Common MSK Swellings Flashcards
important questions in swelling history?
when did it appear - sudden or gradual? trauma? painful? change in size? systemic symotoms? anything similar? what functional problems does it cause?
important examination features of a swelling?
site shape size well defined? consistency - fluctuant? surface texture mobile or fixed temp transluminable? skin changes local lymphadenopathy
history features of an infective cause for swelling?
systemic upset pyrexia trauma association with medical co-morbidities rubor, calor, dolor, tumor
how does cellulitis present?
generalised swelling rather than discreet lump
pain
erythema
what commonly causes cellulitis?
Beta haemolytic strep
staph
how is cellulitis managed?
rest elevation analgesia splint antibiotics (oral or IV) - penicillin
presentation of abscesses?
discreet collection of pus - defined and fluctuant swelling
erythema
pain
history of trauma
how is an abscess managed?
surgical incision and drainage always rest elevation analgesia splint antibiotics
what causes septic arthritis?
bacterial infection of a joint - trauma or haematogenous spread
staph aureus
strep
E coli
how does septic arthritis present?
acute monoarthropathy
reduced ROM +/- swelling
systemic upset
raised WCC + inflammatory markers
how is septic arthritis managed?
urgent orthopaedic review
aspiration
urgent open/arthroscopic washout + debridement
what is a ganglia?
outpouching of synovium lining of joints and filled with synovial fluid
how does a ganglia present?
discreet round swelling non-tender <10mm - several cm skin mobile, fixed to underlying structures seen in wrists, feet and knees
how is a ganglia managed?
nothing
NOT ASPIRATION
percutaneous rupture (hit it)
surgical excision
what is a bakers cyst?
cyst/ganglion of the popliteal fossa
how does a bakers cyst present?
general fullness of the popliteal fossa
soft and non-tender
associated with OA
painful rupture
how is a bakers cyst managed?
non-operative
what is bursitis?
inflammation of the synovium lined sacs that protect bony prominences and joints
can become secondarily infected and form an abscess
how is bursitis managed?
NSAIDs/analgesia
antibiotics
incision and drainage (if secondary infection)
V. rarely needs excision
what is gout?
inflammatory arthritis most commonly affected the great toe but can affect other joints - knee etc
caused by elevated serum urate resulting in a deposition of uric acid crystals in joints
what is gout associated with?
purine rich food
alcohol
dairy
how does gout present?
severe pain
red, hot swollen joint
can have acute attacks and chronic progressive joint damage
how is gout diagnosed and treated?
diagnosis = clinical, aspiration - negatively befringed monosodium urate crystals
how is gout managed?
NSAIDs
steroids
allopurinol
what are rheumatoid nodules?
nodules around joints in RA patients
associated with repetitive trauma
how are rheumatoid nodules managed?
don’t respond to DMARDs
excision of problematic
recurrence high
Bouchards vs Heberdens nodes?
bouchard = PIPs (OA or RA) heberdens = DIPs (only OA)
what is dupuytrens disease and what causes it?
progressive disease of fascia causing digital flexion contractures
excessive myofibril proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
type 3 collagen bands
avascular process involving O2 free radicals
3 contributing factors in dupuytens?
genetic predisposition (northern Europe, Men > women, AD) environmental factors (alcohol, diabetes, trauma) local and global protein expression
how is dupuytrens managed?
depends on functional impediment needle fasciotomy collagenase injection limited fasciectomy dermofasciectomy + graft
what is giant cell tumour of the tendon sheath?
regenerative hyperplasia with inflammatory process
benign, common
don’t confuse with giant cell tumour of bone
what are the 2 types of GCT of tendon sheath?
localised (common)
diffuse (rare)
how does a GCT of tendon sheath present?
slowly enlarging
firm discreet swelling on volar aspect of digits
can occur in toes
may or may not be tender
how is GCT of tendon sheath managed?
leave alone if not causing issue
surgical excision if needed (often only marginal excision)
what is an osteochondroma?
benign tumour most commonly occurring near the knee (distal femur or proximal tibia)
cartilage capped ossified pedicle
how does osteochondroma present?
hard, painless lump growth parallel to the patient pain and numbness on activity can rarely get pain from a fracture occurs in adolescence can have multiple tumours in multiple hereditary exostosis
malignant potential in osteochondroma?
<1%
5% in multiple hereditary exostosis
how is osteochondroma managed?
close observation
surgical excision if needed
what is ewings sarcoma?
malignant primary bone tumour of the endothelial cells in the marrow
usually occurs at the diaphysis/metaphysis of long bones and pelvis
how does ewings sarcoma present?
hot swollen tender joint or limb with raised inflammatory markers (mimics infection)
ask about night pain and duration of symptoms
how is ewings sarcoma managed?
poor prognosis
surgical excision difficult
often chemo and radio sensitive
what is a lipoma?
benign neoplastic proliferation of fat
often subcutaneous
how does a lipoma present?
can be discreet or less well defined slow growing and painless can be large soft, moveable mass no overlying skin changes
how is a lipoma managed?
based on symptoms
can be left alone
surgical excision if causing symptoms
what is a sebaceous cyst and how does it present?
originate at the hair follicle and fill with caseous keratin
slow growing, painless, mobile discreet swellings
can become infected
how are sebaceous cysts managed?
excision if required
what is myositis ossificans?
abnormal calcification of a muscle haematoma
usually initial trauma > initial small swelling > hardness develops over several weeks
how is myositis ossificans diagnosed and managed?
diagnosis = X ray and MRI showing peripheral mineralisation
management
- observation
- only intervene if symptoms
- must wait until maturity of ossification otherwise risk of recurrence (6-12 months)
