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Thigh pain
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Thigh pain - October 20, 2004 3:28:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Hi. Interesting case this week. 23 year old male soldier was playing flag football with unit. He ran directly into another player during the game. he came out of game and was unable to return. He came in today to physical therapy. States he was struck on his anterior thigh. On physical exam he has moderate echymosis over anterior mid shaft thigh and complains of loss of range of motion. He is unable to bend his knee past 90 and can not full weight bear without pain. Here are his radiographs. How would you treat this?
[IMG]http://img.photobucket.com/albums/v85/brennerak/thigh2.jpg[/IMG]
[IMG]http://img.photobucket.com/albums/v85/brennerak/thigh.jpg[/IMG]
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Alex Brenner, PT, MPT, OCS
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Re: Thigh pain - October 20, 2004 4:03:00 AM
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SJBird55
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Looks like he's got something there in his soft tissues - I'd guess a clump of blood. If he just injured himself, I wouldn't be too worried as of yet (unless of course he's a hemophiliac, which is doubtful since he's in the military). Ice and compression for the first 48-72 hours and if he's on his feet walking, I'd probably be conservative and have him use an assistive device as needed to keep him walking with a normal gait pattern as much as possible. If he's still within those hours, I'd also tell him that he's going to potentially hurt worse during the 48-72 hour time period and that is normal and expected. I'd check his meds and make sure he's not on Coumadin or medication with similar effects (doubtful at 23). After the 72 or so hours depending on his symptoms, I'd suggest heat and have him begin gentle knee flexion exercises. I generally tell the patients that they are at risk for myositis ossificans and educate them on what that is and what that means. So, hopefully the patient understands that normalizing motion is important but when moving into knee flexion pain also needs to be considered. There's that fine line of doing good and redamaging - if he uses common sense he'll be fine. He should have a definitive change 2 weeks post injury - won't be perfect, but he should know that it is better. Follow up with him in 2-3 weeks and go from there. I don't know what he does actively or what his military role is, but he's going to want that thigh protected, so if he is in a position where it might be likely that he could recontuse that area, I'd have some hard padding created for him to keep to use to prevent reinjury in the near future.
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Re: Thigh pain - October 20, 2004 4:05:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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Hi. I forgot to mention that this happened 3 weeks ago and he did not seek care until this week.
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Alex Brenner, PT, MPT, OCS
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Re: Thigh pain - October 20, 2004 4:52:00 AM
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VagusX
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From: Savannah, GA, USA
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myositis ossificans
Probobly didn't RICE afterwards and most likely returned to increased physical activity working thorugh pain therefore reinjuring.
What to do now. If you don't immobilize it now I believe that there is a chance for more reinjury and more ossification to occur.
I have never had a case of M.O. before it was completely ossified so I have no nothing more to go on other than what my books say.
Thanks for the X-Ray
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Re: Thigh pain - December 9, 2004 9:11:00 AM
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cneup
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If it is MO - I'm not sure I would completely agree with immediate immobilization - it depends on his current activity levels and compliance. Can't remember the references but I read a few articles which concluded that gentle ROM and activity did NOT increase progression of ossification. Is he currently on meds such as indocin etc??
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Re: Thigh pain - December 9, 2004 10:10:00 AM
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chiroortho
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I'd wrap the thigh as tightly as I could without compromising circulation and have him NWB till the ecchymosis resolved, then progress --> walk -->run with ice 15 mins. after each activity times two weeks.
He needs to know that he has MO so that if he ever injures the thigh again and has it xrayed, it won't be mistaken for osteosarcoma.
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Greg Priest, DC, DABCO
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Re: Thigh pain - December 9, 2004 4:13:00 PM
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PTupdate.com
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The view is difficult to see on this computer, but looks like MO in the quad. If so, Acetic acid iontophoresis...starting with MH to increase absorption, followed by active but not passive stretching, finishing with acid ionto again with ice while the knee is flexed and hip flexed.
Had a case just like this a few years ago, and reduced the size of the mass by half in two weeks. At 3 weeks, the tissues should be stable enough that the AROM will not cause any excessive bleeding, and the bone is still in fluffy callous/precipitate of hydroxyapatite, and not hardened that it would cause tissue tearing.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Thigh pain - December 10, 2004 12:38:00 AM
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fapt
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I think that we can teache the player that how to prevent the reinjury. And some first aid knowledge.
The treatment in PT is that we can use US for the echymosis area for ruduce the problem. And then, we do some passive ROM exerciseand massage. If the symptom is released, we can do mor aggressive exercise for the player, such as, isometric and isotoin exercises.
We also need to teach him using the assist device for walking untile the the recovery.
At the last, we can teach some pylometric exercise for preparing to return to the sport.
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夏之日，冬之夜，百歲之後，歸于其居。
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Re: Thigh pain - December 10, 2004 12:52:00 AM
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Alex Brenner PT MPT OCS
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This has been a tough patient. I have been working with him fairly regularly and he still lacks about 40 degrees of flexion and you can still palpate the MO in the anterior thigh. He is walking much better but can not run. We don't have an ionto machine, I wouldnt mind trying it at this time.
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Alex Brenner, PT, MPT, OCS
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Re: Thigh pain - December 10, 2004 2:43:00 AM
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PTupdate.com
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If you have some type of DC current unit where you can control power, you might be able to make one with gauze, aluminum foil, a few alligator clips from your base electronics department, and the acetic acid from the pharmacy.
If no luck, let me know and I will pressure the sales guy from a local company to ship you the stuff for no charge. I think it is the least we can do to help out what you guys are doing for this country.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Thigh pain - December 10, 2004 10:12:00 AM
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chiroortho
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Very good of you John. We need more like you.
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Greg Priest, DC, DABCO
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