Common MSK swellings

Question 1

What questions should be asked in the history of an MSK swelling?

Answer 1

Painful?

History of trauma?

Systemic upset?

Change over time?

Any similar lesions at any time?

Sudden or gradual onset?

Functional disturbance?

Question 2

What does the image show and how is it treated?

Answer 2

Cellulitis, usually caused by staph or B-haemolytic strep

Treated with penicillin (oral or IV depending on extent)

Question 3

How does this lesion present and how is it treated?

Answer 3

Painful, erythematous, fluctuant swelling

Surgical incision and drainage; rest; elevation; analegesia; antibiotics

Question 4

What are ganglia?

Answer 4

Discrete, painless outpouchings of the synovial membrane around a joint

Question 5

What is this lesion and what is a potential complication?

Answer 5

Baker’s cyst

Painful rupture

Question 6

What is the indication for incision and drainage in bursitis?

Answer 6

Secondary bacterial infection and formation of an abscess

Question 7

What is bursitis of the 1st MTP joint more commonly known as?

Answer 7

Bunion

Question 8

What are these lesions?

Answer 8

Rheumatoid nodules

Question 9

Differentiate between Bouchards and Heberden’s nodes.

Answer 9

Bouchards- proximal, less common, OA or RA.

Heberdens- distal, more common, OA

Question 10

What causes Dupuytrens contracture?

Answer 10

Thickening of the palmar fascia causing a flexion deformity

Question 11

What is this lesion?

Answer 11

Giant cell tumour of the tendon sheath

Question 12

What do the image and associated X-ray show?

Answer 12

Osteochondroma

Question 13

How does Ewing’s sarcoma present?

Answer 13

Mimics infection- hot, painful swollen joint with raised inflammatory markers

Commonest in ages 10-20

Question 14

What does the X-ray show? How is this caused?

Answer 14

Myositis ossificans. Caused by abnormal calcification of muscle haematoma