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Neurological Rehabilitation

A case report of range of motion restriction from Hip Heterotopic Ossification mimicking increased muscular tone following subarachnoid hemorrhage

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Andres Gronda, MD

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • Hannah Park, DO

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • CC

    Cherie Chen, DO (she/her/hers)

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • DG

    Daniel Good, DO

    PM&R Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • Prin Amorapanth, MD, PhD

    Assistant Professor
    NYU Rusk Rehabilitation
    New York, New York

Disclosure(s):
Andres Gronda, MD: No financial relationships to disclose
Hannah Park, DO: No financial relationships to disclose
Prin Amorapanth, MD, PhD: No financial relationships to disclose
Case Diagnosis: 51-year-old man with subarachnoid hemorrhage presented with restricted active and passive range of motion, eventually found to have bilateral hip heterotopic ossification (HO).

Case Description or Program Description: 51-year-old man developed a subarachnoid hemorrhage (SAH) secondary to anterior communicating aneurysm rupture. The patient’s acute care course lasted over 11 weeks and was complicated by central fevers, cerebral vasospasm, prolonged ventilation requiring tracheostomy, pneumonia, and gastrointestinal bleeding, after which he was transferred to an acute rehabilitation hospital.

Setting: Acute rehabilitation hospital.

Assessment/Results: The patient’s therapy became limited by reduced hip active and passive range of motion, initially attributed to increased lower extremity proximal muscle tone by the therapy team. However, exam did not demonstrate clear spasticity or dystonia. A routine abdominopelvic CT scan incidentally found extensive bridging HO in bilateral hips. He was treated with a 3-week course of indomethacin and a progressive hip range of motion routine, and was referred to orthopedic surgery. The patient demonstrated improved hip range of motion at outpatient follow up.

Discussion (relevance): Brain injury rehabilitation is often marked by the development of abnormal motor tone, often in dystonic or spastic patterns, affecting rehabilitation and functional capacity. HO is a more uncommon complication of brain injury which has a higher risk of occurring with prolonged immobility, tracheostomy, and prior trauma, among other factors. Recency and availability bias may predispose clinicians to attribute abnormal musculoskeletal exams to changes in motor tone alone without evaluating for underlying joint pathology. This case highlights the importance of screening for HO in patients who appear to show changes in tone and associated range of motion and who possess other factors which increase HO risk.

Conclusions: Heterotopic ossification should be considered when evaluating changes in range of motion or muscle tone in patients with brain injury, especially if changes in tone do not follow a clear pattern of spasticity, rigidity, or dystonia.