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Musculoskeletal > Common MSK Swellings > Flashcards

Common MSK Swellings Flashcards

1
Q

Why are MSK swellings important?

A

Uncommon but may be presentation of malignancy

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2
Q

What are questions to ask when taking a history of an MSK lump?

A

When did it appear (gradual/sudden), history of trauma, painful, size (changing/constant), other symptoms, other similar lumps, dose it impair function

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3
Q

What should be considered when examining an MSK lump?

A

Site, size, shape, ill/well-defined, consistency of size, texture, mobile/fixed, temperature, transluminable, skin changes, local lymphadenopathy

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4
Q

What would be the history and examination findings of a patient with an infection?

A 
History = systemic upset, pyrexia, break in skin, co-morbidities
Examination = calor, dolor, rubor, tumor
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5
Q

What is cellulitis?

A

Inflammation and infection of soft tissues = causes generalised swelling

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6
Q

How does cellulitis present?

A

Pain, swelling, erythema, may be minor problem to full blown septic wound

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7
Q

What causes cellulitis and how may it be treated?

A 
Causes = Staph aureus, beta haemolytic strep
Treatment = rest, elevation, splint, oral/IV penicillin, NOT surgery
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8
Q

What are abscesses?

A

Discrete collections of pus

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9
Q

How do abscesses present?

A

Discrete and fluctuant swelling, pain, erythema, history of bite/IV drug use

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10
Q

How are abscesses treated?

A

Surgical incision and drainage of pus

Rest, elevation, analgesia, splint, antibiotics

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11
Q

What is septic arthritis?

A

Bacterial infection of joint = traumatic or haematogenous spread
Caused by staph aureus, strep and E.coli

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12
Q

Why is septic arthritis a surgical emergency?

A

Causes irreversible damage to hyaline articular cartilage

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13
Q

How does septic arthritis present?

A

Acute monoarthroplasty, decreased ROM +/- swelling, systemic upset, raised white cell count and inflammatory markers

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14
Q

How is septic arthritis treated?

A

Urgent orthopaedic review = aspiration (less commonly), urgent arthroscopic/open washout and debridement

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15
Q

What is a ganglion?

A

Outpouching of synovium lining of joints = filled with synovial fluid

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16
Q

How do ganglia appear?

A

Discrete, round swellings, non-tender, <10mm to several cm, skin mobile, fixed to underlying structures
Occur at wrist, feet and ankles

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17
Q

How are ganglia treated?

A

Do nothing, not aspiration, percutaneous rupture, surgical excision

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18
Q

What is a Baker’s cyst?

A

Ganglion of the popliteal fossa

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19
Q

How do Baker’s cysts appear and how are they treated?

A

Can appear as general fullness of popliteal fossa = soft and non-tender, associated with OA, painful rupture
Non-surgical management

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20
Q

What is bursitis?

A

Inflammation of the synovium-lined sacs that protect bony prominences and joints = may become secondarily infected and form abscesses

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21
Q

How is bursitis treated?

A

NSAIDs/analgesia, antibiotics, incision and drainage for secondary infection, very rarely excision in chronic cases

22
Q

What is gout?

A

Inflammatory arthritis most commonly affecting the great toe and knee = caused by uric acid crystal deposition in joints due to elevated serum urate

23
Q

How does gout present and how is it diagnosed?

A

Severe, red, hot swollen joint

Diagnosed by aspirate = negatively birefringent needle shaped crystals

24
Q

How is gout treated?

A

NSAIDs, steroids, allopurinol

25
Q

What are rheumatoid nodules associated with an how do they present?

A

Associated with repetitive trauma

Presentation = chronic, more severe RA patients, rheumatoid factor positive

26
Q

How are rheumatoid nodules treated?

A

Excision if problematic, otherwise leave alone

27
Q

What are Bouchard’s and Heberden’s nodes?

A

Bony swelling of the IP joints = caused by bony spurs (OA associated)

28
Q

What are some features of Bouchard’s and Heberden’s nodes?

A 
Bouchard's = less common, PIP joints
Heberden's = more common, OA associated, DIP joints
29
Q

What occurs in Dupuytren’s disease?

A

Excessive myofibroblast proliferation and altered collagen matrix deposition = results in digital flexion contractures

30
Q

What are some features of Dupuytren’s disease?

A

Chords of type three collagen, avascular process involving oxygen free radicals

31
Q

What are some associations of Dupuytren’s disease?

A

Genetics = autosomal dominant, more common in males and Northern Europeans
Linked to alcohol, diabetes and trauma

32
Q

How is Dupuytren’s disease treated?

A

Needle fasciotomy = if single chord
Collaginase fasciotomy = for mild cases
Limited fasciectomy = chord removal
Dermofasciectomy and graft

33
Q

What are the two types of giant cell tumour of the tendon sheath?

A

Localised (common) and diffuse (uncommon, PVNS associated)

34
Q

What occurs in giant cell tumours of the tendon sheath?

A

Benign regenerative hyperplasia with inflammatory process

35
Q

How do giant cell tumours of the tendon sheath present?

A

Firm, discrete swelling, usually on volar aspect of digits, can occur in toes, may be tender

36
Q

How are giant cell tumours of the tendon sheath treated?

A

Leave alone if no functional issue, surgical excision (usually marginal excision)

37
Q

What is a lipoma?

A

Benign neoplastic proliferation of the fat, normally subcutaneous

38
Q

How do lipomas present?

A

Presentation = can be discrete/less well defined, slow growing, painless, can be several cm, no overlying skin changes

39
Q

How are lipomas treated?

A

Leave alone or surgical excision (s-shaped incision)

40
Q

What is an osteochondroma?

A

Benign lesion derived from aberrant cartilage from perichondral ring = may be solitary or multiple hereditary exostosis (MHE)

41
Q

How do osteochondromas present?

A

Painless, hard lump, symptoms with activity, commonly occurs near knee, usually in adolescence, MHE carry higher risk of malignancy

42
Q

How are osteochondromas treated?

A

Close observation or surgical excision

43
Q

What is Ewing’s sarcoma?

A

Malignant primary bone tumour of endothelial cells in marrow = most common in ages 10-20, poor prognosis

44
Q

How does Ewing’s sarcoma present?

A

Hot, swollen, tender joint = mimics infection

Night pain and weight loss

45
Q

How are Ewing’s sarcomas treated?

A

Chemo or radiotherapy, surgery is difficult

46
Q

How do sebaceous cysts form?

A

Originate at hair follicles and fill with caseous material (keratin)

47
Q

How do sebaceous cysts present and how are they treated?

A

Slow growing, painless, mobile, discrete swelling, can become infected
Excise if necessary, otherwise leave alone

48
Q

What is myositis ossificans?

A

Abnormal calcification of muscle haematoma

49
Q

What is the history of myositis ossificans?

A

Trauma, initial soft swelling, hardness develops over several weeks

50
Q

What investigations can be done for myositis ossificans and how is it treated?

A

Image with MRI and x-rays

Treatment = observe, intervene only if symptoms demand

51
Q

Why must you wait for maturity of ossification before intervening surgically in myositis ossificans?

A

Otherwise risk recurrence

Musculoskeletal (57 decks)

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