Ossifying myositis

Myositis is an inflammatory process that affects the muscles of the skeleton. Ossifying myositis is characterized by partial ossification of the muscles. The development of the disease contribute to injuries, sprains, fractures. There are cases when ossifying myositis is a congenital disease.

Causes and forms

The disease manifests itself in the form of limb deformity, which causes severe pain and reduces human activity. At the beginning of the disease, the patient has swelling and redness of the skin, the phenomenon is accompanied by painful sensations. At the next stage, the seal in the muscle tissue occurs. On examination, the doctor identifies hard areas that do not differ in sensation from the bone. These are warped areas.

Ossificatory myositis develops mainly in the muscles of the shoulder and thigh. In the event of a lesion of the shoulder joint, there is a gradual immobilization.

Pathology of the hip muscle causes deformity of the knee joint.

Ossifying myositis is divided into several forms, depending on which doctor prescribes treatment. So, the name and characteristics of each form:

  1. Traumatic is the fastest growing form that is difficult to diagnose. When taking a sample of an inflamed area, a specialist may make an erroneous diagnosis of sarcoma. It is important to correctly and promptly identify the disease, since a neglected state can cause serious complications.
  2. Trophanevrotic - characterized by damage to the nerve trunks. The disease leads to deformity of the knee and hip joint.
  3. Progressive - diagnosed mainly in the first year of life. May develop during the intrauterine state. Progressive ossifying myositis causes muscle damage, partial immobilization and curvature of the posture.

Myositis is able to develop against the background of toxic damage to the body - alcoholism and drug addiction. Also, the disease occurs after taking certain medications that cause local muscle damage. However, doctors do not name the exact causes of the disease, because it can develop over several weeks or years.

Concomitant diseases of ossifying myositis are osteomelitis, erysipelas of the skin, stones in the bladder. Doctors note the development of myositis in patients with viral diseases and infections. Mild disease is provoked by hypothermia, injury, exercise. It is curious that musicians, drivers and people with sedentary occupations are most susceptible to the development of myositis. This is due to the fact that during the work it is necessary to be in one position for quite a long time.

Symptoms of myositis

The disease develops on the increasing line. The most susceptible to the disease of men under the age of 40 years. In many cases, the causes of myositis are injuries and other types of damage. As mentioned above, the disease affects the hips, shoulders, buttocks and other limbs.

The main symptoms of myositis can be divided into the following groups:

  • first of all, the patient notices a slight swelling in the damaged area,
  • after a certain time the affected tissues are compacted. It is at this stage that the disease is amenable to detection and examination.
  • muscles lose their elasticity and become limp.

Depending on the nature and extent of the lesion, the doctor prescribes the treatment of myositis. For example, in case of damage to blood vessels, a rapidly developing picture will be observed. After a couple of weeks, a person may notice swelling and redness in the damaged area. With this course of the disease, urgent surgical intervention is necessary, otherwise the disease will give serious complications.

Traumatic myositis

Ossificatory traumatic myositis occurs as a residual phenomenon from injuries suffered. It is characterized by partial ossification of muscle tissue. Basically, the disease of this form are subject to athletes, because their profession is traumatic.

Ossification of the thigh muscles is most often diagnosed in football players due to injuries received (bruises, sprains). Summarizing, you can make a list of symptoms:

  1. Painful sensations 2-3 weeks after the injury. In addition, there is swelling and redness, and after a couple of days the appearance of seals is possible. After a couple of months, the seal ossifies. The reason for immobilizing the patient is that the new bone is located close to the joint.
  2. To identify the disease is used differential diagnosis. This method is necessary to accurately diagnose and begin an effective treatment.
  3. Gypsum must be applied to the damaged area to prevent the ossification from progressing. In case of refusal of such a measure, ossification of the damaged area is possible in a couple of months. Treatment will then have to be carried out with the help of surgical intervention.

Progressive myositis

Most often diagnosed in newborns, because it is hereditary. The disease affects the locomotor system, which causes disability. Subjects to this form of the disease are mostly men. Symptomatology is represented by pain and gradual ossification of the muscles. Ossifying myositis of this type causes complete immobilization of the patient.

Unfortunately, the treatment of progressive myositis is ineffective. Doctors can only give advice in order to slow the progression of the disease. First of all, a person must maintain a certain diet with a sufficient level of calcium. The surgical path does not help to solve the problem, it can only aggravate the disease and lead to an even worse condition, cause the growth of new ossification.

