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
