common MSK swellings Flashcards
what are history features of infection?
- systemic upset
- pyrexia
- trauma
- associated with medial corbiditiesw
what can be seen on examination when there is infection?
- calor
- dolor
- rubor
- tumor
what is cellulitis?
- inflammation and infection of the soft tissue
- it is a generalised swelling rather than a discreet lump
how does cellulitis present?
- pain
- generalised swelling
- erythema
what organisms are involved involved in cellulitis?
B- haemolytic streps
staphylococci
what is the management for cellulitis?
- rest
- elevation
- analgesia
- splint
- antibiotics (penicillin)
what is an abscess?
-discreet collection of pus
how may an abscess present?
- defined and fluctuant swelling
- erythema
- pain
- history of trauma (e.g. bite, IVDU)
what is the management for an abscess?
-surgical incision and drainage
what is septic arthritis?
-bacterial infection of joint
can be traumatic or due to haemotoginous spread
what organisms usually cause septic arthritis?
- staph aureus
- strep
- E.coli
how does septic arthritis usually present?
Acute monoarthropathy
-decrease ROM
+/- swelling
-raised WCC + inflammatory markers
what is the management for septic arthritis?
A + E assessment
urgent orthopaedic review
Aspiration; M, C and S
Urgent open/ arthoscopic washout + debreivement
what are ganglia?
outpouchings of the synovium lining of joints and filled with synovial fluids
how do ganglia present?
-discreet, round swellings
-non tender
<10mm to several cms
skin is mobile, ganglia fixed to unedrlying structures
usually on wrists, feet + knees
what is the management for ganglia?
usually just leave
-based on how severe symptoms are
aspiration usually leeds to it filling back up so not recommended
- percutaneous rupture
- surgical excision
what is bakers cyst?
cyst/ganglion of the popliteal fossa
how does bakers cyst present?
Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture
what is the treatment for bakers cyst?
non -operative
what is bursitis?
Inflammation of the synovium lined sacs that protect bony prominences and joints
what can burisitis form is it is secondarily infected?
an abscess
management for bursitis?
NSAIDs / Analgesia Antibiotics Incision and drainage (secondary infection) V. rarely excision (chronic cases)
what bursitis is this?
olecranon bursitis
what bursitis is this?
pre- patella bursitis
what is gout?
An inflammatory arthritis most commonly affecting the great toe but can affect other joints, esp the knee
what causes gout?
Elevated serum urate causes a deposition of uric acid crystals in joints
how does gout present?
Severe pain, Red, hot, swollen joint
Sometimes mistaken for septic arthritis
what is diagnoses of gout?
Clinical features
Aspirate: Negatively birefringent monosodium urate crystals
what is treatment for gout?
NSAIDs
Steroids Allopurinol
what are rheumatoid nodules?
nodules that appear around joints in rheumatoid patients, associated with repetitive trauma
managment of rheumatoid nodules?
no not respond to DMARDs
- excision if problamatic
- recurrence is high
where are bouchard’s nodes found?
PIPJ
where are Heberden’s nodes found?
DIPJ
what conditions are associated with Bouchard’s nodes?
OA or RA
what conditions are associated with Heberden’s nodes?
OA
what is Dupuytrens?
Progressive disease resulting in digital flexion contractures
-tends to affect fascia
pathophysiology of Dupuytrens?
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
is Dupuytrens a disease of flexor tendons?
no
is dupuytrens autosomal dominant or recessive?
autosomal dominant
what increases chances of getting Dupuytrens?
acohol
diabetes
trauma
Men
what is management for dupuytrens?
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)
what are the tpyes of giant cell tumour of tendon sheath?
Localised (more common)
Diffuse
are giant cell tumours of tendon sheath malignant or benign?
BENIGN
how do giant cell tumours of tendon sheath present?
- firm
- discreet swelling
- usually on the volar aspect of digirs
- can occur in toes
- sometimes tender
what is the management of giant cell tumour of tendon sheath?
-leave alone if no functional issue
if functional issue: SURGICAL EXCISION (usually marginal)
what is a lipoma?
benign neoplastic proliferation of fat subcutaneous
how does a lipoma present?
Can be discreet or less well defined Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes
what is the management for lipoma?
Based on symptoms
Can be left alone
Surgical excision if causing symptoms
Balance of removal vs scarring
S-shaped incision
Langer’s lines
what is an osteochondroma?
-a benign lesion derived from aberrant cartilage from the perichondral ring that may take to form of:
solitary osteochondroma
Multiple Hereditary Exostosis (MHE)
where does ostechondroma usually present?
Near knee
-distal femur/proximal tibia
who does osteochondroma usually present in?
adolescence
how does osteochondroma usually present?
Painless, hard lump
Symptoms with activity
(pain from tendons; numbness from nerve compression)
what is the management of osteochondroma?
- close observation
- surgical excision
What is Ewigns sarcoma?
Malignant primary bone tumour of the endothelial cells in the marrow
who is usually affected by Ewings sarcoma?
10-20 years
what bone tumour has the worst prognosis?
Ewings sarcoma
how does Ewigns sarcoma present?
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
what is management for Ewigns sarcoma?
Poor prognosis Surgical excision problematic Because it’s the tumour of the bone marrow Prosthesis and function after surgery Often radio- and chemo-sensitive
what are sebacous cysts?
cysts that originate at hair follicles and fill with caseous material (keratin)
how do sebaceous cysts present?
Slow growing, painless, mobile discreet swellings
Can become infected
what is myositis ossificans?
Abnormal calcification of a muscle haematoma
what is the usual history of a patient who has myositis ossificans?
Trauma, initial soft swelling, hardness develops over several weeks
what investigations are used for myositis ossificans?
Xrays
MRI
what is the management for myositis ossificans?
Observation
Intervene only if symptoms demand
Must wait until maturity of ossification, otherwise risk of recurrence (6-12 months)
