swellings Flashcards
what kind of lump would be seen in cellulitis?
a generalised swelling rather than a discreet lump
what kind of presentation would be seen with cellulitis?
pain, swelling, erythema
what organisms could it be in cellulitis?
beta-haemolytic streps
staph
what is the management of cellulitis?
Rest, elevation, analgesia, splint Antibiotics; oral vs IV; penicillin NOT SURGERY
what is an abscess?
discreet collection of pus
how would an abscess present?
Defined and fluctuant swelling
Erythema, pain
History of trauma (eg. bite, IVDU)
what’s the management of an abscess?
surgical incision & drainage
rest, elevation, analgesia, splint
antibiotics
what is the management of septic arthritis?
Urgent orthopaedic review
Aspiration
Urgent Open/arthoscopic washout + debridement
what presentation is usually seen in septic arthritis?
Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflam markers
what are ganglia?
Outpouchings of the synovium lining of joints and filled with synovial fluid
describe the appearance of ganglia?
discreet, round swellings
Non-tender
what is a baker’s cyst?
cyst/ganglion of the popliteal fossa
what is the normal presentation of a baker’s cyst?
Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture
what is the management of a baker’s cyst?
non-operative
what is bursitis?
inflammation of the synovium lined sacs that protect bony prominence & joints
what can happen to the bursa in bursitis?
Can become secondarily infected and form an abscess
what is the management of bursitis?
NSAIDs / Analgesia
Antibiotics
Incision and drainage (secondary infection)
V. rarely excision (chronic cases)
what are rheumatoid nodules?
Appear around joints in rheumatoid patients, again, associated with repetitive trauma
describe the normal presentation of rheumatoid nodules?
Chronic, more severely affected RA patients, rheumatoid factor +ve
what’s seen histologically in rheumatoid nodules?
intense inflammatory changes
what are bouchard’s & heberden’s nodes?
bony swellings of the interphalangeal joints in hands caused by bony spurs due to chronic trauma
describe bouchard’s nodes
Proximal IPJ
Less common OA or RA
describe heberden’s nodes
Distal IPJ More common
OA
what is dupuytren’s disease
Progressive disease resulting in digital flexion contractures
describe the pathogenesis of dupuytren’s disease
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia, avascular process involving O2 free radicals
what type of collagen are the bands commonly in dupuytren’s disease
collagen type 3
what is the management of dupuytren’s disease?
Needle fasciotomy Collaginase injection Limited fasciectomy Dermofasciectomy + graft can recur
what is an osteochondroma?
Benign tumour most commonly occurring near the knee
Distal femur / proximal tibia metaphyseal regions
what does an osteochondroma look like macroscopically?
Cartilage capped ossified pedicle
what is the normal presentation of an osteochondroma?
Painless, hard lump
Symptoms with activity
(pain from tendons; numbness from nerve compression)
what is the management of an osteochondroma?
Close observation
Surgical excision
what is Ewings sarcoma?
Malignant primary bone tumour of the endothelial cells in the marrow
describe the normal presentation of ewings sarcoma
The great mimic: Hot, swollen, tender joint or limb with raised inflammatory markers
Can mimic infection
Be suspicious; ask about night pain and duration of symptoms; investigate early
describe the management of wings sarcoma
Poor prognosis
Surgical excision problematic
Often radio- and chemo-sensitive
what is a lipoma
Benign neoplastic proliferation of fat
Often subcutaneous
describe the normal 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
describe the management of a lipoma
Based on symptoms
Can be left alone
Surgical excision is causing symptoms
what is myositis ossificans
Abnormal calcification of a muscle haematoma