In the case when the disease has no complications, various supporting vitamins and biostimulants are used for treatment. When complications prescribed hormones and steroids. In case of progressive myositis, injections should be refused, since they can cause ossification.

Damage to the thigh muscles

Myositis, by its nature, causes a loss of muscle plasticity. In this case, the disease can develop several months. Contribute to her dislocations, bruises, and other injuries. Ossifying thigh myositis is of three types:

  • connection of ossification with the femur,
  • contact of ossification with the femur,
  • broad base of ossification.

Usually, the disease is not diagnosed immediately, but after a few weeks. The examination is performed using fluoroscopy, which can show the degree of deformation. Redness, swelling and redness of the skin can be the reason for seeking medical attention.

If the disease is detected at an early stage, then you need to resort to a conservative method, physiotherapy.

Treatment methods

To diagnose the disease, you need to contact the therapist. He will appoint the patient a consultation with a neurologist and a rheumatologist and fluoroscopy. Based on the results of the examination, the degree of the disease is established. In the early stages, physiotherapy methods are used for the treatment: electrophoresis and ultrasound. This will help to numb the affected area and promote the resorption of the formations.

For successful treatment, the patient needs rest and rest. Nervous experiences and physical activity are contraindicated. In conjunction with the procedures, you must also follow a special diet, which includes vitamins, cereals and fruits. Under strict prohibition is the use of alcohol, fried and salty foods.

Depending on the reasons for the development of myositis, produce drugs of various kinds. When bacterial manifestations prescribed antibiotics. Purulent inflammations are treated only surgically with subsequent rehabilitation.

Ossificiruyuschii myositis may cure drug only at an early stage. For later development, surgery is indicated.

Prevent the occurrence of the disease by using nutrition, maintaining an active lifestyle and reducing injuries.

Causes of ossifying myositis

The causes of ossifying myositis are rooted in the pathological physiological processes of the denervation of muscle fibers. The disease can develop due to exposure to various kinds of toxic substances. Toxic myositis occurs when alcoholism and drug addiction. Taking certain medications can also cause an unstable muscle damage. But the exact pathogenesis of the disease is not known. Ossifikaty can be formed within several weeks, and even years.

Very often, the disease occurs against the background of osteomyelitis, erysipelas of the skin, cystitis with stones in the bladder. Various viral diseases, bacterial and fungal infections, also provoke myositis. Myositis of moderate and mild severity occurs after various injuries, hypothermia, muscle cramps, intense physical exertion. The risk of development of myositis occurs in people of a certain profession - musicians, drivers, PC operators. Long loads on certain muscle groups and uncomfortable body position provoke pathology.

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Symptoms of ossifying myositis

Symptoms of ossifying myositis are progressive. Often the disease occurs in young men and in 50% of cases due to injuries and mechanical damage. Foci of inflammation are localized in skeletal muscles, an advantage in its deep sections. Less commonly, the inflammatory process begins near the periosteum. As a rule, ossifying myositis affects the hips, buttocks, upper and lower limbs, and shoulder region.

Consider the main symptoms that occur as the disease progresses:

  • A mild swelling occurs on the affected surface, which, on palpation, resembles dough in consistency.
  • After a time, the affected tissues begin to thicken due to ossification. As a rule, during this period, the disease is detected and treatment begins.
  • The ossification unit is surrounded by muscle masses, which, due to degenerative processes, have become similar to jelly. The proliferation of fibrous tissue and the replacement of the knot by bone-shaped, pierced with fibrous tissue and cysts is possible.

The clinical picture of the disease depends entirely on the nature of the damage that caused myositis. If the vessels are damaged and the injury is serious, then the symptoms are progressive. Within a month, swelling and tenderness appear on the injured limb, which indicate an inflammatory process. In this case, the patient is waiting for surgical intervention in the first months after the detection of pathology. If ossifying miositis appears on the background of secondary microtraumas, then the illness is asymptomatic, the only complaint of the patient is a slight swelling in the lesion.

Initiating traumatic myositis

Ossificatory traumatic myositis is the extra-skeletal ossification of muscle tissue after injuries. The illness occurs due to acute and chronic injuries, that is, as a result of sprains, bruises, sprains, fractures, often recurring minor trauma (in athletes and people of certain professions).

