MSK Swellings Flashcards
Hx points for MSK swelling
When did it appear; gradually or suddenly?
Any history of trauma?
Is it painful?
Is the size increasing, staying the same or does that fluctuate?
Is the patient unwell in any way? (Systemic symptoms)
Do they have or have they had any other similar swellings?
What functional problems does it cause?
examination features of swelling
site/size/shape generalised (ill defined) discreet (well defined) mobile or fixed temp transluminable local lymphadenopathy
Hx of infections
systemic upset
pyrexia
trauma - break in skin
co-morbities
Ex of infections
calor
dolor
rubor
tumor
what is cellulitis
inflammation an infection of soft tissues
Sx of cellulitis
generalised swelling rather than a discreet lump pain swelling erythema septic
organisms of cellulitis
beta haemolytic streps
staph
Mx of cellulitis
Rest + Elevation
Analgesia
Splint if very sore
Antibiotics; penicillin or flucloxacillin
what is an abscesses
discreet collection of pus
presentation of abscess
defined and fluctuant swelling
erythema, pain
history of trauma e.g.bite, IVDU
Mx of abscess
surgical incision
DRAINAGE
‘if there’s pus, let it out’
what is septic arthritis
orthopaedic emergency
bacterial infection of a joint
- either traumatic or haematoginous
why is sceptic arthritis an orthopaedic emergency
due to the possibility of irreversible damage to hyaline articular cartilage
presentation of septic arthritis
Acute monoarthropathy Refuse to weight bear Swelling Systemic upset Raised WCC + inflam markers
Ix for septic arthritis
synovial fluid gram stain and culture
X-ray
US - for effusion
Mx for septic arthritis
Aspirate the joint Joint washout/debridement IV antibiotics (empirical or specific)
what swellings can occur around the joints
Ganglia - esp Baker’s cyst
Bursitis
Gout
Rheumatoid nodules
whats is a ganglia
Outpouchings of the synovium lining of joints and filled with synovial fluid
what are appearance of ganglia
Discreet, round swellings
Non-tender
Mx of ganglia
based upon symptoms/function impairment
- nothing if not bothering the patient
- percutaneous rupture
- surgical excision; leaves scar
what is not recommended for ganglia treatment
aspiration
what is a baker’s cyst
a ganglion of the popliteal fossa
appearance of baker’s cyst
Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture
Mx of baker’s cyst
non-operative
what is bursitis
Inflammation of the synovium lined sacs that protect bony prominences and joints
complications of bursitis
can become secondarily infected and form an abscess
Mx of bursitis
NSAIDs/Analgesia
Antibiotics
Incision and drainage (secondary infection)
Excision - for chronic cases
what is a common bursitis
bunion
what causes gout
elevated urate causes a deposition of uric acid crystals in joints
presentation of gout
Severe pain, Red, hot, swollen joint
Sometimes mistaken for septic arthritis
what is seen in an aspirate of gout
Negatively birefringent monosodium urate crystals
what are rheumatoid nodules
Appear around joints in rheumatoid patients
associated with repetitive trauma
presentation of rheumatoid nodules
Chronic, more severely affected RA patients, rheumatoid factor +ve
what is seen in the histology of rheumatoid nodules
intense inflammatory changes
Mx of rheumatoid nodules
do not respond to DMARDs
excise if problematic (scar vs nodule)
recurrence high
where are bouchard’s nodes seen and associations
proximal IPJ i.e. closer to your Body
less common
OA or RA
where are Heberden’s nodes seen and their associations
distal IPJ - think outer Hebrides
more common
OA only
what is Dupuythren’s disease
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
what are the features of Dupuytren’s disease
bands are collagen type III
abnormal palmar fascia
what does D.Disease resultin
digital flexion contractures
NOT a disease of flexor tendons
what finger is commonly affected in D.disease
ring finger
Mx of D.disease
dependant on functional impediment
Needle fasciotomy - single band
Limited fasciotomy - removal of bands
Dermofasciectomy + graft - removal of the band, adherent/contracted skin and covering graft
Firm, discreet swelling, usually on volar aspect of digits - diagnosis?
giant cell tumour of tendon sheath
what are the two types of giant cell tumours of the tendon sheath
localised - common
diffuse - uncommon, associated with Pigmented villonodular synovitis
what is a giant cell tumour
benign
regenerative hyperplasia with inflammatory process
Mx of giant cell tumour of tumour sheath
leave alone if no functional issue
surgery - marginal excision
what are lipomas
benign neoplastic proliferation of fat that are subcutaneous
presentations of lipomas
Can be discreet or less well defined (if very large) Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes
Mx of lipoma
based on symptoms
can be left alone
surgical excision
what surgical techniques are used in excisions to reduce risk of scars
S-shaped incision
Langer’s lines
what are osteochondromas
benign lesion derived from aberrant cartilage from the perichondral ring
what are the two types of osteochondromas
solitary osteochondromas
multiple hereditary exostosis (MHE)
where do osteochondromas commonly occur
near the knee
distal femur/proximal tibia
description of osteochondromas
cartilage capped ossified pedicle
is there a potential for malignant change in osteochondromas
yes but a small potential
more chance in MHE
presentation of osteochondromas
Painless, hard lump
Symptoms with activity (pain from tendons; numbness from nerve compression)
Mx of osteochondromas
close observation
surgical excision
Ix for osteochondromas
X-rays
what is an Ewings sarcoma
malignant primary bone tumour of the endothelial cells in the marrow
2nd most common malignant bone tumour
worst prognosis
10-20 y.o
presentation of Ewings sarcoma
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
Tx for ES
radio and chemo sensitive
what is a sebaceous cysts
originate at hair follicles and fill with caseous material (keratin)
Presentation of sebaceous cysts
Slow growing, painless, mobile discreet swellings
Face/Neck/Trunk
Can become infected
Mx of sebaceous cysts
excision if required
what is myositis ossificans
abnormal calcification of a muscle haematoma
Hx of MO
trauma
initial soft swelling»_space; hardness develops over several weeks
Ix for MO
Xray
MRI
Mx for MO
Observation
Intervene if symptoms demand
