200 Section - Extracorporeal Shock Wave Therapy in Heterotopic Ossification Post Covid-19

Diagnosing heterotopic ossification (HO) relies on clinical suspicion in patients with relevant risk factors and is confirmed by imaging. It presents with progressive edema, pain, joint mobility loss, functional decline, and even neuropathic symptoms. HO most commonly develops after surgery, trauma, prolonged immobilization, neurological injury, or genetic conditions. Imaging is essential to identify abnormal lamellar bone formation within soft tissues. 

Case Description:

A 48 year old man was hospitalized with COVID-19 and developed severe respiratory failure requiring ICU care, orotracheal intubation, tracheostomy, 100 days of mechanical ventilation, and multiple other complications. After 122 days, he was discharged but experienced progressive pain, functional deterioration, distal hypoesthesia, and disproportionate tetraparesis, becoming wheelchair-dependent. Imaging revealed bilateral HO forming bony bridges between the acetabulum and femur. From 2024 to 2025, he underwent 15 sessions of focal extracorporeal shockwave therapy (ESWT), combined with physiotherapy. Treatment resulted in recovery of distal sensation, >70% pain reduction, decreased analgesic reliance, improved hip and ankle mobility, strength gains, enhanced trunk control, increased independence in transfers and self-care, and the ability to take steps, though not full ambulation.

Discussions:

To our knowledge, this is the first reported use of ESWT for HO following COVID-19. Existing treatments often provide mild benefits and may involve procedural risks, underscoring the relevance of noninvasive options. ESWT is a well tolerated, low risk modality. In this case, it was associated with reduced pain and improved joint mobility and function. Proposed mechanisms include modulation of local inflammation, decreased nociceptive neurotransmitter release, stimulation of angiogenic pathways, and tissue remodeling. However, improvements cannot be attributed solely to ESWT due to concurrent rehabilitation and lack of post-treatment imaging.

Conclusions:

ESWT may offer clinical benefits in HO without the risks associated with invasive procedures; its physiological mechanisms support a plausible therapeutic role. Further studies are essential to confirm efficacy and treatment parameters.