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MSK- Spine and Upper Limb > Soft Tissue Swellings > Flashcards

Soft Tissue Swellings Flashcards

1
Q

A swelling causing what type of pain may suggest a malignancy?

A

A chronic, constant dull pain which keeps you up at night

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2
Q

What investigation is best to differentiate between fluid filled and solid nodules?

A

Ultrasound

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3
Q

What tests can be used to investigate soft tissue swelings?

A

Ultrasound, MRI, biopsy

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4
Q

What are lipomas and where do they usually occur?

A

Common benign fatty tumours which are usually seen in subcutaneous fat

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5
Q

How would you describe lipomas?

A

They are entirely benign. They are painless though can be large

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6
Q

Where in the upper limb are lipomas found?

A

At the back of the shoulder

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7
Q

Are liposarcomas common?

A

No, very rare

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8
Q

What is the commonest type of hand swelling?

A

Ganglion

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9
Q

Describe the outer and inner lining of a ganglion?

A

Fibrous outer lining and synovial inner lining

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10
Q

When ganglions occur at the DIP joint what do they become?

A

Mucous cysts

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11
Q

What are mucous cysts due to? Why should they be excised?

A

OA, there is a risk of infection

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12
Q

What is the success rate of aspiration of a ganglion? When should they be excised?

A

50% recurrence rate, should only be excised if painful

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13
Q

What is the second most common soft tissue swelling of the hand?

A

Giant cell tumour

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14
Q

Where do giant cell tumours usually occur on the hand?

A

The palmar surface, especially around the PIP of the index/middle fingers

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15
Q

Where do giant cell tumours arise from?

A

The synovium of a tendon sheath or joint

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16
Q

What do giant cell tumours contain?

A

Haemosiderin and multinucleate giant cells

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17
Q

How do giant cell tumours usually look?

A

They are usually well circumscribed but can be diffuse

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18
Q

Why should giant cell tumours be excised?

A

Because they are painful and can become malignant

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19
Q

What are some problems that giant cell tumours can cause?

A

Envelope a digital nerve or artery and can erode through bone

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20
Q

What is the risk of recurrence of giant cell tumours?

A

10-20%

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21
Q

What is pigmented villonodular synovitis?

A

A tumour from the synovium

22
Q

What are the two types of pigmented villonodular synovitis?

A

Nodular or diffuse

23
Q

Where is pigmented villonodular synovitis usually seen?

A

Large joints, especially the knee

24
Q

What can pigmented villonodular synovitis result in?

A

Destruction and arthritis

25
Q

What is the treatment for pigmented villonodular synovitis?

A

Synovectomy if young, joint replacement if old

26
Q

What is a Baker’s cyst a type of?

A

Ganglion

27
Q

A Baker’s cyst is a cyst from synovial fluid through a one way valve to where?

A

Semimembranosus bursa or medial gastrocnemius bursa

28
Q

What is the outcome of a Baker’s cyst in children?

A

Will usually resolve

29
Q

What does a Baker’s cyst in adults suggest?

A

Intra-articular pathology or arthritis

30
Q

Should Baker’s cysts be excised? Why/why not?

A

No because there is a really high recurrence rate

31
Q

What is bursitis?

A

Inflammation of a bursa

32
Q

What is the function of a bursa?

A

Prevent friction

33
Q

Where are the most common presentations of bursitis?

A

Olecranon, pre patellar, infra patellar, 1st metatarsal head (bunion)

34
Q

What is the treatment for bursitis?

A

Arthroscopic bursectomy

35
Q

What should you not do in cases of bursitis?

A

Inject or excise

36
Q

What type of bursitis communicates with the knee joint? What is this usually a type of?

A

Suprapatellar bursa, usually septic arthritis

37
Q

What types of bursitis are outwith the knee joint?

A

Infrapatellar and prepatellar

38
Q

What is an implantation dermoid usually a result of?

A

Penetrating trauma

39
Q

What happens in an implantation dermoid?

A

Epithelial cells in the subcutaneous tissue which form a reactive cyst with a pseudocapsule and grey fluid

40
Q

Will a patient with an epidermoid cyst always recall an incident which caused it?

A

Not necessarily

41
Q

Epidermoid (sebaceous) cysts are common and can occur everywhere except where?

A

Palms and soles

42
Q

What happens in epidermoid cysts?

A

Epidermal cells get into the subcutaneous tissue and form a cyst, cells lining this cyst secrete keratin

43
Q

How will an abscess present clinically?

A

Fluctuating in size and very painful

44
Q

How is an abscess treated?

A

Excision and drainage

45
Q

What is heterotrophic ossification/myositis ossificans?

A

Blunt trauma causes intramuscular haematoma which calcifies

46
Q

How does heterotrophic ossification progress?

A

Usually painless, can diminish over time

47
Q

What can heterotrophic ossification be confused with on MRI?

A

Osteosarcoma

48
Q

What can heterotrophic ossification occur after? What does it cause?

A

Hip replacement- causes diminished range of movement

49
Q

What are some treatment options for heterotrophic ossification?

A

Excision after 12 months or radiotherapy

50
Q

How do malignant soft tissue swellings present?

A

Can occur at any age and are often painless

51
Q

What is the first test for suspected soft tissue malignancy? If there is still uncertainty after this what should be done?

A

MRI, if unsure do biopsy

MSK- Spine and Upper Limb (13 decks)

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