate it you need to take a broth of dogrose.
• As for physical activity, in the prevention of ossifying myositis, more time should be spent in the fresh air. It is also recommended to temper the body, alternate rest and exercise and follow the posture. And swimming, cycling and gymnastics reduce the risk of ossification of the muscular tissues

For the prevention of myositis, it is necessary to exclude a sedentary lifestyle, hypothermia and stay in drafts. Danger is a long load on one group of muscles. By eliminating all these factors and adhering to preventive measures, you can protect your body not only from ossifying myositis, but also a number of other pathologies.

Prognosis of ossifying myositis

The prognosis of ossifying myositis completely depends on the stage at which the disease was detected and how the treatment was treated. With a timely and adequate therapy, the prognosis is favorable. The prognosis depends on the speed of ossification, which all have different. The pathological process can last for years, hitting all the muscle structures. But the most interesting is that ossification does not apply to the eye muscles, heart, diaphragm, larynx and tongue.

If the ossifying myositis has an innate pathological character, most of the patients die before reaching the age of ten. This is due to the fact that the muscles of the abdominal wall and intercostal muscles are subjected to ossification, which entails a violation of the respiration process. Severe ossification leads to limited movements of the spine and all major joints. If ossification affects the muscular tissues of the lower jaw, the patient is difficult to chew and swallow food, to breathe normally. Unfortunately, for this form of the disease treatment is not developed, so the forecast is unfavorable.