A 6-year-old girl with an improperly rehabilitated elbow fracture complicated by severe myositis ossificans and joint stiffness was successfully managed using manual release, minimally invasive needle-knife surgery, and external herbal soaks.

Case ID: CHC-0056

Case Summary

This case describes a 6-year-old girl who presented with a rigidly stiff left elbow 82 days after suffering a supracondylar fracture. Improper forceful rehabilitation at a local clinic had caused secondary trauma, leading to the development of myositis ossificans (bone tissue forming inside muscle) and locking her elbow at a 70-degree angle. The original report documented a conventional diagnosis of left elbow joint stiffness with myositis ossificans and a TCM assessment of Bone Impediment (Gu Bi) driven by Blood Stasis and Sinew Impediment. She was managed through a highly integrative approach combining “Zhao’s plucking and swaying” manual release, needle-knife joint capsule release under anesthesia, and specialized external herbal heat soaks to dissolve the adhesions and restore full mobility.

Patient Presentation

• Patient: 6-year-old female (Surname: Zhong).
• Main Complaint: Left elbow stiffness with moderate swelling and restricted movement following a fall 82 days prior.
• History: The patient sought consultation on July 21, 2023. Eighty-2 days earlier, she fell and suffered a left humeral supracondylar fracture. A local hospital performed manual reduction and cast immobilization. One month later, the cast was removed, and her elbow was stiff at a 90° angle. A local doctor then forcibly bent and extended the joint, causing severe pain. Following this violent manipulation, the traumatized child refused to see any doctors, and her elbow progressively locked into an extended position of roughly 70°.

Examination and Diagnosis

• Physical Exam: The left elbow was moderately swollen and rigidly stiff, though distal finger movement, sensation, and blood circulation remained normal. Localized mild tenderness was present. Range of motion (ROM) was severely restricted to only 10° of movement (locked between 60° and 70° of extension).
• Imaging (X-ray): Confirmed the formation of a large ossification mass (myositis ossificans) at the anterior aspect of the left elbow.
• Conventional Diagnosis: 1. Left elbow joint stiffness; 2. Myositis ossificans.
• TCM Tongue and Pulse: The tongue body was pale and dark (舌淡暗) with a thin, white coating. The pulse was fine and choppy (脉细涩).

TCM Assessment

The original practitioner interpreted the presentation as Bone Impediment driven by Blood Stasis and Sinew Impediment (骨痹 – 血瘀筋痹证).

According to the holistic principles of yin and yang Chinese Medicine trauma immediately causes Qi and blood stagnation. In this young patient, the initial fracture caused standard stasis, but the subsequent violent forced manipulation by the local doctor caused severe secondary tearing of the muscles and periosteum.

This massive secondary bleeding localized around the joint. Because the blood could not flow, the stagnant stasis “wilted” the local sinews (tendons/ligaments), eventually solidifying and transforming into heterotopic bone (myositis ossificans). The physical block severely restricted the joint’s movement. The pale-dark tongue directly indicates the presence of deep, chronic congealed blood, while the fine-choppy pulse confirms that the local tissues were deprived of smooth, nourishing blood flow (fine) due to the physical stasis (choppy).

Treatment Approach

The primary treatment principle was to relax the sinews and unblock the impediment (舒筋通痹). The strategy aimed to physically break the adhesions utilizing minimally invasive tools, while heavily relying on external herbal heat therapy to “melt” the stasis, soften the sinews, and slowly reabsorb the abnormal calcification without triggering further inflammatory bone growth.

Interventions and Herbal Formulas

• Needle-Knife and Manual Joint Release (Under Anesthesia):
  • Under intravenous general anesthesia, the practitioner applied “Zhao’s plucking and swaying release” (招氏弹拨摇摆松解). The practitioner gently palpated the stiff sinew nodes (adhesions) and plucked them in all directions to soften the tissue, applying gentle traction and swaying.
  • A small amount of compound betamethasone was injected into the joint cavity and around the calcification mass to immediately halt the inflammatory ossification process.
  • A needle-knife (针刀) was used to puncture and release the tight elbow joint capsule. Following this, manual flexion/extension was applied, successfully improving ROM to roughly 110° flexion and 30° extension. The arm was temporarily immobilized in a plaster splint for 3 days to allow acute tissue rest.
• Post-Operative Medication: Ibuprofen granules (50mg twice daily) were given to manage acute post-op pain and inflammation.
• External Herbal Wash (Shujin Huoluo Fang): Initiated on post-op day 3 to be used as a hot soak.
  • Formula: Xi Xin (20g), Hai Feng Teng (50g), Bai Fan (Alum, 30g), Ce Bai Ye (20g), Shen Jin Cao (Lycopodium, 20g), Tou Gu Cao (Phryma, 20g), Bing Pian (Borneol, 30g), Fang Feng (20g), Lu Lu Tong (Liquidambar, 20g), Hai Tong Pi (Erythrina, 20g), Sang Zhi (Mulberry Twig, 20g), Wu Mei (Mume, 20g), and Wei Ling Xian (Clematis, 20g).
  • Usage: Boiled in 3000ml of water down to 2500ml. The child’s elbow was soaked and washed twice daily. These herbs specifically target the meridians, warm the channels, deeply relax spasmodic sinews, and aggressively scatter localized masses.

Follow-Up

• Discharge (Day 4 Post-Op): Left elbow ROM improved to 15°–95°. She was discharged with instructions to actively exercise the joint and continue the daily herbal soaks for one full month.
• Day 45 Post-Op (September 11, 2023): The swelling had largely subsided. ROM improved to 10°–120°. An X-ray confirmed that the large calcification mass in front of the elbow had mostly dissipated.
• Day 95 Post-Op (November 1, 2023): The joint swelling completely disappeared, and movement was basically normal (ROM 5°–135°, with only very slight restriction in full extension). The X-ray showed the calcification had essentially vanished.
• Six-Month Follow-Up: The child’s left elbow function had completely returned to normal with absolutely no restriction in movement.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the correction of a severe iatrogenic (doctor-caused) complication using integrated, gentle techniques. Myositis ossificans in children often occurs when a doctor or physical therapist aggressively and violently forces a stiff joint to bend after a fracture.

This violent tearing triggers the body to lay down bone instead of soft scar tissue. Recognizing this, Professor Zhao explicitly avoided any further violent manipulation. Instead, he utilized anesthesia and a tiny needle-knife to release the joint capsule from the inside, preventing further massive tissue trauma. Crucially, he relied heavily on external herbal fumigation and soaking (Shujin Huoluo Fang). The warmth of the water combined with deep-penetrating herbs like Hai Feng Teng, Shen Jin Cao, and Tou Gu Cao gently softened the contractures, promoted blood flow, and remarkably allowed the body to completely reabsorb the abnormal bone mass over the course of three months.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：舒筋通痹法治疗左肘关节僵硬并骨化性肌炎案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: September 7, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation