I thought it was just a bruise

One of the most common injuries that athletes deal with are bruises. While most bruises are relatively minor injuries, they can lead to some serious problems. A bruise, or contusion, is caused by a blow from an external object causing the soft tissue, including muscle, tendon, skin, fat, etc., to be compressed against hard bone underneath.

A majority of contusions are followed by discoloration, called ecchymosis, caused by blood vessels breaking. Swelling, inflammation, pain with muscle contraction, and decreased range of motion are typically felt. In most cases, contusions can be treated with ice, rest, and time, but sometimes they call for a lot more attention.

One of these cases is when the direct blow to the soft tissue is extremely forceful or repetitive causing calcium (or bone) formation in the muscle fibers. This build up of calcium in the muscle fiber is called myositis ossificans which is usually a gradual process. Myositis ossificans most generally occurs in the quadriceps in the thigh, and the biceps in the arm. In early cases, most often resulting from specific occupation, myositis was common in shoe makers’ thighs, the "rifle shoulders" of infantry men, and in the hamstrings of calvary men, also called "rider’s bone". Myositis ossificans can be very painful and function decreased.

Although contusions may seem easy to take care of, the ones that have the possibility of developing myositis ossificans recieve a much more intense rehab. If there is loss of muscle contraction range of motion and regaining muscle contraction are extremely important in the rehab and treatment process. It is also important to immediately get ice and compress on the affected area and have the muscle in a stretched position. Most myositis ossificans usually take 2 to 4 weeks, in its early stages, to be noticeable. Myositis ossificans is detected by X-ray and is the preferred imaging to detect its existence.

Myositis ossificans can be a serious injury and it can complicate the return to play for an athlete. If detected early enough rest, immobilization and anti-inflammatory medications can be given, but in some severe cases surgery may be needed. If surgery is the preferred option, most surgeons will wait 6 to 12 months before considering removal so that the myositis ossificans has time to fully mature.

Examples of Myositis Ossificans:



One thought on “I thought it was just a bruise

  1. Hi,

    This is a nice review. Thanks!

    A couple interesting points:
    The first is that this pathology is not deposition of calcification or formation of calcium in the soft tissues, rather it is bone or osteoid tissue that is formed.

    The second is that a good consideration prior to surgery (in addition to waiting as mentioned in the above article) is for a nuclear medicine bone scan. If the lesion is not “hot” on bone scan, that is a good indicator that it is not active. When the lesion is not active, the chances of recurrence after resection are less.

    Keep on posting these informative articles!


    Dr. Brian Sabb

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