Common MSK Swellings Flashcards
Why are MSK swellings important?
Uncommon but may be presentation of malignancy
What are questions to ask when taking a history of an MSK lump?
When did it appear (gradual/sudden), history of trauma, painful, size (changing/constant), other symptoms, other similar lumps, dose it impair function
What should be considered when examining an MSK lump?
Site, size, shape, ill/well-defined, consistency of size, texture, mobile/fixed, temperature, transluminable, skin changes, local lymphadenopathy
What would be the history and examination findings of a patient with an infection?
History = systemic upset, pyrexia, break in skin, co-morbidities Examination = calor, dolor, rubor, tumor
What is cellulitis?
Inflammation and infection of soft tissues = causes generalised swelling
How does cellulitis present?
Pain, swelling, erythema, may be minor problem to full blown septic wound
What causes cellulitis and how may it be treated?
Causes = Staph aureus, beta haemolytic strep Treatment = rest, elevation, splint, oral/IV penicillin, NOT surgery
What are abscesses?
Discrete collections of pus
How do abscesses present?
Discrete and fluctuant swelling, pain, erythema, history of bite/IV drug use
How are abscesses treated?
Surgical incision and drainage of pus
Rest, elevation, analgesia, splint, antibiotics
What is septic arthritis?
Bacterial infection of joint = traumatic or haematogenous spread
Caused by staph aureus, strep and E.coli
Why is septic arthritis a surgical emergency?
Causes irreversible damage to hyaline articular cartilage
How does septic arthritis present?
Acute monoarthroplasty, decreased ROM +/- swelling, systemic upset, raised white cell count and inflammatory markers
How is septic arthritis treated?
Urgent orthopaedic review = aspiration (less commonly), urgent arthroscopic/open washout and debridement
What is a ganglion?
Outpouching of synovium lining of joints = filled with synovial fluid
How do ganglia appear?
Discrete, round swellings, non-tender, <10mm to several cm, skin mobile, fixed to underlying structures
Occur at wrist, feet and ankles
How are ganglia treated?
Do nothing, not aspiration, percutaneous rupture, surgical excision
What is a Baker’s cyst?
Ganglion of the popliteal fossa
How do Baker’s cysts appear and how are they treated?
Can appear as general fullness of popliteal fossa = soft and non-tender, associated with OA, painful rupture
Non-surgical management
What is bursitis?
Inflammation of the synovium-lined sacs that protect bony prominences and joints = may become secondarily infected and form abscesses
How is bursitis treated?
NSAIDs/analgesia, antibiotics, incision and drainage for secondary infection, very rarely excision in chronic cases
What is gout?
Inflammatory arthritis most commonly affecting the great toe and knee = caused by uric acid crystal deposition in joints due to elevated serum urate
How does gout present and how is it diagnosed?
Severe, red, hot swollen joint
Diagnosed by aspirate = negatively birefringent needle shaped crystals
How is gout treated?
NSAIDs, steroids, allopurinol
What are rheumatoid nodules associated with an how do they present?
Associated with repetitive trauma
Presentation = chronic, more severe RA patients, rheumatoid factor positive
How are rheumatoid nodules treated?
Excision if problematic, otherwise leave alone
What are Bouchard’s and Heberden’s nodes?
Bony swelling of the IP joints = caused by bony spurs (OA associated)
What are some features of Bouchard’s and Heberden’s nodes?
Bouchard's = less common, PIP joints Heberden's = more common, OA associated, DIP joints
What occurs in Dupuytren’s disease?
Excessive myofibroblast proliferation and altered collagen matrix deposition = results in digital flexion contractures
What are some features of Dupuytren’s disease?
Chords of type three collagen, avascular process involving oxygen free radicals
What are some associations of Dupuytren’s disease?
Genetics = autosomal dominant, more common in males and Northern Europeans
Linked to alcohol, diabetes and trauma
How is Dupuytren’s disease treated?
Needle fasciotomy = if single chord
Collaginase fasciotomy = for mild cases
Limited fasciectomy = chord removal
Dermofasciectomy and graft
What are the two types of giant cell tumour of the tendon sheath?
Localised (common) and diffuse (uncommon, PVNS associated)
What occurs in giant cell tumours of the tendon sheath?
Benign regenerative hyperplasia with inflammatory process
How do giant cell tumours of the tendon sheath present?
Firm, discrete swelling, usually on volar aspect of digits, can occur in toes, may be tender
How are giant cell tumours of the tendon sheath treated?
Leave alone if no functional issue, surgical excision (usually marginal excision)
What is a lipoma?
Benign neoplastic proliferation of the fat, normally subcutaneous
How do lipomas present?
Presentation = can be discrete/less well defined, slow growing, painless, can be several cm, no overlying skin changes
How are lipomas treated?
Leave alone or surgical excision (s-shaped incision)
What is an osteochondroma?
Benign lesion derived from aberrant cartilage from perichondral ring = may be solitary or multiple hereditary exostosis (MHE)
How do osteochondromas present?
Painless, hard lump, symptoms with activity, commonly occurs near knee, usually in adolescence, MHE carry higher risk of malignancy
How are osteochondromas treated?
Close observation or surgical excision
What is Ewing’s sarcoma?
Malignant primary bone tumour of endothelial cells in marrow = most common in ages 10-20, poor prognosis
How does Ewing’s sarcoma present?
Hot, swollen, tender joint = mimics infection
Night pain and weight loss
How are Ewing’s sarcomas treated?
Chemo or radiotherapy, surgery is difficult
How do sebaceous cysts form?
Originate at hair follicles and fill with caseous material (keratin)
How do sebaceous cysts present and how are they treated?
Slow growing, painless, mobile, discrete swelling, can become infected
Excise if necessary, otherwise leave alone
What is myositis ossificans?
Abnormal calcification of muscle haematoma
What is the history of myositis ossificans?
Trauma, initial soft swelling, hardness develops over several weeks
What investigations can be done for myositis ossificans and how is it treated?
Image with MRI and x-rays
Treatment = observe, intervene only if symptoms demand
Why must you wait for maturity of ossification before intervening surgically in myositis ossificans?
Otherwise risk recurrence
