Ann Rehabil Med.  2015 Apr;39(2):318-322. 10.5535/arm.2015.39.2.318.

Extracorporeal Shock Wave Therapy for Painful Chronic Neurogenic Heterotopic Ossification After Traumatic Brain Injury: A Case Report

• Choi YM
• Hong SH
• Lee CH
• Kang JH
• Oh JS

• KMID: 2273056
• DOI: http://doi.org/10.5535/arm.2015.39.2.318

Abstract

Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. It is a common complication in major CNS injuries, such as traumatic brain injury, spinal cord injury, and stroke. Here, we report the case of a 72-year-old male, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint. Three applications of extracorporeal shock wave therapy (ESWT) were administered to the area of NHO, which resulted in pain relief and an improvement in the loss of motion in the left hip joint. Improvements were also noted in walking performance and activities of daily living, although the size of NHO remained unchanged. Therapeutic effects of ESWT lasted for 12 weeks.

Keyword

Heterotopic ossification; Extracorporeal shock wave therapy; Brain injury

MeSH Terms

Activities of Daily Living
Aged
Brain Injuries*
Central Nervous System
Hip Joint
Humans
Joints
Male
Ossification, Heterotopic*
Osteogenesis
Shock*
Spinal Cord Injuries
Stroke
Walking

Figure

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  Fig. 1 (A) Radiograph of the hip showed before extracorporeal shock wave therapy (ESWT). (B) Radiograph of the hip showed after ESWT.

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  Fig. 2 (A) Dornier AR2 (Dornier MedTech, Wessling, Germany). (B) Extracorporeal shock wave therapy was applied below the anterior superior iliac spine (asterisk).

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  Fig. 3 (A) Transverse ultrasound image taken before extracorporeal shock wave therapy (ESWT) showed multiple hyperechoic foci with no shadowing (arrowhead), vascularity was presented in the color Doppler image (arrow). (B) Blood supply was increased in the color Doppler image (arrow) 4 weeks after ESWT.

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