MSK Swellings Flashcards
what is important to ask in a history of trauma
onset, trauma, painful, size changes, systemic symptoms, other swellings, functional problems
what must you include in an exam of a swelling
site, size, shape generalised or discreet consistency- is it fluctuant surface texture mobile/ fixed temperature transluminable skin changes local lymphadenopathy
what are the history and exam features of a infection swelling
systemic upset
pyrexia
trauma (break in skin)
association with medical co morbities
calor, dolor, rubor, tumor
what is cellulitis
inflammation and infection of the soft tissues
describe the presentation of cellulitis
pain, generalised swelling, erythema, spectrum from minor infection to sepsis
what organisms commonly cause cellulitis
bet- haemolytic streps, staphylcocci
what is the management for cellulitis
rest, elevation, analgesia, splint, antibiotics (oral/ IV depending on severity)
NOT SURGERY
what is an abscess
discrete collection of pus
how do abscesses present
defined and fluctuant swelling, erythema, pain, history of trauma (bite, PWIDs)
spectrum from minor to septic
how do you manage abscesses
surgical incision and drainage
rest elevation, analgesia, splint, antibiotics
how can you get an infected joint (septic arthritis)
traumatic (joint penetration)
haematoginous spread
why is septic arthritis an orthopaedic emergency
as causes irreversible damage to hyaline articular cartilage
how does septic arthritis present
acute monoarthropathy
decreased ROM +/- swelling
systemic upset
raised WCC and inflammatory markers
how do you manage septic arthritis
urgent orthopaedic review, aspiration (M, C and S), urgent open/ arthoscopic washout + debridement
name 4 swelling specifically relating to joints
ganglia (bakers cyst), bursitis, gout, rheumatoid nodules
what are ganglia
outpouchings of the synovium lining of joints which are filled with synovial fluid
what do ganglia look like
discreet, round swellings, non tender, vary in size (mm to cms), skin mobile, fixed to underlying structure
often on wrists, feet and knees
what is the management for ganglia
based on symptoms/ function impairment
- nothing
- NOT ASPIRATION
- percutaneous rupture
- surgical excision
what is a bakers cyst
cyst/ ganglion of the popliteal fossa
what is the presentation of a bakers cyst
can appear as general fullness of the popliteal fossa
soft and non tender
associated with OA
painful rupture- swelling and bruising down calf
what is the management for a bakers cyst
non operative
what is bursitis
inflammation of the synovium lined sacs that protect bony prominences and joints
what is a possible complication of bursitis
can become secondarily infected and form an abscess
what is the management for bursitis
NSAIDs/ analgesia, antibiotics, incision and drainage (secondary infection), V rarely excision (chronic cases)
what is gout
an inflammatory arthritis most commonly affecting the great toe but can affect other joints (esp the knee) caused by deposition of uric acid crystal in the joint due to elevated serum urate
what is tophi
deposition of urate acid crystals in the joint
what cause acute attacks of gout
episodes of inflammation
what will chronic gout cause
progressive joint damage
what is gout associated with
purine rich food, alcohol, dairy
what is podagra
gout in the big toe
how does gout present
severe pain, red, hot, swollen joint
What shows on an aspiration of gout
negatibely birefringent monosodium urate crystals
what is the treatment for gout
NSAIDs, steroids, allopurinol
what are rheumatoid nodules
appear around joints in rheumatoid patients, associated with repetitive trauma
what is the presentation of rheumatoid nodules
chronic, in more severe RA, rheumatoid factor positive
what is seen in histology of rheumatoid nodules
intense inflammatory changes
how do you treat rheumatoid nodules
do not respond to DMARDs, excision if problematic, recurrence high
what are bouchards and heberdens nodes
bony swellings of the interphalangeal joints in the HAND caused by bony spurs due to chronic trauma
what the specific features of bouchards nodes
proximal IPJ, less common, OA or RA
what are the specific features of heberdens nodes
distal IPJ (think outer hebrides) , more common, just in OA
what is dupuytrens disease
progressive disease resulting in digital flexion contractures (not a disease of flexor tendons)
what is the pathology of dupuytrens
excessive myofibroblast proliferation and altered collagen matrix composition (type 3) cause thickened and contracted palmar fascia
avascular process involving o2 free radicals
what are the three factors thought to interact and cause dupuytrens
genetic predisposition (autosomal dominant, common in northern europe men>women), environmental factors (alcohol, diabetes and trauma), local and global protein expression (up and down enzyme regulation)
what is the management of dupuytrens
dependent on functional impediment
needle fasciotomy (cutting fascia to relive pressure),
collaginase injection
limited fasciectomy
dermofasciectomy + graft
what are the two types of giant cell tumour of the tendon sheath
localised (common) and diffuse (uncommon associated with PVNS)
what is a giant cell tumour of the tendon sheath
regenerative hyperplasia with inflammatory process, benign
how do giant cell tumour of the tendon sheath present
slowly enlargingm firm, discrete swelling, volar aspects of digits, can occur in toes, may/ nay not be tender
what is the management for giant cell tumour of the tendon sheath
leave alone if no functional issue
surgical excision
(marginal)
what is an osteochondroma
benign tumour- outgrowth of physis commonly occurring near the knee (distal femur/ proximal tibia metaphyseal regions)
its growth parallels that of the patient
who gets osteochondromas
occurs in adolescence
what does an osteochondroma look like pathologically
cartilage capped ossified pedicle
is there a risk of malignant change in osteochondroma
yes but low
when is there a higher chance of malignancy in osteochondromas
in multiple hereditary exostosis- multiple tumours
what is the presentation of an osteochondroma
painless hard lump
symptoms with activity- pain from tendons, numbness from nerve compression
rarely can be painful due to fracture
what is the management for a osteochondroma
close observation
surgical excision
what is an ewings sarcoma
malignant primary bone tumour of the endothelial cells in the marrow
which bone tumour has the worst prognosis
ewings sarcoma
who gets ewings sarcoma
most common age 10-20 years
where is the most common place to get ewings sarcoma
diaphysis/ metaphysis of long bones and pelvis
what is the presentation of ewings sarcoma
hot, swollen, tender joint or limb with raised inflammatory markers- CAN MIMIC INFECTION
BE SPECIFIC- ASK ABOUT NIGHT PAIN AND DURATION OF SYMPTOMS INVESTIGATE EARLY
what is the management for ewings sarcoma
prognosis poor
surgical excision problematic
often radio and chemo sensitive
what is a lipoma
benign neoplastic proliferation of fat, often subcutaneous
what is the presentation of a lipoma
can be discreet or less well defined slow growing and painless/ non-tender can be large (several cms) soft, movable masses no overlying skin changes
how do you manage lipomas
based on symptoms
can be left alone
surgical excision
(removal vs scarring)
what is a sebaceous cyst
(epidermoid/ pilar)
when hair follicles fill with caseous materal (keratin)
what is the presentation of a sebaceous cyst
slow growing, painless, mobile discreet swellings
can become infected
often of face, neck and trunk
what is the management for a sebaceous cyst
excision if required
what is myositis ossificans
abnormal calcification of a muscle haematoma
what is the typical history of myositis ossificans
trauma, initial soft tissue swelling, hardness develops over several weeks
how can you image myositis ossificans
XRs and MRI (shows peripheral mineralisation)
how do you manage myositis ossificans
observation
intervene only if symptoms demand
must wait until maturity of ossification- otherwise risk recurrence
