Revista de fisioterapia y rehabilitación física

Combined Therapy of Extracorporeal Shock Waves and Etidronate Disodium as a Potential Treatment for Post-traumatic Myositis Ossificans in the Quadriceps Muscle: A Case Report

Abstract

Noriyuki Hara, Koji Suzuki, Susumu Mikami, Jun Uchida, Naoki Seito and Tatsuhisa Takahashi

Objective: To investigate the therapeutic effect of the combination of extracorporeal shock waves (ESWs) and Etidronate sodium (EHDP) on post-traumatic Myositis Ossificans (MO) in the quadriceps muscle.

Case description: A 26-year-old male ice hockey player complained of left thigh pain and stiffness, 4 weeks after a direct blow to the thigh from the knee of an opponent in a game. A firm mass with tenderness was palpated at the antero-mid area of the Rectus Femoris. Movement of his left knee was restricted to 50 degrees of flexion from full extension. A radiograph showed a lacy pattern of new bone formation in the anterior aspect of the left femur at 4 weeks after the injury. The injury was thus diagnosed as post-traumatic MO in the left quadriceps muscle. Indomethacin was administered for the first 7 days of hospitalization. EHDP was given orally for 3 months. ESW therapy was performed for the treatment of MO without any anesthesia: 3500 pulses at an energy density of 0.03 to 0.36 mJ/mm² per week, in seven sessions. Pain in the muscle improved with 2 weeks of complete rest with immobilization, and thereafter by moving the knee actively and passively within pain-free limits. A normal range of pain-free motion of the affected knee was achieved in 8 weeks. The athlete then started various rehabilitation exercises, such as stretching and walking. He returned to full sporting activity 5 months after the initial treatment.

Conclusion: Combined therapy of ESW and EHDP was useful for the treatment of post-traumatic MO in the quadriceps muscle.