MSK Swellings Flashcards
What features of an MSK history would make you think of an infection?
Systemic upset
Pyrexia
Trauma (break in skin)
Association with medical co-morbities
What are the common examination findings when there is infection present
Calor
Dolor
Rubor
Tumor
What is cellulitis and how does it normally appear?
Inflammation and infection of the soft tissues
A generalised swelling rather than a discreet lump
What organisms usually cause a cellulitis?
β-haemolytic streps, staphylococci
How is cellulitis managed?
Rest elevation analgesia splint Antibiotics - penicillin
NOT SURGERY
What is an abscess and how does it clinically present?
Discreet collection of pus
Presentation: Defined and fluctuant swelling
Erythema, pain
How is an abscess treated?
SURGICAL INCISION and DRAINAGE
“If there’s pus, let it out”
+ Rest, elevation, analgesia, splint, Antibiotics
How does a joint become bacterially infected?
Traumatic (joint penetration)
Haematoginous spread
Why is septic arthritis an orthopaedic emergency?
Pus causes irreversible damage to hyaline articular cartilage
What organisms are most likely to cause a septic arthritis?
Staph. Aureus / Strep. / E.Coli
How do ganglia usually appear?
Discreet, round swellings
Non-tender
<10mm – several cms
Skin mobile, fixed to underlying structures
What joints are more prone to ganglia?
Wrists
feet
knees
Why should ganglia not be aspirated?
They will just refill with synovial fluid
What name is given to a ganglion of the popliteal fossa?
Baker’s Cyst
How does a Bakers cyst usually present?
Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture
What can happen if a Bakers Cyst ruptures?
Fluid can travel down calf and produce pain there
What condition is characterised by Inflammation of the synovium lined sacs that protect bony prominences and joints?
Bursitis
What can form if a bursitis becomes secondarily infected?
abscess
How is a bursitis treated?
NSAIDs / Analgesia
If infected:
Antibiotics
Incision and drainage
Very rarely excision (chronic cases)
What is thought to be the cause of Rheumatoid nodules?
Repetitive trauma in RA
Rheumatoid nodules respond to DMARDS. TRUE/FALSE?
FALSE
What is the difference between Bouchard’s and Heberden’s Nodes?
Bouchard’s nodes:
- PIP joints
- OA or RA
Heberden’s nodes:
- DIP
- OA
What are the two types of Giant Cell Tumours that occur in the tendon sheath
Localised (common)
Diffuse (uncommon)
How do Giant cell Tumours of the tendon sheath usually present?
Slowly enlarging
Firm, discreet swelling, usually on volar aspect of digits
Can occur in toes
May or may not be tender
How are giant cell tumours of the tendon sheath usually treated?
No tx if not affecting Pt
Surgery:
marginal excision, ie. not complete
BUT Incidence of recurrence
Where does an osteochondroma usually present?
Distal femur / proximal tibia metaphyseal regions
Who usually gets an osteochondroma?
adolescents, outgrowth of physis
Why do osteochondromas feel hard when palpated
Cartilage capped ossified pedicle
How would a patient with an osteochondroma present?
Painless, hard lump
Symptoms with activity
(pain from tendons; numbness from nerve compression)
How is an osteochondroma treated?
Close observation
Possible surgical excision
What condition is described as a malignant primary bone tumour of the endothelial cells in the marrow?
Ewings Sarcoma
What age are the patients who usually develop a Ewings sarcoma?
10-20 years old
Where does a Ewings sarcoma usually present?
diaphysis/metaphysis of long bones and pelvis
How does a Ewings sarcoma present clinically?
Hot, swollen, tender joint or limb with raised inflammatory markers
=> Can mimic infection
=> ask about night pain etc
What is a Lipoma?
Benign neoplastic proliferation of fat
How does a lipoma usually present?
- discreet or less well defined
- Slow growing
- painless/non-tender
- large (several cms)
- soft, movable masses
- No overlying skin changes
What must the patient consider about surgery for a lipoma?
The scar they are left with may be larger or more painful than the original lipoma
Where are sebaceous cysts more commonly found?
Head
Neck
Trunk
What condition is described as abnormal calcification of a muscle?
Myositis ossificans
Why must you wait until a muscle ossification has matured before surgically intervening?
If ossification is not mature, there is a risk of recurrence (6-12 months)