The shoulder muscles (due to the posterior dislocation of the forearm), as well as the adductor and quadriceps muscles of the thigh, the gluteus maximus muscle, are subject to ossification. This pathology often appears in football players on the outer surface of the thigh due to bruises. Less commonly, an ossifying traumatic myositis is formed in the shoulder girdle, the muscles of the leg and forearm. Regular reduction of dislocations, traumatic operations and a number of other causes contribute to the development of ossifying myositis.

  • The first symptoms appear 2-3 weeks after the injury. In the area of ​​the damaged muscle, pain, swelling and noticeably increasing compaction are increasing. After 1-2 months, the seal turns into bone and the pain subsides. Since the newly formed bone is located near the joint, it limits movement in it. In some cases, the ossification of the muscles occurs simultaneously with the ossification of other tissues, which can cause ankylosis.
  • Detection of the traumatic form of the disease is a differentiated diagnosis. The pathology of muscle tissue must be separated from the possible ossification of the joint capsule and ligaments, hematomas, pathologies of non-traumatic origin, fibroids, synovi and other diseases.
  • The treatment of any injuries begins with the immobilization of the injured limb and the imposition of a plaster cast for 10 days. This is necessary in order to prevent the development of ossifying myositis. If this is not done, then 1-3 months after the injury, the ossification will begin and conservative treatment will not help. In this case, the patient is waiting for surgery, and complete removal of the resulting bone with the capsule. The prognosis of the traumatic form of myositis is favorable, since the ailment does not cause irreversible disturbances in the movement of the joints.

Progressive ossifying myositis

Progressive ossifying miositis is a hereditary disease, that is, congenital. The disease is characterized by a long progressive course, which entails violations in the work of the musculoskeletal system and can lead to disability of patients even of childhood.

Munchmeyer syndrome or progressive ossifying myositis is most often diagnosed in male patients. Symptoms of the disease can occur immediately after birth or at an early age, causing a gradual ossification of muscle tissue. On palpation of damaged areas, tissue density is felt, but no painful sensations occur. Myositis leads to an unnatural position of the body, restricts the movement of the joints or completely immobilizes them.

  • Treatment does not bring the proper effectiveness. But there are a number of recommendations that do not allow the disease to progress. Patients need to follow a special diet with a minimum of calcium in the food. As for surgical intervention, many doctors consider this to be meaningless, and in some cases even dangerous, since the operation can provoke the growth of ossification.
  • If the disease has an uncomplicated course, anti-inflammatory and desensitizing agents, various biostimulants and vitamins are used for treatment. With a complicated form of myositis, therapy is carried out with hormonal preparations and steroids. A number of important treatment rules are the rejection of any intramuscular injections, as they may become new foci of ossification.

Ossifying thigh myositis

Ossifying myositis of the hip is a pathological process that causes a loss of muscle elasticity. The disease has a long progressive course, that is, ossificats are formed within a few months and may not be felt. Various injuries, dislocations and sprains cause damage to muscle fibers and myositis. To date, there are three forms of ossifying thigh myositis:

  • Ossifikat connected to the presenting bone of the thigh with a jumper.
  • Periosteal form - ossicate in contact with the femur.
  • Ossifikat has a broad base, and part of the ectopic bone protrudes into the thickness of the quadriceps muscle.

Most often, the extent of the lesion is limited to the middle third of the thigh, but can extend to the proximal third. Diagnose diseases in a couple of weeks, or even a month after the trauma. The patient complains of swelling, which becomes painful, and the skin above it is hot to the touch. For the diagnosis using x-ray examination, which shows the degree of deformation of muscle tissue and bones of the thigh.

If the disease is detected at an early stage, the treatment is the immobilization of the joint and conservative therapy. But even with complex forms of ossifying thigh myositis, surgical treatment is not carried out. All therapy is reduced to taking medications and physiotherapy.

Diagnosis of ossifying myositis

Diagnosis of ossifying myositis is based on the typical clinical picture of the disease. The patient complains of dull aching pains, muscular weakness and discomfort during attempts to palpation of the affected area. Very often, when probing, it is possible to determine the presence of nodules and cords in the muscles. In addition, characteristic changes in the general blood test indicate the presence of myositis.

