Objective: To evaluate the possible risk factors of heterotopic ossification (HO) in traumatic brain injury (TBI) patients. Methods: A total of 151 patients with TBI were included. Demographical variables, laboratory investigations and risk factors for HO including spasticity, walking ability (using Functional Ambulation Category (FAC)), pressure ulcer, neurogenic bladder and systemic infection were recorded. Results: Fifty-six patients (37.1%) had HO. Time since injury and serum ALP and ESR levels were significantly higher in HO patients than in non-HO patients. Hip (73.2%) and knee (44.6%) were the most commonly involved joints. This study has detected significant associations between FAC scores (FAC 0-1-2 vs. FAC 3-4-5, p < 0.001), degree of spasticity (p = 0.01), pressure ulcer (Absent/Grade 1 vs. Grade 2, 3 and 4, p = 0.001), presence of neurogenic bladder (p < 0.001) and systemic infection (p = 0.002) with the development of HO. According to the final logistical regression analysis, only lower FAC score was independently associated with HO development (p = 0.006). Conclusion: As lower scores of FAC is an independent risk factor for HO formation and is related to the severity and consequences of injury, ambulation and regular/cautious mobilization of the joints are of paramount importance in the early period of the rehabilitation in TBI patients.

A 60-yr-old woman reported severe pain in the proximal part of her left forearm. The pain was also radiating toward the median nerve-innervated areas of the arm, especially during elbow flexion. Ultrasonographic imaging showed a well defined ganglion cyst around the distal biceps tendon close to the median nerve. Under ultrasound guidance, the cyst was aspirated and corticosteroid injection was performed. The patient's complaint improved 1 wk after the injection, and she started to flex her elbow without any pain. This case highlights the role of ultrasonography as a useful adjunctive tool not only to morphologically confirm a peripheral nerve entrapment but also to uncover the possible underlying etiology and to guide precisely during an intervention.