意識障害後に肩肘関節強直をきたした 1 例

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Heterotopic ossification of the shoulder and the elbow joints simultaneously following coma is a significantly rare occurrence. A 36-year-old female, presented a stiffness of the shoulder and elbow joints after coma for a month. The range of motion of the shoulder joint was limited and all of the motion occurred at the scapulothoracic articulation. The elbow joint was ankylosis at 45 degree flexion. Radiographs and computed tomography demonstrated that heterotopic ossification was present. In the shoulder joint, a mature boney bridge between the humerus and scapula was observed. In the elbow joint, a mature boney bridge between the humerus and ulna was also observed. A bone scintigraphy revealed increased uptake in the part with the ossification. 16 months after the onset, excision of the heterotopic ossification of the shoulder and the elbow joints was performed with a one month interval between them. The ossification showed a mature bone in pathology. The patient underwent physical therapy from postoperative dayl and was given a diphosphonate to prevent a recurrence. The range of motion improved markedly after surgery and there has been no evidence of recurrence of the heterotopic ossification up until now.