12: Common MSK swellings

Question 1

What features of a soft tissue swelling suggest it is benign?

Answer 1

Small

Fluctuates in size

Fluid-filled

Well defined

Soft

Question 2

What signs suggest a soft tissue swelling may be malignant?

Answer 2

Large

Growing rapidly

Solid

Poorly defined

Irregular

Constitutional symptoms

Lymphadenopathy

Question 3

What investigations are used to view soft tissue swellings?

Answer 3

Ultrasound

MRI

Question 4

What is a benign tumour of fat called?

Answer 4

Lipoma

Question 5

Are lipomas painful?

Answer 5

No

Question 6

What are common hand swellings made by outpouchings of the synovial cavity?

Answer 6

Ganglion cysts

Question 7

A cyst found at the DIP joint is called a ___ cyst.

Answer 7

mucous

Question 8

What should a ganglion cyst do when a bright light is shone on it?

Answer 8

Transilluminate

i.e the light should pass through

Question 9

What are the surgical options for treating symptomatic ganglion cysts?

Answer 9

Aspiration (50% recurrence rate)

Excision

Question 10

Only ___ ganglion cysts are indicated for excision.

Answer 10

painful

Question 11

Ganglion and mucous cysts are associated with which joint disease?

Answer 11

OA

Question 12

What is the 2nd most common hand swelling after ganglion cysts?

Answer 12

Giant cell tumours

Question 13

What is a feature of giant cell tumours histologically (apart from the giant cells)?

Answer 13

Pigmented

due to haemosiderin deposits

Question 14

If giant cell tumours are painful, how are they managed?

Answer 14

Excision

Question 15

What is a condition, affecting the knee, involving pigmented swellings similar to giant cell tumours?

Answer 15

Pigmented villonodular synovitis

or PVNS

Question 16

What are some consequences of PVNS of the knee?

Answer 16

Joint destruction > Arthritis

eventually leading to knee replacement

Question 17

What swelling appears behind the knee?

What causes it?

Answer 17

Baker’s cyst

Synovial fluid leaks through into bursa of semimembranosus or gastrocnemius (posterior thigh muscles)

Question 18

Baker’s cysts in children tend to…

In adults, the management tends to be…

Answer 18

resolve themselves

leave them alone in adults (high recurrence)

Question 19

What pouches of fluid around joints can become inflamed?

Answer 19

Bursae

Question 20

What are four common locations for bursitis to occur?

Answer 20

Olecranon

Prepatellar

Infrapatellar

1st metatarsal head (bunion)

Question 21

How is bursitis treated surgically?

Answer 21

Bursectomy

Question 22

What is an abscess?

Answer 22

Inflammatory nodule containing pus

Question 23

What may cause an abscess?

Answer 23

Cellulitis

Infected wound

Epidermoid cyst

Blocked sebaceous gland

Question 24

Do abscesses fluctuate in size?

Answer 24

Yes

Question 25

How are abscesses treated?

Answer 25

Drained

Question 26

What is myositis ossificans?

Answer 26

Trauma causes IM bleeding which then ossifies for unknown reasons

Question 27

Is myositis ossificans painful?

Answer 27

No

Question 28

What are:

a) angiosarcomas
b) fibrosarcomas
c) liposarcomas
d) rhabdomyosarcomas?

Answer 28

Malignant tumours of…

a) blood vessels
b) fibrous tissue
c) fat
d) skeletal muscle

Question 29

What investigation must be performed if you think a tumour is malignant?

Answer 29

Biopsy