swelling Flashcards
name some general causes of swelling
Infection
Cellulitis
Abscess
Septic Arthritis
name some swellings related to joints
Ganglion Bakers Cyst Bursitis Gout Rheumatoid nodules
what are some swellings relating to hand nodes
Bouchards Nodes
Heberden’s Nodes
what are the history features of swelling
Systemic upset
Pyrexia
Trauma (break in skin)
Association with medical co-morbities
what is cellulitis
Inflammation and infection of the soft tissues
A generalised swelling rather than a discreet lump
presentation of cellulitis
pain
swelling
erythema
microorganisms for cellulitis
β-haemolytic streps, staphylococci
management of cellulitis
Rest, elevation, analgesia, splint Antibiotics; oral vs IV; penicillin
management for an abscess
SURGICAL INCISION & DRAINAGE
“If there’s pus, let it out” (Mr Clift)
Rest, elevation, analgesia, splint
Antibiotics
organisms for septic arthritis
Staph. Aureus / Strep / E.Coli
does septic arthritis cause Irreversible damage to hyaline articular cartilage
yes
presentation of septic arthritis
Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflammatory markers
management of septic arthritis
A-E Assessment
Urgent orthopaedic review
Aspiration; M,C & S
Urgent Open / arthoscopic washout + debridement
describe the appearance of ganglia
Discreet, round swellings Non-tender <10mm – several cms Skin mobile, fixed to underlying structures Wrists, feet, knees
management of ganglia
Nothing
NOT aspiration
Percutaneous rupture
Surgical excision
what is a baker’s cyst
cyst/ganglion of the popliteal fossa
presentation of a baker’s cyst
Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture
management of baker’s cyst
analgesia
what is bursitis
Inflammation of the synovium lined sacs that protect bony prominences and joints
management of 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
Elevated serum urate causes a deposition of uric acid crystals in joints
Episodes of inflammation result in acute attacks
Will cause chronic progressive joint damage
associations of gout
Purine rich food, alcohol, dairy
presentation of gout
Severe pain,
Red, hot, swollen joint
Sometimes mistaken for septic arthritis
treatment for gout
NSAIDs
Steroids
Allopurinol
what are Bouchards and hebredens nodes
These are bony swellings of the interphalangeal joints in hands
Caused by bony spurs due to chronic trauma
where are bouchards nodes
Proximal IPJ
Less common
OA or RA
where are heberdens nodes
Distal IPJ
More common
OA
what is dupuytren’s
Progressive disease resulting in digital flexion contractures
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
risk factors for dupuytrens
alcohol
diabetes
genetics
trauma
management of dupuytren’s
Needle fasciotomy (single band)
Limited fasciectomy (removal of the bands)
Dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)
what is a lipoma
Benign neoplastic proliferation of fat
subcutaneous
presentation of a lipoma
Can be discreet or less well defined Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes
management of lipoma
Based on symptoms
Can be left alone
Surgical excision if causing symptoms
what is myositis ossificans
Abnormal calcification of a muscle haematoma
history of myositis ossificans
Trauma, initial soft swelling, hardness develops over several weeks
management of myositis ossificans
Observation
Intervene only if symptoms demand
Must wait until maturity of ossification, otherwise risk of recurrence (6-12 months)
