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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
Rheumatoid factor positive in rheumatoid nodule presentation?
Yesh
26
What causes Bouchards/Heberden's nodes?
Bony spurs due to chronic trauma
27
Which are more common, Bouchards or Heberdens?
Heberdens
28
Which conditions would you fins bouchards and heberdens nodes in?
Bouchards: OA/RA Heberdens: OA
29
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
Dupuytren's disease
30
Which type of collagen makes up the bands in Dupuytren's disease?
Collagen type III
31
Dupuytren's disease
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
Avascular process involving O2 free radicals?
Dupuytren's disease
33
Excessive MYOFIBROBLAST proliferation and altered collagen matrix composition leading to thickened and contracted PALMAR FASCIA?
Dupuytren's disease
34
Which 3 factors contribute to Dupuytrens?
- Genetic predispostion - Environmental factors - Local and global protein expression
35
Method of inheritance of Dupuytrens
Autosomal dominant with variable penetration
36
Environmental factors contributing to Dupuytren's disease
Alchohol, diabetes, trauma
37
Factors predisposing to Dupuytren's disease
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
Traeatment for Dupuytren's disease
Needle fasciotomy Collaginase injection Limited fasciectomy Dermofasciectomy + graft
39
PVNS
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
Giant Cell Tumour of the Tendon Sheath
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
Management of giant cell tumour of the tendon sheath
Leave alone if no functional issue! Surgical excision: Usually marginal excision, i.e. not complete as adherent to tendon sheath Incidence of recurrence
42
Where would an osteochonroma most likely occur?
Near the knee | Distal femur / proximal tibia metaphyseal regions
43
Presentation of osteochondroma
Painless, hard lump | Symptoms with activity (pain from tendons; numbness from nerve compression)
44
Why might you feel numbness during activity if you have an osteochondroma?
Osteochondroma might compress nerves
45
Managment of osteochondroma
Management: Close observation Surgical excision
46
Which cells does a Ewings sarcoma originate from?
Endothelial cells (E for Ewings, E for endothelial)
47
Ages affected by Ewings sarcoma?
10-20
48
Ewing's Sarcoma
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
Ewing's Sarcoma Presentation
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
Should you be suspicious of night pain in bone?
Yes, investigate early and ask about duration of symptoms | Could be Ewing's sarcoma :(
51
Management for Ewing's sarcoma
Management: Poor prognosis Surgical excision problematic Often radio- and chemo-sensitive
52
Why is Ewing's sarcoma called the great mimc?
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
Lipoma
``` 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
What is a lipoma?
Benign neoplastic proliferation of fat | Often subcutaneous
55
Management of lipomas
Based on symptoms Can be left alone Surgical excision is causing symptoms Balance of removal vs scarring
56
Where do sebaceous cysts occur?
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
Where do sebaceous cysts occur?
Hair follicles | Think head, neck, trunk
58
Myositis ossificans?
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
Abnormal calcification of a muscle haematoma?
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
If you are going to intervene in myositis ossificans, e.g. with surgery, how long to you have to wait and why?
Must wait until maturity of ossification otherwise risk of recurrence 6-12 months

Musculoskeletal (44 decks)

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