heterotopic ossification

[mumujen]

does anyone know anything about heterotopic ossification (HTO)? I know that it happens after traumatic brain injury or spinal cord injury? but what exactly is it? any treatment for that?

[NARSTR]

This is a worrying condition that occurs fairly frequently around the M-T or insertion site of a hypertonic muscle, frequently biceps fem and quads. It is a osteoclastic response to focal trauma, stress+++ at the site due to constant contractions. It is painful and irreversible once it has occured, but will gradually become less painful over months. Early splinting may prevent it, but there is no evidence.

[Mich]

HTO is the process of ectopic bone formation . it can occur, as previously mentioned in MT junctions and can potentially occur at any joint but more commenly the knee, hip, shoulder or elbow. Early detection is difficult as often onset is insidious with pain, swelling and heat with a reduction of range of movement noted in the area. Diagnosis is confirmed by bone scans where it shows as an area of active uptake.
The effectiveness of physio in HTO remains controversial. Maintaining range of movement in the area is vital so the joint does not fuse however it is not known if too vigorous a mobilisation could affect the process. Splinting could also be of use to maintain a position but care must be taken that the joint is still ranged so it does not fuse in the splinted position.
HTO can be treated with medication (I think indomethacin may be one of the ones used) and if it should come to it corrective surgey usually isn't carried out until the HTO is inactive. This may be up to 2 years after the injury and is shown by inactivity on bone scan.
It can adversly affect rehab due to pain as well as ROM, I guess making sure pain relief is sufficient and ensuring a good ROM in the joints surrounding the area is a start.