The examination process begins with a survey and examination, the results of which the doctor prescribes further laboratory and instrumental examinations. Consider the main stages of diagnosis of ossifying myositis:

  1. Medical history and examination

The doctor asks the patient about the onset of the disease, past injuries and other pathologies of the body. After that, the patient is waiting for inspection. The doctor visualizes a potential lesion, examines the skin. If myositis progresses a long time ago, then it causes muscle atrophy, and the skin over this area has a scanty network of blood vessels, that is, pale. The affected muscle is probed to assess the tone and identify painful points. Ossifying miositis is characterized by progressive muscle weakness, so the pain is moderate on palpation, but the muscles are dense.

X-ray picture of ossifying myositis has a certain appearance. So, in the area of ​​damaged muscle tissues, shadows of irregular shape are visible, which follow the growth of muscle fibers, can merge with bones, or go isolated from them. It is this sign indicates the presence of myositis and ossification.

Revm tests are tests that are needed to differentiate between local and systemic rheumatic diseases. Revm tests are necessary to determine the etiology of the disease and exclude autoimmune diseases. In addition, this study allows to establish the intensity of the inflammatory process. Revm tests consist of indicators such as: •

C-reactive protein - an increased concentration of this substance indicates an inflammatory process in the body. This is a kind of marker of the acute phase of inflammation, it is detected during exacerbation of chronic myositis and infectious forms of the disease. This indicator is used not only for differential diagnosis, but evaluates the effectiveness of treatment.

  • Antistreptolysin-O is an antibody that is produced when there is a streptococcal infection in the body. Allows you to identify rheumatism and rheumatoid arthritis.
  • Rheumatic factor - elevated values ​​of these antibodies indicate autoimmune pathologies, rheumatoid seropositive arthritis, or dermatomyosis. The analysis is carried out before treatment and after primary therapy.
  • Myositis-specific autoantibodies are markers for the detection of dermatomyositis, polymyositis and myositis with inclusions. The most common antibodies are: Anti Jo-1 - in 90% of patients with myositis, Anti-Mi-2 - in 95% of patients with dermatomyositis, and Anti-SRP - in 4% of patients with myositis.
  1. Morphological study

This type of diagnosis is a biopsy. That is, taking a biopsy for careful examination. The main objective of the study is to identify structural degenerative changes in the muscle and connective tissues surrounding the vessels. The main indications for biopsy are: infectious myositis, polyfibromiositoses and polymyositis.

But, as a rule, of all the diagnostic methods described above, radiography, computed tomography and radioisotope examination of the affected muscle tissue are used to detect ossifying myositis.

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What it is?

The whole spectrum of diseases, based on the inflammatory process that occurs in the muscles, is related to myositis. A key symptom indicating the possible occurrence of a disease in the body is muscle pain, aggravated by movement or palpation.

The causes of the disease are conventionally classified into two groups:

  • endogenous - which occur inside the body,
  • exogenous - causes outside.

To endogenous include:

  • autoimmune diseases such as lupus erythematosus, rheumatoid arthritis, etc.,
  • infections of different nature - enterovirus, typhoid, influenza,
  • diseases caused by activity in the human body of parasites (echinococcosis, trichinosis),
  • intoxication of the body.

Exogenous causes are injuries, hypothermia, periodic muscle tension caused by any activity. Myositis is considered an occupational disease of musicians, athletes.

According to the origin of the disease, the nature of its course and other signs of myositis are classified into infectious, purulent and parasitic categories. Also known toxic and traumatic varieties. Polymyositis (ossifying myositis) is a pathology with the most severe course and ambiguous consequences. This disorder is a disease of the connective tissue and, in turn, is classified into:

  • traumatic ossifying myositis,
  • progressive ossifying myositis,
  • neuromyositis.

Traumatic ossifying myositis (the symptoms of the disease will be discussed later) is an inflammatory disease that occurs against the background of severe trauma or repeated repeated microtraumas. Pathology is localized in the articular ligaments and subsequently leads to the occurrence of ossification in the problem area. Successfully treated surgically.

Progressive ossifying miositis (we will describe the symptoms of the disease below) is a genetic disease caused by a mutation of a particular gene, leading to severe disturbances in the body and, as a result, to death of a person. It is considered very rare (no more than 200 cases known to world medical practice).

Neurotrophic myositis occurs on the background of injuries of large nerve trunks or the spinal cord. Most often, the pathology develops in the knee or hip joint.

