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Poster 215 Myositis Ossificans Traumatica of the Upper Arm in a High School Football Player: A Case Report
PM&R
and to improve the functional status a prompt diagnosis and a multidisciplinary treatment is required.
Poster 214 Rupture of Bilateral Quadriceps Tendon and Left Rotator Cuff in a 59-Year-Old Man: A Case Report. Hamilton Chen, MD (UCI Medical Center, Orange, CA, United States). Disclosures: H. Chen, none. Patients or Programs: We present a case in which a patient sustained both a bilateral quadriceps tendon rupture and a complete rotator cuff tear. Program Description: A 59-year-old man presented with bilateral knee and left shoulder pain and/or weakness. For the 3 months before injury, he had exercised for 3 hours per day on an elliptical trainer. A few days before evaluation, the patient had a misstep while walking downstairs and felt his right knee pop, which resulted in a fall. When attempting to ambulate with his right knee, he heard his left knee pop and fell on his left arm. Evaluation at an outside hospital determined no fractures on radiographs, and he was discharged home. Unable to ambulate, he brought himself to our facility. On magnetic resonance imaging, he was found to have bilateral quadriceps tendon rupture and a complete left rotator cuff tear. Setting: Tertiary care center. Results: The patient underwent surgical repair. Weight bearing was restricted in the lower extremities. He was transferred to the subacute rehabilitation unit to facilitate healing and undergo physiotherapy. With disuse of 3 limbs, he was granted an electric wheelchair. Discussion: Quadriceps tendon rupture is an uncommon injury that has been well documented in the literature. Bilateral rupture combined with a rotator cuff tear is an extremely rare presentation. Known risk factors for bilateral quadriceps tendon rupture include the following: renal failure, chronic steroid and/or quinolone use, metabolic diseases, rheumatic diseases, infection, history of rupture, and advanced age. Even though our patient was at risk for his injuries because of his age, he had no other risk factors. The only other anomaly in his presentation was a strenuous exercise program by using an elliptical trainer, which suggests that overuse can be a potential risk for quadriceps tendon rupture and rotator cuff tear. Conclusions: Overuse is a known risk factor for rotator cuff tears, but this case suggests that it also can be a risk factor for quadriceps tendon rupture. This case also stresses the importance of consideration of tendon injury as a differential, especially when x-ray imaging is negative, and there is a subjective history of a traumatic incident. Reliance on physical examination of the knee may be difficult due to pain and swelling from injury.
Poster 215 Myositis Ossificans Traumatica of the Upper Arm in a High School Football Player: A Case Report. Antwon L. Morton, DO (Eastern Virginia Medical School, Norfolk, VA, United States); Peter Gonzalez, MD, Brian Waters, ATC. Disclosures: A. L. Morton, none. Patients or Programs: A 17-year-old male athlete presenting with a hard mass in right lateral arm.
Vol. 3, Iss. 10S1, 2011
S245
Program Description: The patient was a high school football player who presented with right lateral arm pain of 1-year duration. Patient initially reported pain after taking a helmet hit to his right arm during a football game. He was evaluated and treated for a contusion. Over time, his symptoms of pain decreased, but the mass did not. One year later, he was hit again over this region and had increasing pain. Setting: An academic sports medicine clinic. Results: He underwent a limited musculoskeletal ultrasound examination of the right upper extremity, which demonstrated a hyperechoic focus consistent with calcification in the lateral head of the triceps muscle. An adjacent hematoma superficial to the mass was noted. Plain radiograph of the humerus revealed an ovoid area of calcification without evidence of periosteal reaction or a fracture. No bone destruction or other osseous lesions were seen. Discussion: Myositis ossificans traumatica is defined as a localized formation of heterotopic, non-neoplastic bone caused by physical trauma, usually occurring near bone and in muscle. In this case, the athlete had minimal range of motion deficits and resolving pain. He returned to play with padding to protect the lateral arm from further injury and with recommendations to follow up after the season. Conclusions: Myositis ossificans traumatica is frequently encountered in adolescent and young adult men as a consequence of a sports-related injury. A comprehensive understanding of the etiology and clinical presentation will often lead to the diagnosis of this benign extraskeletal formation of bone. Musculoskeletal ultrasound examination is an excellent and cost-effective method to assist in the diagnosis of Myositis ossificans traumatica and monitor the progression over time.
Poster 216 Ankle Inversion Injury With a Tibial Plafond Fracture in a Collegiate Runner: A Case Report. Joshua R. Johnson, MD (University of Louisville, Louisville, KY, United States); Jonathan Becker, MD. Disclosures: J. R. Johnson, none. Patients or Programs: A healthy 21-year-old white male collegiate track and field athlete. Program Description: The patient presented to the athletic training room with a history of right lateral ankle pain. He indicated an initial ankle inversion injury that occurred in the weight room 4 weeks earlier. The patient experienced a second acute inversion event during a race approximately 2 weeks before physician evaluation. Plain films were negative for a fracture or dislocation, and he had since been managed conservatively for a lateral ankle sprain. He was participating in modified running activities but indicated persistent discomfort. The patient had no obvious bruising or swelling but had pain on palpation of the lateral malleolus and near the anterior talofibular ligament. He had positive anterior drawer and talar tilt tests but negative squeeze test. Magnetic resonance imaging of the right ankle indicated complete tear of the anterior talofibular ligament, high-grade calcaneal fibular ligament injury, and a nondisplaced anterolateral tibial plafond fracture. The patient was placed in a fracture boot and was withheld from competitive activities. Setting: Collegiate training room. Results: He remained in a fracture boot for 4 weeks until free of discomfort and was gradually returned to weight-bearing activities.
and to improve the functional status a prompt diagnosis and a multidisciplinary treatment is required.
