A 22-year-old man sustained an elbow dislocation 6 weeks ago, treated with closed reduction. He now has progressive elbow stiffness and firm swelling over the anterior arm. X-ray shows fluffy calcification within the brachialis muscle. Passive forcible stretching was advised earlier. The MOST appropriate next step is:
- A Gentle active assisted movements and wait for maturation before considering excision ✓
- B Immediate surgical excision of the calcified mass
- C Aggressive passive stretching under anaesthesia
- D Local steroid injection into the mass
Correct answer: A. Gentle active assisted movements and wait for maturation before considering excision
Explanation
This is myositis ossificans traumatica, commonest around the elbow and quadriceps after trauma or forced passive stretching. The lesion matures over roughly 6 to 12 months, becoming sharply delineated with a peripheral rim of mature bone. Excision before maturation carries a high recurrence risk, so surgery is deferred until the lesion is mature and function is still limited. Active mobilisation is the mainstay of early treatment.
Reference: Apley and Solomon's Concise System of Orthopaedics and Trauma, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.