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MSK > Common MSK Swellings > Flashcards

Common MSK Swellings Flashcards

1
Q

important questions in swelling history?

A 
when did it appear - sudden or gradual?
trauma?
painful?
change in size?
systemic symotoms?
anything similar?
what functional problems does it cause?
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2
Q

important examination features of a swelling?

A 
site
shape
size
well defined?
consistency - fluctuant?
surface texture
mobile or fixed
temp
transluminable?
skin changes
local lymphadenopathy
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3
Q

history features of an infective cause for swelling?

A 
systemic upset
pyrexia
trauma
association with medical co-morbidities
rubor, calor, dolor, tumor
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4
Q

how does cellulitis present?

A

generalised swelling rather than discreet lump
pain
erythema

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5
Q

what commonly causes cellulitis?

A

Beta haemolytic strep

staph

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6
Q

how is cellulitis managed?

A 
rest
elevation
analgesia
splint
antibiotics (oral or IV)
- penicillin
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7
Q

presentation of abscesses?

A

discreet collection of pus - defined and fluctuant swelling
erythema
pain
history of trauma

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8
Q

how is an abscess managed?

A 
surgical incision and drainage always
rest
elevation
analgesia
splint
antibiotics
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9
Q

what causes septic arthritis?

A

bacterial infection of a joint - trauma or haematogenous spread
staph aureus
strep
E coli

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10
Q

how does septic arthritis present?

A

acute monoarthropathy
reduced ROM +/- swelling
systemic upset
raised WCC + inflammatory markers

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11
Q

how is septic arthritis managed?

A

urgent orthopaedic review
aspiration
urgent open/arthroscopic washout + debridement

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12
Q

what is a ganglia?

A

outpouching of synovium lining of joints and filled with synovial fluid

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13
Q

how does a ganglia present?

A 
discreet round swelling
non-tender
<10mm - several cm
skin mobile, fixed to underlying structures
seen in wrists, feet and knees
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14
Q

how is a ganglia managed?

A

nothing
NOT ASPIRATION
percutaneous rupture (hit it)
surgical excision

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15
Q

what is a bakers cyst?

A

cyst/ganglion of the popliteal fossa

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16
Q

how does a bakers cyst present?

A

general fullness of the popliteal fossa
soft and non-tender
associated with OA
painful rupture

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17
Q

how is a bakers cyst managed?

A

non-operative

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18
Q

what is bursitis?

A

inflammation of the synovium lined sacs that protect bony prominences and joints
can become secondarily infected and form an abscess

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19
Q

how is bursitis managed?

A

NSAIDs/analgesia
antibiotics
incision and drainage (if secondary infection)
V. rarely needs excision

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20
Q

what is gout?

A

inflammatory arthritis most commonly affected the great toe but can affect other joints - knee etc
caused by elevated serum urate resulting in a deposition of uric acid crystals in joints

21
Q

what is gout associated with?

A

purine rich food
alcohol
dairy

22
Q

how does gout present?

A

severe pain
red, hot swollen joint
can have acute attacks and chronic progressive joint damage

23
Q

how is gout diagnosed and treated?

A

diagnosis = clinical, aspiration - negatively befringed monosodium urate crystals

24
Q

how is gout managed?

A

NSAIDs
steroids
allopurinol

25
Q

what are rheumatoid nodules?

A

nodules around joints in RA patients

associated with repetitive trauma

26
Q

how are rheumatoid nodules managed?

A

don’t respond to DMARDs
excision of problematic
recurrence high

27
Q

Bouchards vs Heberdens nodes?

A 
bouchard = PIPs (OA or RA)
heberdens = DIPs (only OA)
28
Q

what is dupuytrens disease and what causes it?

A

progressive disease of fascia causing digital flexion contractures
excessive myofibril proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
type 3 collagen bands
avascular process involving O2 free radicals

29
Q

3 contributing factors in dupuytens?

A 
genetic predisposition (northern Europe, Men > women, AD)
environmental factors (alcohol, diabetes, trauma)
local and global protein expression
30
Q

how is dupuytrens managed?

A 
depends on functional impediment
needle fasciotomy
collagenase injection
limited fasciectomy
dermofasciectomy + graft
31
Q

what is giant cell tumour of the tendon sheath?

A

regenerative hyperplasia with inflammatory process
benign, common
don’t confuse with giant cell tumour of bone

32
Q

what are the 2 types of GCT of tendon sheath?

A

localised (common)

diffuse (rare)

33
Q

how does a GCT of tendon sheath present?

A

slowly enlarging
firm discreet swelling on volar aspect of digits
can occur in toes
may or may not be tender

34
Q

how is GCT of tendon sheath managed?

A

leave alone if not causing issue

surgical excision if needed (often only marginal excision)

35
Q

what is an osteochondroma?

A

benign tumour most commonly occurring near the knee (distal femur or proximal tibia)
cartilage capped ossified pedicle

36
Q

how does osteochondroma present?

A 
hard, painless lump
growth parallel to the patient
pain and numbness on activity
can rarely get pain from a fracture
occurs in adolescence
can have multiple tumours in multiple hereditary exostosis
37
Q

malignant potential in osteochondroma?

A

<1%

5% in multiple hereditary exostosis

38
Q

how is osteochondroma managed?

A

close observation

surgical excision if needed

39
Q

what is ewings sarcoma?

A

malignant primary bone tumour of the endothelial cells in the marrow
usually occurs at the diaphysis/metaphysis of long bones and pelvis

40
Q

how does ewings sarcoma present?

A

hot swollen tender joint or limb with raised inflammatory markers (mimics infection)
ask about night pain and duration of symptoms

41
Q

how is ewings sarcoma managed?

A

poor prognosis
surgical excision difficult
often chemo and radio sensitive

42
Q

what is a lipoma?

A

benign neoplastic proliferation of fat

often subcutaneous

43
Q

how does a lipoma present?

A 
can be discreet or less well defined
slow growing and painless
can be large
soft, moveable mass
no overlying skin changes
44
Q

how is a lipoma managed?

A

based on symptoms
can be left alone
surgical excision if causing symptoms

45
Q

what is a sebaceous cyst and how does it present?

A

originate at the hair follicle and fill with caseous keratin
slow growing, painless, mobile discreet swellings
can become infected

46
Q

how are sebaceous cysts managed?

A

excision if required

47
Q

what is myositis ossificans?

A

abnormal calcification of a muscle haematoma

usually initial trauma > initial small swelling > hardness develops over several weeks

48
Q

how is myositis ossificans diagnosed and managed?

A

diagnosis = X ray and MRI showing peripheral mineralisation
management
- observation
- only intervene if symptoms
- must wait until maturity of ossification otherwise risk of recurrence (6-12 months)

MSK (66 decks)

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