Ann Rehabil Med.  2017 Jun;41(3):498-504. 10.5535/arm.2017.41.3.498.

Intramuscular Hematoma Following Radial Extracorporeal Shockwave Therapy for Chronic Neurogenic Heterotopic Ossification: A Case Report

• Kim H
• Cheon JH
• Lee DY
• Cheon JH
• Cho YK
• Lee SH
• Kang EY

• KMID: 2389468
• DOI: http://doi.org/10.5535/arm.2017.41.3.498

Abstract

Extracorporeal shockwave therapy (ESWT) has been reported to be a safe and effective method for decreasing pain and relieving range of motion (ROM) limitations caused by neurogenic heterotopic ossification (NHO), though there has been no report that it might cause hematoma if applied to NHO. We hereby report a case of massive hematoma after ESWT, specifically the radial shockwave therapy (RSWT) device at both hips in a 49-year-old female patient with NHO. She had developed NHO after extensive subarachnoid hemorrhage. We had applied RSWT according to the previous report. The pain and the ROM limitations were gradually improved. Six weeks later, she reported pain and ROM limitations on the right hip. From a medial aspect, swelling and bruising of the right thigh could be seen. Magnetic resonance imaging and ultrasonography suggested a large hematoma between right hip adductor muscles. The symptoms disappeared after conservative treatment for one month, and subsequent follow-up imaging studies demonstrated resolution of the hematoma.

Keyword

High-energy shockwaves; Hematoma; Heterotopic ossification

MeSH Terms

Female
Follow-Up Studies
Hematoma*
Hip
Humans
Magnetic Resonance Imaging
Methods
Middle Aged
Muscles
Ossification, Heterotopic*
Range of Motion, Articular
Subarachnoid Hemorrhage
Thigh
Ultrasonography

Figure

• 

  Fig. 1 (A) MP200 (Storz Medical AG, Tagerwilen, Switzerland). (B) Radial shockwave therapy was applied around a lesser trochanter (asterisk) below anterior inferior iliac spine (arrowhead).

• 

  Fig. 2 Comparison of X-rays pretreatment (A) and post-treatment (B), which radial shockwave therapy revealed that the size had become slightly smaller in posttreatment on both right (arrow) and left neurogenic heterotopic ossification (arrowhead).

• 

  Fig. 3 (A) From a medial aspect of the right thigh, swelling and bruising were seen. Axial (B) and coronal (C) T1-weighted magnetic resonance images show an area of heterogeneous high signal intensity in the right pectineus muscle, consistent with hematoma (arrow).

• 

  Fig. 4 (A) Swelling and bruising almost disappeared after one month of conservative treatment. Axial (B) and coronal (C) T1-weighted magnetic resonance images show that an area of hematoma had markedly decreased (arrow).

Reference

1. Chang KV, Chen SY, Chen WS, Tu YK, Chien KL. Comparative effectiveness of focused shock wave therapy of different intensity levels and radial shock wave therapy for treating plantar fasciitis: a systematic review and network meta-analysis. Arch Phys Med Rehabil. 2012; 93:1259–1268. PMID: 22421623.

2. Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006; 86:672–682. PMID: 16649891.

3. Brissot R, Lassalle A, Vincendeau S, Polard JL, Fouche M, Ninubona D, et al. Treatment of heterotopic ossification by extracorporeal shock wave: 26 patients. Ann Readapt Med Phys. 2005; 48:581–589. PMID: 15993976.

4. Reznik JE, Milanese S, Golledge J, Biros E, Gordon S, Galea MP. Extracorporeal shock wave therapy as a treatment for heterotopic ossification. Phys Ther Rev. 2013; 18:300–307.

5. Choi YM, Hong SH, Lee CH, Kang JH, Oh JS. Extracorporeal shock wave therapy for painful chronic neurogenic heterotopic ossification after traumatic brain injury: a case report. Ann Rehabil Med. 2015; 39:318–322. PMID: 25932431.

6. Haake M, Boddeker IR, Decker T, Buch M, Vogel M, Labek G, et al. Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow. Arch Orthop Trauma Surg. 2002; 122:222–228. PMID: 12029512.

7. Sistermann R, Katthagen BD. Complications, side-effects and contraindications in the use of medium and high-energy extracorporeal shock waves in orthopedics. Z Orthop Ihre Grenzgeb. 1998; 136:175–181. PMID: 9615982.

8. Csaszar NB, Angstman NB, Milz S, Sprecher CM, Kobel P, Farhat M, et al. Radial Shock Wave Devices Generate Cavitation. PLoS One. 2015; 10:e0140541. PMID: 26509573.

9. Kiessling MC, Milz S, Frank HG, Korbel R, Schmitz C. Radial extracorporeal shock wave treatment harms developing chicken embryos. Sci Rep. 2015; 5:8281. PMID: 25655309.

10. Alkhamaali ZK, Crocombe AD, Solan MC, Cirovic S. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis. Comput Methods Biomech Biomed Engin. 2016; 19:1069–1078. PMID: 26465270.