Neuromyositis

As noted earlier, it infects intramuscular nerve fibers. It happens as follows. The inflammatory process leads to the destruction of muscle cells, resulting in the release of various kinds of substances that have a toxic effect on nerve fibers. The nerve sheath is gradually destroyed, which leads to the defeat of the axial nerve cylinder.

Signs of neuromyositis are:

  • decrease or increase of sensitivity in the area of ​​localization of pathology,
  • pain sensations
  • weakness in muscles
  • joint pain.

The destruction of the sheath of nerve fibers causes a change in skin sensitivity. This can be manifested by numbness or tingling, which are accompanied by progressive pain. At first, the pain syndrome is moderate, but it increases even with minor loads. Pain causes breathing, turning or tilting of the body, movement of the limbs. Later, she makes herself felt even at rest. Often, when a pathology occurs, a symptom of tension occurs when palpation of muscles in a stressed state becomes very sensitive.

Progressive form of the disease

The second type of polymyositis due to genetic disorders is progressive ossifying myositis. Symptoms of pathology is almost impossible to eliminate, because it is considered incurable. With progressive ossifying myositis, the muscles, tendons and ligaments ossify. The disease occurs almost spontaneously and over time covers a large group of muscles. Fatal outcome is inevitable, since the ossification of the pectoral and swallowing muscles prevents a person from eating and breathing. Progressive ossifying miositis has another name - ossifying progressive fibrodysplasia (FOP).

Only in 2006, thanks to research conducted by a group of scientists from the University of Pennsylvania, a gene was identified, the mutation of which leads to severe pathology. Today, experts are developing blockers of mutations in the gene.

Symptoms of FOP

As mentioned above, FOP occurs in childhood. The possible formation of the disease in a baby can be indicated by several signs, which appear mostly in the case of ossifying myositis. What are the most obvious symptoms of the disease?

It is possible to diagnose pathology in a child with a 95% chance if one or several phalanges of the big toe are twisted inwards. In some cases, the finger is missing a joint. Most often, progressive miositis affects boys. Symptom disease in early infancy is painful palpation of the muscles, while they are quite dense, tense.

Another sign of pathology is swelling of the soft tissues of the head, which could occur with minor bruises or scratches, insect bites. However, in the presence of FOP, the edema does not respond to drug therapy and does not pass in a period of up to a month. Seals up to ten centimeters in size can also occur under the skin in the back, forearm, or neck.

Initially, the FOP affects the muscles of the neck, back, head, and later falls into the abdominal and femoral parts of the muscles. However, the ailment never affects the muscle tissue of the heart, the diaphragm, the tongue, and eye muscles.

The disease is often confused with oncology and they try to remove the hardening that has arisen, which does not lead to recovery, but provokes the rapid growth of "unnecessary" bones.

Unfortunately, today, progressive ossifying myositis is almost impossible to eliminate, and the therapy used is ineffective. There are no proven methods of preventing FOP. With the discovery of the mutated gene, it became possible only to study the processes of the disease. Methods of treatment are developed in the laboratory and are not used in medical practice. In addition, possible experimental therapies should be seriously assessed in terms of dosage and duration of treatment.

Specialists who deal specifically with ossifying miositis work in the United States, at McKay's Laboratory at the Pennsylvania Federal University. The scientific work is led by Dr. Frederik Kaplan.

In the initial stages of the disease, therapy includes anti-inflammatory drugs, ascorbic acid, vitamins A and B, biostimulants. In severe cases of pathology, steroid hormones are used, although their effectiveness has not been proven either.

Some improvements result in physiotherapy - ultrasound, electrophoresis. These procedures give absorbing and analgesic effect. You should adhere to the minimum intake of calcium-containing foods, avoid any intramuscular injections. Surgical intervention and removal of bone formations is meaningless.

Traumatic ossifying myositis

Localized traumatic ossifying myositis is a disease that leads to bone formation as a result of acute injuries - sprains, fractures, sprains, or due to recurring minor injuries, for example, in athletes or musicians.

The basis of the pathology is hemorrhage into the muscle tissue. Most often, ossificats are formed in the gluteal, femoral, and shoulder muscles. Some time after the injury, the first symptoms of pathology appear. A thickening is formed in the muscle, which quickly grows and is painful on palpation. After a few weeks, compaction is transformed into an indefinite form of ossification, which limits the mobility of the nearby joint. Then the pain smoothly disappears. Disease prone to young people, most of them are men with developed muscles.

