Forceful Joint Manipulation in Head-injured Adults with Heterotopic Ossification

Twenty-eight joints with heterotopic ossification in 16 head-injured adults were forcefully manipulated 39 times under general anesthesia. The etiology of the heterotopic bone was trauma in seven joints and idiopathic (neurogenic) in 21. Indications for manipulation were inability to participate in therapy due to a lowered pain threshold, uncontrolled spasticity, voluntary muscle guarding or early bony ankylosis. An increase in motion was achieved under anesthesia in 23 joints (82%). Eighteen joints (64%) maintained or gained further motion with rehabilitation. Repeated manipulations were indicated if the patient evidenced neurological improvement. Five of 11 hips were manipulated once, five twice, and one hip three times. Seven hips (63%) gained an average of 52 degrees. Seven of 13 elbows were manipulated once and six twice. Eight elbows (62%) gained an average of 47 degrees. Four shoulders were manipulated, and three of the four increased in degree of external rotation. No exacerbation of the heterotopic process was detected. No fractures of long bones occurred.