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MSK > MSK Swellings > Flashcards

MSK Swellings Flashcards

1
Q

what is important to ask in a history of trauma

A

onset, trauma, painful, size changes, systemic symptoms, other swellings, functional problems

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2
Q

what must you include in an exam of a swelling

A 
site, size, shape 
generalised or discreet 
consistency- is it fluctuant 
surface texture 
mobile/ fixed
temperature 
transluminable
skin changes 
local lymphadenopathy
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3
Q

what are the history and exam features of a infection swelling

A

systemic upset
pyrexia
trauma (break in skin)
association with medical co morbities

calor, dolor, rubor, tumor

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4
Q

what is cellulitis

A

inflammation and infection of the soft tissues

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5
Q

describe the presentation of cellulitis

A

pain, generalised swelling, erythema, spectrum from minor infection to sepsis

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6
Q

what organisms commonly cause cellulitis

A

bet- haemolytic streps, staphylcocci

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7
Q

what is the management for cellulitis

A

rest, elevation, analgesia, splint, antibiotics (oral/ IV depending on severity)

NOT SURGERY

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8
Q

what is an abscess

A

discrete collection of pus

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9
Q

how do abscesses present

A

defined and fluctuant swelling, erythema, pain, history of trauma (bite, PWIDs)
spectrum from minor to septic

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10
Q

how do you manage abscesses

A

surgical incision and drainage

rest elevation, analgesia, splint, antibiotics

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11
Q

how can you get an infected joint (septic arthritis)

A

traumatic (joint penetration)

haematoginous spread

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12
Q

why is septic arthritis an orthopaedic emergency

A

as causes irreversible damage to hyaline articular cartilage

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13
Q

how does septic arthritis present

A

acute monoarthropathy
decreased ROM +/- swelling
systemic upset
raised WCC and inflammatory markers

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14
Q

how do you manage septic arthritis

A

urgent orthopaedic review, aspiration (M, C and S), urgent open/ arthoscopic washout + debridement

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15
Q

name 4 swelling specifically relating to joints

A

ganglia (bakers cyst), bursitis, gout, rheumatoid nodules

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16
Q

what are ganglia

A

outpouchings of the synovium lining of joints which are filled with synovial fluid

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17
Q

what do ganglia look like

A

discreet, round swellings, non tender, vary in size (mm to cms), skin mobile, fixed to underlying structure
often on wrists, feet and knees

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18
Q

what is the management for ganglia

A

based on symptoms/ function impairment

  • nothing
  • NOT ASPIRATION
  • percutaneous rupture
  • surgical excision
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19
Q

what is a bakers cyst

A

cyst/ ganglion of the popliteal fossa

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20
Q

what is the presentation of a bakers cyst

A

can appear as general fullness of the popliteal fossa
soft and non tender
associated with OA
painful rupture- swelling and bruising down calf

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21
Q

what is the management for a bakers cyst

A

non operative

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22
Q

what is bursitis

A

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

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23
Q

what is a possible complication of bursitis

A

can become secondarily infected and form an abscess

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24
Q

what is the management for bursitis

A

NSAIDs/ analgesia, antibiotics, incision and drainage (secondary infection), V rarely excision (chronic cases)

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25
Q

what is gout

A

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

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26
Q

what is tophi

A

deposition of urate acid crystals in the joint

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27
Q

what cause acute attacks of gout

A

episodes of inflammation

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28
Q

what will chronic gout cause

A

progressive joint damage

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29
Q

what is gout associated with

A

purine rich food, alcohol, dairy

30
Q

what is podagra

A

gout in the big toe

31
Q

how does gout present

A

severe pain, red, hot, swollen joint

32
Q

What shows on an aspiration of gout

A

negatibely birefringent monosodium urate crystals

33
Q

what is the treatment for gout

A

NSAIDs, steroids, allopurinol

34
Q

what are rheumatoid nodules

A

appear around joints in rheumatoid patients, associated with repetitive trauma

35
Q

what is the presentation of rheumatoid nodules

A

chronic, in more severe RA, rheumatoid factor positive

36
Q

what is seen in histology of rheumatoid nodules

A

intense inflammatory changes

37
Q

how do you treat rheumatoid nodules

A

do not respond to DMARDs, excision if problematic, recurrence high

38
Q

what are bouchards and heberdens nodes

A

bony swellings of the interphalangeal joints in the HAND caused by bony spurs due to chronic trauma

