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Musculoskeletal > Common Musculoskeletal swellings > Flashcards

Common Musculoskeletal swellings Flashcards

1
Q

Generalised or discreet swelling?

A

Ill defined / well defined

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2
Q

What type of swelling is cellulitis?

A

Generalised

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3
Q

Which organisms cause cellulitis?

A

Beta haemolytic strep and staphylococci

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4
Q

Presentation of cellulitis?

A

Pain, swelling, erythema

Spectrum: Minor problem – septic

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5
Q

Presentation of abscess

A

Defined and fluctuant swelling
Erythema, pain
History of trauma (eg. bite, IVDU)
Spectrum: Minor problem – septic

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6
Q

Organisms causing spetic arthritis?

A

Staph aureus/strep/E. coli

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7
Q

Bacterial infection of a joint e.g. septic arthritis

A

Traumatic (joint penetration)

Haematoginous spread

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8
Q

Presentation of septic arthritis

A

Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflam markers

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9
Q

Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflam markers

A

Septic arthritis

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10
Q

Management of septic arthritis

A

Urgent orthopaedic review
Aspiration; M,C & S
Urgent Open / arthoscopic washout + debridement

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11
Q

What are ganglion?

A

Outpouchings of synovium lining of joints and filled with synovial fluid

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12
Q

Appearance of ganglia

A 
Discreet, round swellings
Non-tender
<10mm – several cms
Skin mobile, fixed to underlying structures
Wrists, feet, knees
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13
Q

Management of ganglia

A

Nothing
NOT aspiration
Percutaneous rupture
Surgical excision

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14
Q

Where would you find a baker’s cyst?

A

Popliteal fossa

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15
Q

Presentation of baker’s cyts

A

Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture

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16
Q

Which type of cyst may be associated with OA?

A

Baker’s cyst

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17
Q

Bursitis

A

Inflammation of the synovium lined sacs

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18
Q

Management of bursitis

A

NSAIDs / Analgesia
Antibiotics
Incision and drainage (secondary infection)
V. rarely excision (chronic cases)

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19
Q

Symptoms of bursitis

A

Symptoms of bursitis may include localized tenderness, pain, edema, erythema, or reduced movement. Pain is aggravated by movement of the specific joint, tendon, or both.

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20
Q

Which condition is associated with purine rich food, alcohol, dairy?

A

Gout

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21
Q

What may rheumatoid nodules be associated with?

A

Repetitive trauma

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22
Q

Do rheumatoid nodules respond to DMARDs?

A

No :(

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23
Q

Management of rheumatoid nodules

A

Excision if problematic but recurrence high

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24
Q

Histology of rheumatoid nodules

A

Intense inflammatory changes

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25
Q

Rheumatoid factor positive in rheumatoid nodule presentation?

A

Yesh

26
Q

What causes Bouchards/Heberden’s nodes?

A

Bony spurs due to chronic trauma

27
Q

Which are more common, Bouchards or Heberdens?

A

Heberdens

28
Q

Which conditions would you fins bouchards and heberdens nodes in?

A

Bouchards: OA/RA
Heberdens: OA

29
Q

Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia

A

Dupuytren’s disease

30
Q

Which type of collagen makes up the bands in Dupuytren’s disease?

A

Collagen type III

31
Q

Dupuytren’s disease

A

Progressive disease resulting in digital flexion contractures
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
Bands are primarily collagen type III
Avascular process involving O2 free radicals
It is NOT a disease of the flexor tendons

32
Q

Avascular process involving O2 free radicals?

A

Dupuytren’s disease

33
Q

Excessive MYOFIBROBLAST proliferation and altered collagen matrix composition leading to thickened and contracted PALMAR FASCIA?

A

Dupuytren’s disease

34
Q

Which 3 factors contribute to Dupuytrens?

