Authors' Note:
(HET-uhr-oh-top-ic, as here, or het-uhr-oh-TOP-ic)
Usually asymptomatic, new bone formation in extra-skeletal sites seems to occur after physical or surgical trauma, particularly in the lower limbs following joint replacement. Occasionally, within several weeks after the inciting episode, tenderness and swelling near major joints may occur, needing to be differentiated from venous blockage, and requiring bone scanning for detection, as initial radiographs may be negative; this variant syndrome is known as myositis ossificans. Rarely, in progressive cases, surgery is eventually required to allow mobility at affected joints.
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