39
Q

what the specific features of bouchards nodes

A

proximal IPJ, less common, OA or RA

40
Q

what are the specific features of heberdens nodes

A

distal IPJ (think outer hebrides) , more common, just in OA

41
Q

what is dupuytrens disease

A

progressive disease resulting in digital flexion contractures (not a disease of flexor tendons)

42
Q

what is the pathology of dupuytrens

A

excessive myofibroblast proliferation and altered collagen matrix composition (type 3) cause thickened and contracted palmar fascia
avascular process involving o2 free radicals

43
Q

what are the three factors thought to interact and cause dupuytrens

A 
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)
44
Q

what is the management of dupuytrens

A

dependent on functional impediment

needle fasciotomy (cutting fascia to relive pressure),
collaginase injection
limited fasciectomy
dermofasciectomy + graft

45
Q

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

A

localised (common) and diffuse (uncommon associated with PVNS)

46
Q

what is a giant cell tumour of the tendon sheath

A

regenerative hyperplasia with inflammatory process, benign

47
Q

how do giant cell tumour of the tendon sheath present

A

slowly enlargingm firm, discrete swelling, volar aspects of digits, can occur in toes, may/ nay not be tender

48
Q

what is the management for giant cell tumour of the tendon sheath

A

leave alone if no functional issue
surgical excision
(marginal)

49
Q

what is an osteochondroma

A

benign tumour- outgrowth of physis commonly occurring near the knee (distal femur/ proximal tibia metaphyseal regions)
its growth parallels that of the patient

50
Q

who gets osteochondromas

A

occurs in adolescence

51
Q

what does an osteochondroma look like pathologically

A

cartilage capped ossified pedicle

52
Q

is there a risk of malignant change in osteochondroma

A

yes but low

53
Q

when is there a higher chance of malignancy in osteochondromas

A

in multiple hereditary exostosis- multiple tumours

54
Q

what is the presentation of an osteochondroma

A

painless hard lump
symptoms with activity- pain from tendons, numbness from nerve compression
rarely can be painful due to fracture

55
Q

what is the management for a osteochondroma

A

close observation

surgical excision

56
Q

what is an ewings sarcoma

A

malignant primary bone tumour of the endothelial cells in the marrow

57
Q

which bone tumour has the worst prognosis

A

ewings sarcoma

58
Q

who gets ewings sarcoma

A

most common age 10-20 years

59
Q

where is the most common place to get ewings sarcoma

A

diaphysis/ metaphysis of long bones and pelvis

60
Q

what is the presentation of ewings sarcoma

A

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

61
Q

what is the management for ewings sarcoma

A

prognosis poor
surgical excision problematic
often radio and chemo sensitive

62
Q

what is a lipoma

A

benign neoplastic proliferation of fat, often subcutaneous

63
Q

what is the presentation of a lipoma

A 
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
64
Q

how do you manage lipomas

A

based on symptoms
can be left alone
surgical excision
(removal vs scarring)

65
Q

what is a sebaceous cyst

A

(epidermoid/ pilar)

when hair follicles fill with caseous materal (keratin)

66
Q

what is the presentation of a sebaceous cyst

A

slow growing, painless, mobile discreet swellings
can become infected
often of face, neck and trunk

67
Q

what is the management for a sebaceous cyst

A

excision if required

68
Q

what is myositis ossificans

A

abnormal calcification of a muscle haematoma

69
Q

what is the typical history of myositis ossificans

A

trauma, initial soft tissue swelling, hardness develops over several weeks

70
Q

how can you image myositis ossificans

A

XRs and MRI (shows peripheral mineralisation)

71
Q

how do you manage myositis ossificans

A

observation
intervene only if symptoms demand

must wait until maturity of ossification- otherwise risk recurrence

MSK (71 decks)

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