Extracorporeal Shock Wave Therapy for Painful Chronic Neurogenic Heterotopic Ossification After Traumatic Brain Injury: A Case Report

Ann Rehabil Med, 2015 · DOI: 10.5535/arm.2015.39.2.318 · Published: April 1, 2015

Neurology Pain Management Rehabilitation

Simple Explanation

Neurogenic heterotopic ossification (NHO) is a process of benign bone formation and growth in soft tissues surrounding major synovial joints and is associated with central nervous system (CNS) injuries. The patient, who experienced a traumatic brain injury and painful chronic NHO around the left hip joint, received three applications of extracorporeal shock wave therapy (ESWT). ESWT resulted in pain relief and an improvement in the loss of motion in the left hip joint, as well as improvements in walking performance and activities of daily living.

Study Duration

12 weeks

Participants

One 72-year-old male

Evidence Level

Level IV, Case Report

Key Findings

1
ESWT resulted in pain relief, as measured by a decrease in VAS scores from 8-10 to 3, which was maintained throughout the 12-week follow-up period.
2
The patient experienced improved hip joint flexion, increasing from 30° before ESWT to 80° at the 4 and 12 week follow-ups.
3
Walking distance increased from 72m to 203m after ESWT, and sitting tolerance in a wheelchair improved from 10 minutes to 120 minutes.

Research Summary

This case report describes the use of extracorporeal shock wave therapy (ESWT) to treat a 72-year-old male with painful chronic neurogenic heterotopic ossification (NHO) following a traumatic brain injury (TBI). Three applications of ESWT led to significant improvements in pain, range of motion, walking performance, and activities of daily living, with therapeutic effects lasting for 12 weeks. The authors conclude that ESWT may be an effective, safe, and easy-to-use treatment for chronic painful NHO after TBI.

Practical Implications

Pain Management

ESWT can be considered as a non-invasive option for managing chronic pain associated with NHO following TBI.

Improved Mobility

ESWT may improve joint range of motion and walking performance in patients with NHO, facilitating rehabilitation.

Enhanced Quality of Life

By reducing pain and improving physical function, ESWT can potentially enhance the quality of life for individuals with NHO.

Study Limitations

1
The study is limited to a single case report, which restricts the generalizability of the findings.
2
An electrodiagnostic study was not performed to confirm nerve injuries around the area of NHO.
3
Power Doppler sonography was not performed and thus it was not possible to quantify the neovascularization.

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