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Final Program


Final Program

1630 - Myositis ossificans of obturator internus causes neurogenic bladder: A rare complication of a rare condition

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: Neurogenic bladder secondary to myositis ossificans of obturator internus.

Case Description: A previously independent 47-year-old man was found unresponsive in his vehicle with a gunshot wound to the head involving the left vertex with bilateral parietal multifocal hemorrhagic contusions with edema. Once medically stabilized, he was admitted to inpatient rehabilitation for comprehensive neurorehabilitation. Physical examination demonstrated absent right upper and bilateral lower extremity strength with spastic tone in bilateral hip adductors and hamstrings and bilateral ankle clonus. Shortly after admission, he retained urine with high-volume catheterizations. Repeat physical examination showed abdominal distension and diffuse tympany. Computed tomography revealed external compression of prostate and rectum and an incidental asymmetric, heterogeneous thickening of left obturator internus. At three weeks post-injury, he developed left hip pain provoked with hip movements and worsening lower extremity clonus. Repeat imaging showed new areas of linear mineralization within bilateral obturator internus muscles, and myositis ossificans was diagnosed. He received indomethacin and eventually recovered some bladder function.

Discussions: Neurogenic bladder is a condition frequently encountered in rehabilitation, especially for patients following neurotrauma. The brain-bladder axis, responsible for maintaining urinary continence, is disrupted after brain injury, leading to dysregulation of urinary function. Another common finding in neurotrauma is myositis ossificans, a rare clinical condition caused by initial inflammation and subsequent calcium deposition into soft tissue. Most cases are diagnosed after traumatic injury and typically develop in the large muscle groups of the extremities. However, variations in ossification sites can occur and lead to significant functional deficits. While neurogenic bladder often explains urinary retention in rehabilitation settings, this case illustrates an alternative, treatable cause of bladder dysfunction.

Conclusions: This case reflects the importance of myositis ossificans as a differential diagnosis for neurogenic bladder and urinary outlet dysfunction in patients with traumatic injuries.