A patient sustained a severe TBI 3 months ago. During the exam of passive ROM, the therapist notices decreased passive knee extension and moderate hamstring spasticity. Palpation reveals a firm mass on the lateral aspect of the joint. The therapist should refer the patient to a physician for a review of probable:

A patient sustained a severe TBI 3 months ago. During the exam of passive ROM, the therapist notices decreased passive knee extension and moderate hamstring spasticity. Palpation reveals a firm mass on the lateral aspect of the joint. The therapist should refer the patient to a physician for a review of probable:

• A. Osteogenic sarcoma
• B. Patellar fracture
• C. Osteomyelitis
• D. Heterotopic ossification

Answer: (D)

Heterotopic ossification around a joint after a CNS injury. After severe brain injury, bone can form in soft tissues near joints, leading to a periarticular, firm mass and progressively reduced range of motion, even months after the insult. The combination of a palpable firm mass on the lateral knee and decreased passive knee extension with hamstring spasticity fits this pattern, signaling HO and necessitating medical evaluation (often with imaging) to confirm and guide management. Osteogenic sarcoma would usually present as a painful, enlarging bone lesion with systemic symptoms and is not typically linked to a CNS injury or a localized, periarticular mass that acutely restricts joint ROM. A patellar fracture would present with acute pain and deformity, not a delayed, mass-related ROM loss three months post-injury. Osteomyelitis would show infection signs such as fever, warmth, and systemic symptoms, which are not described here.

Heterotopic ossification around a joint after a CNS injury. After severe brain injury, bone can form in soft tissues near joints, leading to a periarticular, firm mass and progressively reduced range of motion, even months after the insult. The combination of a palpable firm mass on the lateral knee and decreased passive knee extension with hamstring spasticity fits this pattern, signaling HO and necessitating medical evaluation (often with imaging) to confirm and guide management.

Osteogenic sarcoma would usually present as a painful, enlarging bone lesion with systemic symptoms and is not typically linked to a CNS injury or a localized, periarticular mass that acutely restricts joint ROM. A patellar fracture would present with acute pain and deformity, not a delayed, mass-related ROM loss three months post-injury. Osteomyelitis would show infection signs such as fever, warmth, and systemic symptoms, which are not described here.