Poster 214 Rupture of Bilateral Quadriceps Tendon and Left Rotator Cuff in a 59-Year-Old Man: A Case Report. Hamilton Chen, MD (UCI Medical Center, Orange, CA, United States). Disclosures: H. Chen, none. Patients or Programs: We present a case in which a patient sustained both a bilateral quadriceps tendon rupture and a complete rotator cuff tear. Program Description: A 59-year-old man presented with bilateral knee and left shoulder pain and/or weakness. For the 3 months before injury, he had exercised for 3 hours per day on an elliptical trainer. A few days before evaluation, the patient had a misstep while walking downstairs and felt his right knee pop, which resulted in a fall. When attempting to ambulate with his right knee, he heard his left knee pop and fell on his left arm. Evaluation at an outside hospital determined no fractures on radiographs, and he was discharged home. Unable to ambulate, he brought himself to our facility. On magnetic resonance imaging, he was found to have bilateral quadriceps tendon rupture and a complete left rotator cuff tear. Setting: Tertiary care center. Results: The patient underwent surgical repair. Weight bearing was restricted in the lower extremities. He was transferred to the subacute rehabilitation unit to facilitate healing and undergo physiotherapy. With disuse of 3 limbs, he was granted an electric wheelchair. Discussion: Quadriceps tendon rupture is an uncommon injury that has been well documented in the literature. Bilateral rupture combined with a rotator cuff tear is an extremely rare presentation. Known risk factors for bilateral quadriceps tendon rupture include the following: renal failure, chronic steroid and/or quinolone use, metabolic diseases, rheumatic diseases, infection, history of rupture, and advanced age. Even though our patient was at risk for his injuries because of his age, he had no other risk factors. The only other anomaly in his presentation was a strenuous exercise program by using an elliptical trainer, which suggests that overuse can be a potential risk for quadriceps tendon rupture and rotator cuff tear. Conclusions: Overuse is a known risk factor for rotator cuff tears, but this case suggests that it also can be a risk factor for quadriceps tendon rupture. This case also stresses the importance of consideration of tendon injury as a differential, especially when x-ray imaging is negative, and there is a subjective history of a traumatic incident. Reliance on physical examination of the knee may be difficult due to pain and swelling from injury.
Poster 215 Myositis Ossificans Traumatica of the Upper Arm in a High School Football Player: A Case Report. Antwon L. Morton, DO (Eastern Virginia Medical School, Norfolk, VA, United States); Peter Gonzalez, MD, Brian Waters, ATC. Disclosures: A. L. Morton, none. Patients or Programs: A 17-year-old male athlete presenting with a hard mass in right lateral arm.
Vol. 3, Iss. 10S1, 2011
S245
Program Description: The patient was a high school football player who presented with right lateral arm pain of 1-year duration. Patient initially reported pain after taking a helmet hit to his right arm during a football game. He was evaluated and treated for a contusion. Over time, his symptoms of pain decreased, but the mass did not. One year later, he was hit again over this region and had increasing pain. Setting: An academic sports medicine clinic. Results: He underwent a limited musculoskeletal ultrasound examination of the right upper extremity, which demonstrated a hyperechoic focus consistent with calcification in the lateral head of the triceps muscle. An adjacent hematoma superficial to the mass was noted. Plain radiograph of the humerus revealed an ovoid area of calcification without evidence of periosteal reaction or a fracture. No bone destruction or other osseous lesions were seen. Discussion: Myositis ossificans traumatica is defined as a localized formation of heterotopic, non-neoplastic bone caused by physical trauma, usually occurring near bone and in muscle. In this case, the athlete had minimal range of motion deficits and resolving pain. He returned to play with padding to protect the lateral arm from further injury and with recommendations to follow up after the season. Conclusions: Myositis ossificans traumatica is frequently encountered in adolescent and young adult men as a consequence of a sports-related injury. A comprehensive understanding of the etiology and clinical presentation will often lead to the diagnosis of this benign extraskeletal formation of bone. Musculoskeletal ultrasound examination is an excellent and cost-effective method to assist in the diagnosis of Myositis ossificans traumatica and monitor the progression over time.
Poster 216 Ankle Inversion Injury With a Tibial Plafond Fracture in a Collegiate Runner: A Case Report. Joshua R. Johnson, MD (University of Louisville, Louisville, KY, United States); Jonathan Becker, MD. Disclosures: J. R. Johnson, none. Patients or Programs: A healthy 21-year-old white male collegiate track and field athlete. Program Description: The patient presented to the athletic training room with a history of right lateral ankle pain. He indicated an initial ankle inversion injury that occurred in the weight room 4 weeks earlier. The patient experienced a second acute inversion event during a race approximately 2 weeks before physician evaluation. Plain films were negative for a fracture or dislocation, and he had since been managed conservatively for a lateral ankle sprain. He was participating in modified running activities but indicated persistent discomfort. The patient had no obvious bruising or swelling but had pain on palpation of the lateral malleolus and near the anterior talofibular ligament. He had positive anterior drawer and talar tilt tests but negative squeeze test. Magnetic resonance imaging of the right ankle indicated complete tear of the anterior talofibular ligament, high-grade calcaneal fibular ligament injury, and a nondisplaced anterolateral tibial plafond fracture. The patient was placed in a fracture boot and was withheld from competitive activities. Setting: Collegiate training room. Results: He remained in a fracture boot for 4 weeks until free of discomfort and was gradually returned to weight-bearing activities.