A
  • Genetic predispostion
  • Environmental factors
  • Local and global protein expression
35
Q

Method of inheritance of Dupuytrens

A

Autosomal dominant with variable penetration

36
Q

Environmental factors contributing to Dupuytren’s disease

A

Alchohol, diabetes, trauma

37
Q

Factors predisposing to Dupuytren’s disease

A

Genetic predisposition:
Autosomal dominant with variable penetration
Common in northern Europe; men > women

Environmental factors:
Alcohol, diabetes and trauma

Local and global protein expression:
Multiple protein expression enzymes up-regulated and down-regulated

38
Q

Traeatment for Dupuytren’s disease

A

Needle fasciotomy
Collaginase injection
Limited fasciectomy
Dermofasciectomy + graft

39
Q

PVNS

A

Pigmented villonodular synovitis (PVNS) is a joint disease characterized by inflammation and overgrowth of the joint lining

Associated with diffuse giant cell tumours of the tendon sheath

40
Q

Giant Cell Tumour of the Tendon Sheath

A

2 types: Localised (common) Diffuse (uncommon; assoc. with PVNS)
Regenerative hyperplasia with inflammatory process
Benign
Presentation:
Firm, discreet swelling, usually on volar aspect of digits
Can occur in toes
May or may not be tender

41
Q

Management of giant cell tumour of the tendon sheath

A

Leave alone if no functional issue!
Surgical excision:
Usually marginal excision, i.e. not complete as adherent to tendon sheath
Incidence of recurrence

42
Q

Where would an osteochonroma most likely occur?

A

Near the knee

Distal femur / proximal tibia metaphyseal regions

43
Q

Presentation of osteochondroma

A

Painless, hard lump

Symptoms with activity (pain from tendons; numbness from nerve compression)

44
Q

Why might you feel numbness during activity if you have an osteochondroma?

A

Osteochondroma might compress nerves

45
Q

Managment of osteochondroma

A

Management:
Close observation
Surgical excision

46
Q

Which cells does a Ewings sarcoma originate from?

A

Endothelial cells (E for Ewings, E for endothelial)

47
Q

Ages affected by Ewings sarcoma?

A

10-20

48
Q

Ewing’s Sarcoma

A

Malignant primary bone tumour of the endothelial cells in the marrow
2nd most common bone tumour
Worst prognosis
Most common age 10 – 20 years

49
Q

Ewing’s Sarcoma Presentation

A

The great mimic: Hot, swollen, tender joint or limb with raised inflammatory markers
Can mimic infection
Be suspicious; ask about night pain and duration of symptoms; investigate early

50
Q

Should you be suspicious of night pain in bone?

A

Yes, investigate early and ask about duration of symptoms

Could be Ewing’s sarcoma :(

51
Q

Management for Ewing’s sarcoma

A

Management:
Poor prognosis
Surgical excision problematic
Often radio- and chemo-sensitive

52
Q

Why is Ewing’s sarcoma called the great mimc?

A

Can present as a hot, swollen, tender joint/limb with raised inflammatory markers

  • Can mimic infection
  • Be suspicious of night pain and duration of symptoms, investigate early
53
Q

Lipoma

A 
Can be discreet or less well defined
Slow growing and painless/non-tender
Can be large (several cms)
Characteristic consistency
No overlying skin changes
54
Q

What is a lipoma?

A

Benign neoplastic proliferation of fat

Often subcutaneous

55
Q

Management of lipomas

A

Based on symptoms
Can be left alone
Surgical excision is causing symptoms

Balance of removal vs scarring

56
Q

Where do sebaceous cysts occur?

A

Head, neck, trunk
Strictly speaking this is a dermatological condition
Mentioned only for completeness
Originate at hair follicles and fill with caseous material (keratin)

Presentation:
Slow growing, painless, mobile discreet swellings
Can become infected

Management: Excision if required

57
Q

Where do sebaceous cysts occur?

A

Hair follicles

Think head, neck, trunk

58
Q

Myositis ossificans?

A

Abnormal calcification of a muscle haematoma
is a benign process characterised by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes.

59
Q

Abnormal calcification of a muscle haematoma?

A

Myositis ossificans
is a benign process characterised by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes.

60
Q

If you are going to intervene in myositis ossificans, e.g. with surgery, how long to you have to wait and why?

A

Must wait until maturity of ossification otherwise risk of recurrence 6-12 months

Musculoskeletal (44 decks)

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