swelling

Question 1

name some general causes of swelling

Answer 1

Infection
Cellulitis
Abscess
Septic Arthritis

Question 2

name some swellings related to joints

Answer 2

Ganglion
Bakers Cyst 
Bursitis 
Gout
Rheumatoid nodules

Question 3

what are some swellings relating to hand nodes

Answer 3

Bouchards Nodes

Heberden’s Nodes

Question 4

what are the history features of swelling

Answer 4

Systemic upset
Pyrexia
Trauma (break in skin)
Association with medical co-morbities

Question 5

what is cellulitis

Answer 5

Inflammation and infection of the soft tissues

A generalised swelling rather than a discreet lump

Question 6

presentation of cellulitis

Answer 6

pain
swelling
erythema

Question 7

microorganisms for cellulitis

Answer 7

β-haemolytic streps, staphylococci

Question 8

management of cellulitis

Answer 8

Rest, elevation, analgesia, splint Antibiotics; oral vs IV; penicillin

Question 9

management for an abscess

Answer 9

SURGICAL INCISION & DRAINAGE
“If there’s pus, let it out” (Mr Clift)
Rest, elevation, analgesia, splint
Antibiotics

Question 10

organisms for septic arthritis

Answer 10

Staph. Aureus / Strep / E.Coli

Question 11

does septic arthritis cause Irreversible damage to hyaline articular cartilage

Answer 11

yes

Question 12

presentation of septic arthritis

Answer 12

Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflammatory markers

Question 13

management of septic arthritis

Answer 13

A-E Assessment
Urgent orthopaedic review
Aspiration; M,C & S
Urgent Open / arthoscopic washout + debridement

Question 14

describe the appearance of ganglia

Answer 14

Discreet, round swellings
Non-tender
<10mm – several cms
Skin mobile, fixed to underlying structures
Wrists, feet, knees

Question 15

management of ganglia

Answer 15

Nothing

NOT aspiration

Percutaneous rupture

Surgical excision

Question 16

what is a baker’s cyst

Answer 16

cyst/ganglion of the popliteal fossa

Question 17

presentation of a baker’s cyst

Answer 17

Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture

Question 18

management of baker’s cyst

Answer 18

analgesia

Question 19

what is bursitis

Answer 19

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

Question 20

management of bursitis

Answer 20

NSAIDs / Analgesia
Antibiotics
Incision and drainage 
	 (secondary infection)
V. rarely excision
	 (chronic cases)

Question 21

what is gout

Answer 21

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

Question 22

associations of gout

Answer 22

Purine rich food, alcohol, dairy

Question 23

presentation of gout

Answer 23

Severe pain,
Red, hot, swollen joint
Sometimes mistaken for septic arthritis

Question 24

treatment for gout

Answer 24

NSAIDs
Steroids
Allopurinol

Question 25

what are Bouchards and hebredens nodes

Answer 25

These are bony swellings of the interphalangeal joints in hands Caused by bony spurs due to chronic trauma

Question 26

where are bouchards nodes

Answer 26

Proximal IPJ Less common OA or RA

Question 27

where are heberdens nodes

Answer 27

Distal IPJ More common OA

Question 28

what is dupuytren's

Answer 28

Progressive disease resulting in digital flexion contractures Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia

Question 29

risk factors for dupuytrens

Answer 29

alcohol diabetes genetics trauma

Question 30

management of dupuytren's

Answer 30

Needle fasciotomy (single band) Limited fasciectomy (removal of the bands) Dermofasciectomy + graft (removal of the band, adherent/contracted skin and covering graft)

Question 31

what is a lipoma

Answer 31

Benign neoplastic proliferation of fat | subcutaneous

Question 32

presentation of a lipoma

Answer 32

``` Can be discreet or less well defined Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes ```

Question 33

management of lipoma

Answer 33

Based on symptoms Can be left alone Surgical excision if causing symptoms

Question 34

what is myositis ossificans

Answer 34

Abnormal calcification of a muscle haematoma

Question 35

history of myositis ossificans

Answer 35

Trauma, initial soft swelling, hardness develops over several weeks

Question 36

management of myositis ossificans

Answer 36

Observation Intervene only if symptoms demand Must wait until maturity of ossification, otherwise risk of recurrence (6-12 months)