- inflammation and infection of the soft tissue - it is a generalised swelling rather than a discreet lump

common MSK swellings Flashcards by Amy Hollis

what are history features of infection?

systemic upset
pyrexia
trauma
associated with medial corbiditiesw

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what can be seen on examination when there is infection?

calor
dolor
rubor
tumor

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what is cellulitis?

inflammation and infection of the soft tissue

- it is a generalised swelling rather than a discreet lump

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how does cellulitis present?

pain
generalised swelling
erythema

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what organisms are involved involved in cellulitis?

B- haemolytic streps

staphylococci

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what is the management for cellulitis?

rest
elevation
analgesia
splint
antibiotics (penicillin)

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what is an abscess?

-discreet collection of pus

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how may an abscess present?

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

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what is the management for an abscess?

-surgical incision and drainage

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what is septic arthritis?

-bacterial infection of joint

can be traumatic or due to haemotoginous spread

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what organisms usually cause septic arthritis?

staph aureus
strep
E.coli

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how does septic arthritis usually present?

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

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what is the management for septic arthritis?

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

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what are ganglia?

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

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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

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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

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what is bakers cyst?

cyst/ganglion of the popliteal fossa

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how does bakers cyst present?

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

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what is the treatment for bakers cyst?

non -operative

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what is bursitis?

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

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what can burisitis form is it is secondarily infected?

an abscess

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management for bursitis?

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

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what bursitis is this?

olecranon bursitis

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what bursitis is this?

pre- patella bursitis

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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?

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?

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)