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common MSK swellings Flashcards

1
Q

what are history features of infection?

A
  • systemic upset
  • pyrexia
  • trauma
  • associated with medial corbiditiesw
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2
Q

what can be seen on examination when there is infection?

A
  • calor
  • dolor
  • rubor
  • tumor
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3
Q

what is cellulitis?

A
  • inflammation and infection of the soft tissue

- it is a generalised swelling rather than a discreet lump

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4
Q

how does cellulitis present?

A
  • pain
  • generalised swelling
  • erythema
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5
Q

what organisms are involved involved in cellulitis?

A

B- haemolytic streps

staphylococci

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6
Q

what is the management for cellulitis?

A
  • rest
  • elevation
  • analgesia
  • splint
  • antibiotics (penicillin)
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7
Q

what is an abscess?

A

-discreet collection of pus

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8
Q

how may an abscess present?

A
  • defined and fluctuant swelling
  • erythema
  • pain
  • history of trauma (e.g. bite, IVDU)
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9
Q

what is the management for an abscess?

A

-surgical incision and drainage

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10
Q

what is septic arthritis?

A

-bacterial infection of joint

can be traumatic or due to haemotoginous spread

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11
Q

what organisms usually cause septic arthritis?

A
  • staph aureus
  • strep
  • E.coli
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12
Q

how does septic arthritis usually present?

A

Acute monoarthropathy
-decrease ROM
+/- swelling
-raised WCC + inflammatory markers

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13
Q

what is the management for septic arthritis?

A

A + E assessment
urgent orthopaedic review
Aspiration; M, C and S
Urgent open/ arthoscopic washout + debreivement

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14
Q

what are ganglia?

A

outpouchings of the synovium lining of joints and filled with synovial fluids

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15
Q

how do ganglia present?

A

-discreet, round swellings
-non tender
<10mm to several cms
skin is mobile, ganglia fixed to unedrlying structures
usually on wrists, feet + knees

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16
Q

what is the management for ganglia?

A

usually just leave

-based on how severe symptoms are

aspiration usually leeds to it filling back up so not recommended

  • percutaneous rupture
  • surgical excision
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17
Q

what is bakers cyst?

A

cyst/ganglion of the popliteal fossa

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18
Q

how does bakers cyst present?

A

Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture

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19
Q

what is the treatment for bakers cyst?

A

non -operative

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20
Q

what is bursitis?

A

Inflammation of the synovium lined sacs that protect bony prominences and joints

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21
Q

what can burisitis form is it is secondarily infected?

A

an abscess

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22
Q

management for bursitis?

A 
NSAIDs / Analgesia
Antibiotics
Incision and drainage 
	 (secondary infection)
V. rarely excision
	 (chronic cases)
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23
Q

what bursitis is this?

A

olecranon bursitis

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24
Q

what bursitis is this?

A

pre- patella bursitis

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25
Q

what is gout?

A

An inflammatory arthritis most commonly affecting the great toe but can affect other joints, esp the knee

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26
Q

what causes gout?

A

Elevated serum urate causes a deposition of uric acid crystals in joints

27
Q

how does gout present?

A

Severe pain, Red, hot, swollen joint

Sometimes mistaken for septic arthritis

28
Q

what is diagnoses of gout?

A

Clinical features

Aspirate: Negatively birefringent monosodium urate crystals

29
Q

what is treatment for gout?

A

NSAIDs

Steroids Allopurinol

30
Q

what are rheumatoid nodules?

A

nodules that appear around joints in rheumatoid patients, associated with repetitive trauma

31
Q

managment of rheumatoid nodules?

A

no not respond to DMARDs

  • excision if problamatic
  • recurrence is high
32
Q

where are bouchard’s nodes found?

A

PIPJ

33
Q

where are Heberden’s nodes found?

A

DIPJ

34
Q

what conditions are associated with Bouchard’s nodes?