Only after an x-ray is performed, the diagnosis of traumatic ossifying myositis is reliably made. Photo X-ray image above. The result of the X-ray shows that in the area of ​​the lesion there is a kind of light "cloud", which has no clear boundaries. The ossificates that appear in pathology initially do not have a definite form, but later acquire a structure and clear contours.

Survey process

In addition to the history and examination, an x-ray is performed to confirm the diagnosis, which makes it possible to detect ossification. Sometimes computed tomography and radioisotope examination of the affected muscles can be performed.

Characteristic changes in the general blood test indicate the presence of myositis in the body. Another method of laboratory research is to conduct tests, which help determine the nature of the disease and exclude autoimmune diseases, as well as identify the intensity of the inflammatory process.

Rheumatic tests indicate various states of the body. For example, C-reactive protein is a marker of the acute phase of the inflammatory process. Antistreptolysin-O is a substance that is produced in the body during streptococcal infection. Its presence indicates rheumatism or rheumatoid arthritis. Rheumatic factor is antibodies that are produced in the body during autoimmune pathologies.

A morphological study in the diagnosis of myositis is a biopsy - taking a biomaterial for analysis and careful study of it. The main task is to determine the structural changes in the muscles and connective tissue.

Prevention

Prevention of ossifying miositis includes several principles, the main of which is adherence to a correct lifestyle - activity without excessive physical exertion, a balanced diet and timely treatment of any diseases.

Good nutrition helps to avoid inflammatory processes in the muscles - useful fatty polyunsaturated acids in fish, foods high in salicylates (vegetables), easily digestible proteins (almonds, chicken), foods that contain large amounts of calcium, cereals.

Drinking regimen is very important, in which about two liters of water should be consumed per day. You should not neglect fruit drinks and fruit drinks, green tea is also useful. To eliminate puffiness it is recommended to take broth hips. For the prevention of myositis it is useful to spend time in the fresh air. Many patients are often worried about this question: is it possible to do exercises with ossifying myositis? You can, but the load should be light and metered. In addition to gymnastics with this disease, hardening, swimming and cycling are recommended.

Prevention of myositis also includes a constant movement, it is important to prevent physical inactivity and hypothermia of the body. Of course, the best prevention of pathology will be the absence of any injuries.

Treatment of ossifying myositis

Treatment of ossifying myositis is directly related to the etiology of the disease:

Treatment of traumatic ossifying traumatic myositis. There is strong evidence that this type of myositis does not respond to conservative therapy.In this regard, doctors recommend sticking to a waiting position. You should wait until the end of the ossification process and determine whether the formation affects the patient's quality of life. If the answer is positive, then it is necessary to remove it surgically.

Indications for surgery are:

Clamping of large nerves or vessels.

Disruption of the functioning of the joints in close proximity.

Chronic muscle trauma.

As a rule, after removal of ossification, there is no recurrence of the disease.

Treatment of progressive ossifying myositis. With this type of myositis, surgical intervention is a direct contraindication, as it threatens with an even greater growth of ossification.

For the therapy of progressive ossifying myositis, ethylenediaminetetraacetic acid is administered intravenously, using biophosphates, potassium iodide, vitamins A, C, B, as well as biostimulants. Intramuscular injections are undesirable because they contribute to the formation of new foci.

From physiotherapy methods using electrophoresis with potassium-iodine, ultrasound, iodine-bromine baths, the implementation of complex exercise therapy.

The prognosis for recovery is unfavorable, the life expectancy of such patients varies. Death occurs due to pulmonary infiltration, or due to exhaustion due to ossification of swallowing and masticatory muscles.

Treatment of trophurological ossifying myositis. Therapy for this form of myositis is closely intertwined with the therapy of nervous disorders. If the quality of life of the patient as a result of the formation of ossification is impaired, then they must be removed surgically. Indications for surgery are similar to those for traumatic myositis. The prognosis for life is favorable.

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical and sanitary unit No. 21, the city of Elektrostal. Since 2016 he has been working in the diagnostic center №3.

Watch the video: Myositis Ossificans - Everything You Need To Know - Dr. Nabil Ebraheim (December 2019).

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