Disclosures: Bo Song, MD: No financial relationships or conflicts of interest

Case Description: The patient developed left medial elbow pain, weakness, and allodynia at the palmar aspect of the left hand and 4th and 5th digits after her accident. Pain was described as a sharp, shooting pain worse with movement in all planes. Physical examination of her left elbow revealed medial elbow edema, tenderness along the medial epicondyle and olecranon process, and reduced range-of-motion in both elbow flexion and extension. She also demonstrated allodynia and dysesthesias throughout the medial and lateral forearm not following a dermatomal distribution as well as weakness in wrist extension, finger extension, finger abduction, and thumb opposition. X-Ray of her left elbow was unrevealing, however diagnostic ultrasound examination revealed left medial elbow heterotopic ossification compressing the ulnar nerve in the cubital tunnel. She was started on Alendronate to slow the heterotopic ossification and preserve the nerve.

Setting: Inpatient Acute Rehabilitation Facility

Patient: 31-year-old female who suffered an acute subarachnoid hemorrhage managed with an extraventricular drain after a motor vehicle collision Assessment/

Results: At follow up, the patient demonstrated no significant clinical or radiologic worsening of her heterotopic ossification

Discussion: Heterotopic ossification(HO), or the formation of mature lamellar bone in soft tissue, is a common complication post traumatic brain injury. Risk factors include immobility, spasticity, fractures, pressure ulcers, or edema. It can compress vasculature, nerves, and other surrounding structures and cause local swelling, pain, or decreased range of motion. Traditionally, diagnosis of early HO is limited to serum alkaline phosphatase or bone scan while radiographs are more sensitive for late HO. This case represents an instance where ultrasound can be beneficial in detecting early HO.

Conclusion: As a noninvasive, quick, and inexpensive modality especially in the early detection of heterotopic ossification, ultrasound has advantages over other diagnostic modalities and can help prevent complications of HO while minimizing symptom burden.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-as-a-diagnostic-modality-in-detecting-early-heterotopic-ossification-a-case-report/