A

OA or RA

35
Q

what conditions are associated with Heberden’s nodes?

A

OA

36
Q

what is Dupuytrens?

A

Progressive disease resulting in digital flexion contractures

-tends to affect fascia

37
Q

pathophysiology of Dupuytrens?

A

Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia

Bands are primarily collagen type III

Avascular process involving O2 free radicals

38
Q

is Dupuytrens a disease of flexor tendons?

A

no

39
Q

is dupuytrens autosomal dominant or recessive?

A

autosomal dominant

40
Q

what increases chances of getting Dupuytrens?

A

acohol
diabetes
trauma
Men

41
Q

what is management for dupuytrens?

A

Dependent on functional impediment

Needle fasciotomy (single band)

Limited fasciectomy (removal of the bands)

Dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)

42
Q

what are the tpyes of giant cell tumour of tendon sheath?

A

Localised (more common)

Diffuse

43
Q

are giant cell tumours of tendon sheath malignant or benign?

A

BENIGN

44
Q

how do giant cell tumours of tendon sheath present?

A
  • firm
  • discreet swelling
  • usually on the volar aspect of digirs
  • can occur in toes
  • sometimes tender
45
Q

what is the management of giant cell tumour of tendon sheath?

A

-leave alone if no functional issue

if functional issue:
SURGICAL EXCISION (usually marginal)
46
Q

what is a lipoma?

A

benign neoplastic proliferation of fat subcutaneous

47
Q

how does a lipoma present?

A 
Can be discreet or less well defined
Slow growing and painless/non-tender
Can be large (several cms)
Characteristic consistency
No overlying skin changes
48
Q

what is the management for lipoma?

A

Based on symptoms
Can be left alone
Surgical excision if causing symptoms

Balance of removal vs scarring
S-shaped incision
Langer’s lines

49
Q

what is an osteochondroma?

A

-a benign lesion derived from aberrant cartilage from the perichondral ring that may take to form of:
solitary osteochondroma
Multiple Hereditary Exostosis (MHE)

50
Q

where does ostechondroma usually present?

A

Near knee

-distal femur/proximal tibia

51
Q

who does osteochondroma usually present in?

A

adolescence

52
Q

how does osteochondroma usually present?

A

Painless, hard lump
Symptoms with activity
(pain from tendons; numbness from nerve compression)

53
Q

what is the management of osteochondroma?

A
  • close observation

- surgical excision

54
Q

What is Ewigns sarcoma?

A

Malignant primary bone tumour of the endothelial cells in the marrow

55
Q

who is usually affected by Ewings sarcoma?

A

10-20 years

56
Q

what bone tumour has the worst prognosis?

A

Ewings sarcoma

57
Q

how does Ewigns sarcoma present?

A

The great mimic:

Hot, swollen, tender joint or limb with raised inflammatory markers (you would be thinking of infection)

Can mimic infection
Be suspicious; ask about night pain and duration of symptoms; investigate early

58
Q

what is management for Ewigns sarcoma?

A 
Poor prognosis
Surgical excision problematic
Because it’s the tumour of the bone marrow
Prosthesis and function after surgery
Often radio- and chemo-sensitive
59
Q

what are sebacous cysts?

A

cysts that originate at hair follicles and fill with caseous material (keratin)

60
Q

how do sebaceous cysts present?

A

Slow growing, painless, mobile discreet swellings

Can become infected

61
Q

what is myositis ossificans?

A

Abnormal calcification of a muscle haematoma

62
Q

what is the usual history of a patient who has myositis ossificans?

A

Trauma, initial soft swelling, hardness develops over several weeks

63
Q

what investigations are used for myositis ossificans?

A

Xrays

MRI

64
Q

what is the management for myositis ossificans?

A

Observation
Intervene only if symptoms demand
Must wait until maturity of ossification, otherwise risk of recurrence (6-12 months)

MSK (64 decks)

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