1. Elbow joint complex Dr. Wajeeha Mahmood BSPT, PPDPT

2. Myositis Ossificans Myositis ossificans Heterotopic bone formation Ectopic bone formation

3. Definition Formation of bone in atypical locations of the body Ossification of muscle Heterotopic bone formation in the muscletendon unit, capsule, or ligamentous structures.

4. Etiology of Symptoms Most frequently involved sites 1.Elbow region 2.Thigh

5. The most important muscle is the brachialis muscle or joint capsule Which occurs as the result of 1.Trauma(supracondylar or radial head fracture) of the elbow. 2.Tear of the brachialis tendon.

6. 1.Traumatic brain injury (TBI) 2.Spinal cord injury (SCI) 3.Patients with burns to the extremities. 4.Aggressive stretching of the elbow flexors after injury 5.Immobilization

7. Management 1.Rest in a splint, which should be removed only periodically during the day for active, pain-free ROM 2.Rest should continue until the boney mass matures and then resorbs. 3.If the capsule is also involved, surgical excision of heterotopic bone from muscle is needed.

8. Contraindications 1.Massage 2.Passive stretching 3.Resistive exercise contraindicated if the brachialis muscle is implicated after trauma

9. Cozen's Test. The clinician stabilizes the patient's elbow with one hand, and the patient is asked to pronate the forearm and extend and radially deviate the wrist against the manual resistance of the clinician. A reproduction of pain in the area of the lateral epicondyle indicates a positive test

10. Mill's Test. The clinician palpates the patient's lateral epicondyle with one hand, while pronating the patient's forearm, fully flexing the wrist,and extending the elbow. A reproduction of pain in the area of the lateral epicondyle indicates a positive test.

11. Golfer's Elbow (Medial Epicondylitis). The clinician palpates the medial epicondyle with one hand while supinating the forearm, and extending the wrist and elbow with the other hand. A reproduction of pain in the area of the medial epicondyle indicates a positive test.

12. Tinel's Sign (at the Elbow). The clinician locates the groove between the olecranon process and the medial epicondyle through which the ulnar nerve passes. This groove is tapped by the index finger of the clinician. A positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point