A 20-year-old footballer develops progressive restriction of elbow extension 6 weeks after a supracondylar humeral contusion. X-ray shows fluffy calcification anterior to the elbow. Which intervention must be strictly avoided?

• A Gentle active range of motion exercises
• B Splinting in the resting position
• C Short course of NSAIDs during the active phase
• D Forceful passive stretching and deep massage of the elbow ✓

Explanation

This is myositis ossificans traumatica, heterotopic bone forming in injured muscle, classically around the elbow and quadriceps. The lesion matures over months and often resorbs partially. Forceful manipulation, passive stretching and deep massage aggravate bleeding and provoke more ectopic bone, so they are contraindicated. Excision, if needed at all, is deferred until maturity confirmed by a sharp border and normal alkaline phosphatase, usually beyond 6 to 12 months.

Reference: Maheshwari's Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.