Soft Tissue Swellings

Question 1

where can a giant cell tumour of the tendon sheath be found

Answer 1

tendon sheath of the hands and feet

Question 2

pathophysiology of a giant cell tumour of the tendon sheath

Answer 2

benign regenerative hyperplasia with inflammatory processes

Question 3

clinical presentation of a giant cell tumour of the tendon sheath

Answer 3

firm, discreet swelling usually on the volar aspects of the digits

Question 4

investigation of a giant cell tumour of the tendon sheath

Answer 4

imaging: x-ray, ultrasound, MRI

Question 5

usually management of a giant cell tumour of the tendon sheath

Answer 5

leave alone if no functional issue

Question 6

what is a mucous cyst

Answer 6

Outpouching of synovial fluid from DIP caused by early OA

Question 7

who usually gets a mucous cyst

Answer 7

women 40-60

Question 8

when may excision of a mucous cyst be considered

Answer 8

particularly deep/cracked nail ridges or constantly discharging

Question 9

what is a ganglion cyst

Answer 9

outpouching of the synovium lining of joints and filled with synovial fluid

Question 10

what can cause a ganglion cyst

Answer 10

can be developmental or as a result of underlying joint damage/arthritis with a build up of pressure in the joint

Question 11

why is a ganglion cyst not seen as a true cyst

Answer 11

has no epithelial lining

Question 12

where are ganglion cysts often seen

Answer 12

around the wrist

Question 13

what is a sebaceous cyst

Answer 13

slow growing, painless, mobile swelling formed by blockage of the sebaceous gland

Question 14

where do sebaceous originate from

Answer 14

the hair follicles

Question 15

where do sebaceous cysts commonly occur

Answer 15

face, trunk and neck

Question 16

management of a sebaceous cyst

Answer 16

may require excision +/- biopsy

Question 17

what is an abscess

Answer 17

a discreet collection of pus

Question 18

what can cause abscess on a limb

Answer 18

cellulitis, bursitis, penetrating wounds, infected sebaceous cysts

Question 19

clinical presentation of an abscess

Answer 19

history of trauma or cellulitis
defined and fluctuant swelling
erythema, pain

Question 20

management of an abscess

Answer 20

surgical excision + drainage
antibiotics
rest, elevation, analgesia and splint

Question 21

what is nodular fasciitis

Answer 21

benign proliferation of fibroblastic and myofibroblast cells

Question 22

clinical presentation of nodular fasciitis

Answer 22

young adults, upper extremity
rapidly growing, <5cm
circumscribed

Question 23

management of nodular fasciitis

Answer 23

reassurance - spontaneous resolution and don’t recur

Question 24

what is myositis ossificans

Answer 24

abnormal calcification of a muscle haematoma following trauma

Question 25

clinical presentation of myositis ossificans

Answer 25

initial soft swelling which hardens over several weeks

Question 26

where is myositis ossificans often associated with

Answer 26

insertions of large muscles of the arms and legs

Question 27

investigations of myositis ossificans and positive findings

Answer 27

x-ray and MRI
shows peripheral mineralisation

Question 28

management of myositis ossificans

Answer 28

observation, intervene if bothersome symptoms
MUST WAIT UNTIL MATURITY OF OSSIFICATION (6-12mths) or they’ll recur

Question 29

what is bursitis

Answer 29

inflammation of the synovium-lined sacks that protect bony prominences and joints

Question 30

what is a bunion

Answer 30

bursitis over the medial 1st metatarsal head in the hallux valgus

Question 31

why does bursitis occur

Answer 31

repeated pressure or trauma

Question 32

management of bursitis

Answer 32

NSAIDs, analgesia
antibiotics