title: Heterotopic ossification of the shoulder after central nervous system lesion: indications for surgery and results.
abstract: BACKGROUND
  Heterotopic ossification (HO) of the shoulder after central nervous system damage has seldom been studied.
  
  
  METHODS
  We performed a single-center retrospective study from 1993 to 2009 including patients who underwent surgery for troublesome shoulder HO. Demographic data, HO location, surgical approach, preoperative and postoperative shoulder range of motion, etiologies, and postoperative complications were collected from patients' files.
  
  
  RESULTS
  We found 19 shoulder HOs in 16 patients (traumatic brain injury in 11, spinal cord injury in 2, stroke in 1, and cerebral anoxia in 2). The data in 2 files were incomplete and were therefore not used. HO locations around the joint were anteroinferomedial in 4 (21.1%), posteroinferomedial in 5 (26.3%), encircling in 3 (15.8%), superior in 1 (5.3%), and mixed (2 associated HOs that are not encircling) in 6 (31.6%). The surgical approaches were as follows: deltopectoral, 5 (26.3%); Neer, 3 (15.8%); posterior, 5 (26.3%); axillary, 1 (5.3%); Martini, 2 (10.5%); posterior associated with deltopectoral, 2 (10.5%); and Neer (superolateral) associated with deltopectoral, 1 (5.3%). The mean range of motion increased significantly (gain at follow-up of 69°, 60°, and 13° in forward elevation, abduction, and lateral rotation, respectively). Regarding postoperative complications, there was 1 case of capsulitis and 1 reoperation for insufficient excision (because of hemorrhage during surgery). There were no other side effects.
  
  
  CONCLUSIONS
  Anatomic relations with nerves and vessels, as well as limited range of motion, require a case-by-case surgical approach, a preoperative scan (looking for a gutter), and sometimes, electromyography. Surgical indications depend on the degree of loss of function or hygiene, control of comorbid factors, and discussion with the patient and his or her family.
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologique, Hôpital Raymond Poincaré, Garches, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Pansard
authors.forename: Alexis
authors.initials: A
authors.lastname: Schnitzler
authors.forename: Christine
authors.initials: C
authors.lastname: Lautridou
authors.forename: Thierry
authors.initials: T
authors.lastname: Judet
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
authors.forename: François
authors.initials: F
authors.lastname: Genêt
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla / Q000294:innervation*; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging; D019637:Orthopedic Procedures; D009999:Ossification, Heterotopic; D011182:Postoperative Care; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012782:Shoulder / Q000473:pathology*; D012785:Shoulder Joint / Q000473:pathology; D013119:Spinal Cord Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult