Myositis ossificans traumatica of the hand.

A 10-year-old boy presented with a history of injury to the left upper limb 8 months earlier. He had fallen from a tree and sustained a closed injury to the left elbow and wrist. He received massage from a local osteopath for the initial 3–4 weeks, following which the elbow and wrist were mobilized. The pain and swelling gradually diminished over 8 months, but there was restriction of movement in the elbow and wrist joints. On presentation, we noted some swelling in the elbow region and on the dorsum of the wrist. The local temperature was not increased and there was no erythema. A bony, hard mass was palpable over the lateral aspect of the elbow and the dorsum of the wrist, which was continuous with the parent bone. There was minimal local tenderness. Both the supracondylar ridges were indistinct and rounded. Active range of elbow movement was 60°–90°. Movement at the wrist ranged from 10° dorsiflexion to 20° palmar flexion. Both pronation and supination were restricted to 0°–40°. There was a mild Volkmann’s ischemic contracture with a positive Volkmann’s sign. Distal pulses were well palpable. Anteroposterior and lateral radiographs of the elbow (Fig. 1) and wrist (Fig. 2) revealed ossification around the elbow and dorsal to the carpals and metacarpals in the location of the extensor tendon sheaths suggestive of traumatic myositis ossificans. There also was a suspicion of an epiphyseal injury to the lower end of the ulna. Considering the significant trauma that was subsequently treated by massage, a diagnosis of posttraumatic myositis ossificans was made. This was confirmed by subsequent histopathological examination.