Myositis ossificans causing ulnar neuropathy: a case report

Abstract

Myositis ossificans (MO) can compress peripheral nerves and cause neuropathy. We herein describe a patient with ulnar neuropathy caused by MO at the medial elbow. A 28-year-old man with a drowsy mentality and multiple organ damage following a traffic accident was admitted to our hospital. After 3 weeks of postoperative care, the patient’s mental status recovered. However, he complained of severe sharp pain in his left medial forearm and fourth and fifth fingers. He exhibited weak fifth finger abduction and wrist adduction. Severe elbow joint pain was elicited during range-of-motion testing of his left elbow. Ultrasound also showed an edematous, enlarged, hypoechoic ulnar nerve lying above the MO, and the MO outwardly displaced the ulnar nerve. Elbow radiographic examination, computed tomography, and magnetic resonance imaging revealed MO development and compression of the left ulnar nerve. The patient underwent surgery; the following day, his left medial forearm pain completely disappeared with slight improvement in the motor weakness of fifth finger abduction. Ultrasound is a useful tool to easily evaluate the presence of MO and compression of peripheral nerves caused by MO.

Posttraumatic Compressive Neuropathy of the Deep Motor Branch of the Ulnar Nerve Caused by Heterotopic Ossification

“… 7 , 8 Posttraumatic myositis ossificans at the medial elbow has been identified as the cause of compressive neuropathy of the ulnar nerve in a multiply injured patient involved in a traffic accident. 9 Finally, heterotopic ossification that formed in the distal forearm following revision carpal tunnel release has been described as causing mixed ulnar and median nerve compression symptoms. 10 …”

Aggressive atraumatic myositis ossificans in a toddler

“…MO is a rare condition in children and infants with limited cases described in the literature [16] . When present MO manifests as a painful growing mass and limited range of motion if in proximity to a joint [5 , 17] . Besides trauma several other, less frequent, risk factors for heterotopic bone formation have been identified such as spinal cord and brain injuries, burns, hip replacement and fractures, especially acetabular ones [12] .…”

“…For uncomplicated MO, the majority of the patients can be managed successfully with observation and NSAIDs [26] . In situations where the MO remains painful, is restricting range of motion, causing a nerve impingement or there is a diagnostic conundrum, resection of the ossified mass is recommended [5 , 17] . Surgical removal of the MO should be performed completely and once the mass has shown features of mature ossification, otherwise risking recurrence [27] .…”

Myositis ossificans in a 29 years old athletic female

“…In most cases, Accepted: November 22 nd 2022 inflammation, ischemia, or repetitive mechanical injuries have been cited as possible factors. Non-traumatic cases are reported in literature and are usually suited to neurogenic conditions such as spinal cord injuries, strokes, brain tumors and other neurological conditions [1][2][3][4][5][6][7][8][9][10][11].…”