Evaluating and managing muscle contusions and myositis ossificans

Muscle contusions almost always completely heal, but sometimes they give rise to hematomas or myositis ossificans. Warning signs of severe quadriceps contusion include marked decreased knee range of motion and a sympathetic knee effusion. Management consists of rest, cooling, compression, and elevation. Corticosteroids should be avoided, but nonsteroidal anti-inflammatory drugs may reduce edema and the risk of myositis ossificans. Rehabilitation protocols that include early flexion exercise can hasten recovery and decrease the likelihood of myositis ossificans. Asymptomatic myositis ossificans needs no treatment, but when it is associated with decreased range of motion, muscle atrophy, and continued pain, lesions may be excised after they mature.