Lecture 4 HO

Question 1

Heterotopic ossification most commonly affects soft tissues where?

Answer 1

peri-articular (near joints)

Question 2

What are the two kinds of heterotopic ossification

Answer 2

neurogenic and traumatic

Question 3

Out of these Neuro conditions, which most commonly get heterotopic ossification:

TBI, SC, CVA, MS

Answer 3

TBI and SCI

Question 4

When does HO usually form in patients w/ spinal cord injury

Answer 4

Incidence: 10-78%

Presents 3-12 weeks later, but can develop a year later or more

Question 5

How soon after injury can HO occur in patient’s with TBI

Answer 5

Incidence: 8-20%

Increase in incidence in patietns in coma/PVS for over 2 weeks

Occurs 7-17 weeks after injury

Question 6

What factors lead to a higher incidence of HO following SCI

Answer 6

-Gender
-Spasticity
-Smoking
-Completeness of cord injury
-pneumonia
-pressure ulcers

Question 7

HO can affect any joint ____________ in patients with SCI/TBI

Answer 7

Below the level of the lesion/injury

SCI: commonly hips, knees

TBI: commonly includes shoulder, elbow, hips

Question 8

What joints are rarely affected by HO

Answer 8

Peripheral joints like wrists, ankles, hands, feet

Question 9

What are the initial signs of HO?

2 weeks later?

Answer 9

Pain

Localized Inflammation

Decreased ROM

2 weeks later: region is hard upon palpation
joint ROM further restricted
serum alkaline phosphatase levels increase and stay elevated

Question 10

What is the gold standard for diagnosing HO?

What does research suggest is more convinent and still very reliable

Answer 10

Triple phase bone scinitigraphy

Diagnostic ultrasound

Question 11

Why is timing of intervention important for managing HO

Answer 11

Wait until the bone is mature before attempting to remove it surgically

Question 12

How does PTs do ROM for patients with HO

Answer 12

Don’t do ROM that is too agressive into any boney endfeels