Common MSK swellings Flashcards
What factors are important to take in the history of MSK swellings?
When did it appear? Gradually or suddenly?
Any history of trauma
Is it painful
Is the size increasing ro does it fluctuate
Systemic symptoms
Do they or have they ever had any other similar swellings
What functional problems does it cause?
What examination findings are important to assess in MSK swellings?
Site Size Shape Generalised or discreet Consistency (fluctuant) Surface texture Mobile or fixed Temperature Transluminable Skin changes Local lymphadenoaphy
What nodes should you look at if you suspect upper limb infection?
Axilla
What nodes should you look at if you suspect a lower limb infection?
Groin
What is cellulitis?
Inflammation and infection of the soft tissues
How will cellulitis present?
Pain
Swelling
Erythema
Can be minor or septic
What organisms commonly cause cellulits?
Beta haemolytic strep
Staphylococci
How is cellulits managed?
Rest Elevation Analgesia Splint Antibiotics - oral or IV usually flucloaxacillin NOT SURGERY
What is an abscess?
Discreet collection of pus
How will an abscess present?
Defined and fluctuant swelling
Erythema
Pain
History of trauma (bite, IVDU)
How is an abscess managed?
Surgical incicision and drainage Rest Elevation Analgesia Splint Antibiotics- this is an ajunct
What is septic arthritis?
A bacterial infection of a joint - can be traumatic (joint penetration) or haematoginous spread
How will septic arthritis present?
Acute monoarthropathy
Decreased ROM
Systemic upset
Raised WCC and PV
How is septic arthritis managed?
Aspiration - microscopy - culture and sensitvity
Urgent open or arthroscopic washout
Debridement
What is a ganglion?
Outpouching of the synoviual lining of joints and is filled with synovial fluid
What is the appearance of a ganglion cyst?
Discreet, round swelling
Non-tender
Skin is mobile but the cyst is attached to underlying structures
How is a ganglion cyst managed?
Based upon symptoms Usually nothing as it is self limiting NOT aspiration Percutaneous rupture Surgical exciion - very rare
How will a bakers cyst present?
General fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture that mimics a DVT
What is bursitis?
Inflammation of the synovium lines sacs that protect bony prominences and joints.
Can become secondarily infected and forms an abscess
How is bursitis managed?
NSAIDs
Antibiotics
Incision and drainage (secondary infection)
V rarely excision (chronic cases)
What is the difference between gout and pseudogout?
Gout: negatively birefringent monosodium urate crystals
Pseudogout: positively birefringent calcium pyrophosphate crystals
What is the difference between bouchards and heberden’s nodes?
Bouchards - PIP in OA or RA
Heberdens - DIP in OA
Bouchards Back
Heberdens like the outer hebrides
What is dupuytrens disease?
Progressive disaese resulting in digital flexion contractures
Excessive myofibroblast proliferation and altered collagen matrix composition leasd to thickened and contracted palmar fascia made of collagen type 3
What can predispose to dupuytrens?
Genetic - autosomal dominant with variable penetration
Environmental: alcohol, diabetes, trauma
How is dupuytrens managed?
Needle fasciotomy
Collaginase injection
Limited fasciectomy
Dermofasciectomy and graft
What are the different types of giant cell tumour of the tendon sheath?
Localised
Diffuse (assoc. with PVNS)
What are giant cell tumours of the tendon sheath?
Regenerative hyperplasia with inflammatory process
How do giant cell tumours of the tenon sheath present?
Slowly enlarging
Firm, discreet swelling usually on volar aspect of digits
Can occur in toes
May or may not be tender
What is an osteochondroma?
Benign tumour most commonly occuring near the knee
Distal femur/ proximal meaphyseal reagions
Occurs in adolescence as an outgrowth of the physis
Cartilage capped ossified pedicle
What are the chances of malignant change in osteochondroma?
1%
What are the chances of malignant changes in multiple heridetary exostosis?
5%
How will an osteochondroma present?
Painless, hard lump
Sympotms with activity (pain from tendons, numbness from nerve compression)
Rarely can be due to fracture
How are osteochondromas managed?
Close observation
Surgical excision
What is an ewings sarcoma?
Malignant primary bone tumour of the endothelial cells in the marrow
Who does ewings sarcoma affect?
Most common in ages 10-20
Most common location is diaphysis of long bones and pelvis
How will ewings sarcoma present?
Great mimic: hot, swollen, tender joint or limb with raised inflammatory markers
Mimics infection
How is ewings sarcoma managed?
Poor prognosis
Surgical excision problematic
Often radio and chemo sensitive
What is a lipoma?
Benign neoplastic proliferation of fat
Often subcutaneous
How will a lipoma present?
Can be discreet or less well defined Slow growin and painless Can be large Characteristic consistency No overlying skin changes
How is a lipoma managed?
Based on symptoms
Can be left alone
Surgical excision commonly causes more harm than good
What is a sebaceous cyst?
Originates at hair follices and fills with keratin
Slow growing, painless, mobile discreet swellings
Can become infected
How is a sebaceous cyst managed?
Excision if required
What is myositis ossificans?
Abonormal calcification of a muscle haematoma
How is myositis ossificans managed?
Obseravtion
Intervene only if symptoms deman
Must wait until maturity of ossification other wise risk recurrence (6-12 months)
