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MSK SB > MSK Swellings > Flashcards

MSK Swellings Flashcards

1
Q

Hx points for MSK swelling

A

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?

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2
Q

examination features of swelling

A 
site/size/shape
generalised (ill defined) 
discreet (well defined)
mobile or fixed
temp
transluminable
local lymphadenopathy
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3
Q

Hx of infections

A

systemic upset
pyrexia
trauma - break in skin
co-morbities

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4
Q

Ex of infections

A

calor
dolor
rubor
tumor

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5
Q

what is cellulitis

A

inflammation an infection of soft tissues

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6
Q

Sx of cellulitis

A 
generalised swelling rather than a discreet lump 
pain
swelling
erythema 
septic
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7
Q

organisms of cellulitis

A

beta haemolytic streps

staph

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8
Q

Mx of cellulitis

A

Rest + Elevation
Analgesia
Splint if very sore
Antibiotics; penicillin or flucloxacillin

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9
Q

what is an abscesses

A

discreet collection of pus

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10
Q

presentation of abscess

A

defined and fluctuant swelling
erythema, pain
history of trauma e.g.bite, IVDU

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11
Q

Mx of abscess

A

surgical incision
DRAINAGE
‘if there’s pus, let it out’

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12
Q

what is septic arthritis

A

orthopaedic emergency
bacterial infection of a joint
- either traumatic or haematoginous

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13
Q

why is sceptic arthritis an orthopaedic emergency

A

due to the possibility of irreversible damage to hyaline articular cartilage

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14
Q

presentation of septic arthritis

A 
Acute monoarthropathy
Refuse to weight bear
Swelling
Systemic upset
Raised WCC + inflam markers
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15
Q

Ix for septic arthritis

A

synovial fluid gram stain and culture
X-ray
US - for effusion

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16
Q

Mx for septic arthritis

A 
Aspirate the joint
Joint washout/debridement
IV antibiotics (empirical or specific)
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17
Q

what swellings can occur around the joints

A

Ganglia - esp Baker’s cyst
Bursitis
Gout
Rheumatoid nodules

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18
Q

whats is a ganglia

A

Outpouchings of the synovium lining of joints and filled with synovial fluid

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19
Q

what are appearance of ganglia

A

Discreet, round swellings

Non-tender

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20
Q

Mx of ganglia

A

based upon symptoms/function impairment

  • nothing if not bothering the patient
  • percutaneous rupture
  • surgical excision; leaves scar
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21
Q

what is not recommended for ganglia treatment

A

aspiration

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22
Q

what is a baker’s cyst

A

a ganglion of the popliteal fossa

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23
Q

appearance of baker’s cyst

A

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

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24
Q

Mx of baker’s cyst

A

non-operative

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25
Q

what is bursitis

A

Inflammation of the synovium lined sacs that protect bony prominences and joints

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26
Q

complications of bursitis

A

can become secondarily infected and form an abscess

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27
Q

Mx of bursitis

A

NSAIDs/Analgesia
Antibiotics
Incision and drainage (secondary infection)
Excision - for chronic cases

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28
Q

what is a common bursitis

A

bunion

29
Q

what causes gout

A

elevated urate causes a deposition of uric acid crystals in joints

30
Q

presentation of gout

A

Severe pain, Red, hot, swollen joint

Sometimes mistaken for septic arthritis

31
Q

what is seen in an aspirate of gout

A

Negatively birefringent monosodium urate crystals

32
Q

what are rheumatoid nodules

A

Appear around joints in rheumatoid patients

associated with repetitive trauma

33
Q

presentation of rheumatoid nodules

A

Chronic, more severely affected RA patients, rheumatoid factor +ve

34
Q

what is seen in the histology of rheumatoid nodules

A

intense inflammatory changes

35
Q

Mx of rheumatoid nodules

A

do not respond to DMARDs
excise if problematic (scar vs nodule)
recurrence high

36
Q

where are bouchard’s nodes seen and associations

A

proximal IPJ i.e. closer to your Body
less common
OA or RA

37
Q

where are Heberden’s nodes seen and their associations

A

distal IPJ - think outer Hebrides
more common
OA only

38
Q

what is Dupuythren’s disease

A

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

39
Q

what are the features of Dupuytren’s disease

A

bands are collagen type III

abnormal palmar fascia

40
Q

what does D.Disease resultin

A

digital flexion contractures

NOT a disease of flexor tendons

41
Q

what finger is commonly affected in D.disease

A

ring finger

42
Q

Mx of D.disease

A

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

43
Q

Firm, discreet swelling, usually on volar aspect of digits - diagnosis?

A

giant cell tumour of tendon sheath

44
Q

what are the two types of giant cell tumours of the tendon sheath

A

localised - common

diffuse - uncommon, associated with Pigmented villonodular synovitis

45
Q

what is a giant cell tumour

A

benign

regenerative hyperplasia with inflammatory process

46
Q

Mx of giant cell tumour of tumour sheath

A

leave alone if no functional issue

surgery - marginal excision

47
Q

what are lipomas

A

benign neoplastic proliferation of fat that are subcutaneous

48
Q

presentations of lipomas

A 
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
49
Q

Mx of lipoma

A

based on symptoms
can be left alone
surgical excision

50
Q

what surgical techniques are used in excisions to reduce risk of scars

A

S-shaped incision

Langer’s lines

51
Q

what are osteochondromas

A

benign lesion derived from aberrant cartilage from the perichondral ring

52
Q

what are the two types of osteochondromas

A

solitary osteochondromas

multiple hereditary exostosis (MHE)

53
Q

where do osteochondromas commonly occur

A

near the knee

distal femur/proximal tibia

54
Q

description of osteochondromas

A

cartilage capped ossified pedicle

55
Q

is there a potential for malignant change in osteochondromas

A

yes but a small potential

more chance in MHE

56
Q

presentation of osteochondromas

A

Painless, hard lump

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

57
Q

Mx of osteochondromas

A

close observation

surgical excision

58
Q

Ix for osteochondromas

A

X-rays

59
Q

what is an Ewings sarcoma

A

malignant primary bone tumour of the endothelial cells in the marrow
2nd most common malignant bone tumour
worst prognosis
10-20 y.o

60
Q

presentation of Ewings sarcoma

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

61
Q

Tx for ES

A

radio and chemo sensitive

62
Q

what is a sebaceous cysts

A

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

63
Q

Presentation of sebaceous cysts

A

Slow growing, painless, mobile discreet swellings
Face/Neck/Trunk
Can become infected

64
Q

Mx of sebaceous cysts

A

excision if required

65
Q

what is myositis ossificans

A

abnormal calcification of a muscle haematoma

66
Q

Hx of MO

A

trauma

initial soft swelling&raquo_space; hardness develops over several weeks

67
Q

Ix for MO

A

Xray

MRI

68
Q

Mx for MO

A

Observation

Intervene if symptoms demand

MSK SB (15 decks)

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