Common MSK swellings

Question 1

What factors are important to take in the history of MSK swellings?

Answer 1

When did it appear? Gradually or suddenly?
Any history of trauma
Is it painful
Is the size increasing ro does it fluctuate
Systemic symptoms
Do they or have they ever had any other similar swellings
What functional problems does it cause?

Question 2

What examination findings are important to assess in MSK swellings?

Answer 2

Site
Size
Shape
Generalised or discreet
Consistency (fluctuant) 
Surface texture
Mobile or fixed
Temperature 
Transluminable 
Skin changes
Local lymphadenoaphy

Question 3

What nodes should you look at if you suspect upper limb infection?

Answer 3

Axilla

Question 4

What nodes should you look at if you suspect a lower limb infection?

Answer 4

Groin

Question 5

What is cellulitis?

Answer 5

Inflammation and infection of the soft tissues

Question 6

How will cellulitis present?

Answer 6

Pain
Swelling
Erythema
Can be minor or septic

Question 7

What organisms commonly cause cellulits?

Answer 7

Beta haemolytic strep

Staphylococci

Question 8

How is cellulits managed?

Answer 8

Rest
Elevation 
Analgesia
Splint
Antibiotics - oral or IV usually flucloaxacillin 
NOT SURGERY

Question 9

What is an abscess?

Answer 9

Discreet collection of pus

Question 10

How will an abscess present?

Answer 10

Defined and fluctuant swelling
Erythema
Pain
History of trauma (bite, IVDU)

Question 11

How is an abscess managed?

Answer 11

Surgical incicision and drainage 
Rest 
Elevation 
Analgesia
Splint
Antibiotics- this is an ajunct

Question 12

What is septic arthritis?

Answer 12

A bacterial infection of a joint - can be traumatic (joint penetration) or haematoginous spread

Question 13

How will septic arthritis present?

Answer 13

Acute monoarthropathy
Decreased ROM
Systemic upset
Raised WCC and PV

Question 14

How is septic arthritis managed?

Answer 14

Aspiration - microscopy - culture and sensitvity
Urgent open or arthroscopic washout
Debridement

Question 15

What is a ganglion?

Answer 15

Outpouching of the synoviual lining of joints and is filled with synovial fluid

Question 16

What is the appearance of a ganglion cyst?

Answer 16

Discreet, round swelling
Non-tender
Skin is mobile but the cyst is attached to underlying structures

Question 17

How is a ganglion cyst managed?

Answer 17

Based upon symptoms 
Usually nothing as it is self limiting 
NOT aspiration 
Percutaneous rupture 
Surgical exciion - very rare

Question 18

How will a bakers cyst present?

Answer 18

General fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture that mimics a DVT

Question 19

What is bursitis?

Answer 19

Inflammation of the synovium lines sacs that protect bony prominences and joints.
Can become secondarily infected and forms an abscess

Question 20

How is bursitis managed?

Answer 20

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

Question 21

What is the difference between gout and pseudogout?

Answer 21

Gout: negatively birefringent monosodium urate crystals
Pseudogout: positively birefringent calcium pyrophosphate crystals

Question 22

What is the difference between bouchards and heberden’s nodes?

Answer 22

Bouchards - PIP in OA or RA
Heberdens - DIP in OA
Bouchards Back
Heberdens like the outer hebrides

Question 23

What is dupuytrens disease?

Answer 23

Progressive disaese resulting in digital flexion contractures
Excessive myofibroblast proliferation and altered collagen matrix composition leasd to thickened and contracted palmar fascia made of collagen type 3

Question 24

What can predispose to dupuytrens?

Answer 24

Genetic - autosomal dominant with variable penetration

Environmental: alcohol, diabetes, trauma

Question 25

How is dupuytrens managed?

Answer 25

Needle fasciotomy Collaginase injection Limited fasciectomy Dermofasciectomy and graft

Question 26

What are the different types of giant cell tumour of the tendon sheath?

Answer 26

Localised | Diffuse (assoc. with PVNS)

Question 27

What are giant cell tumours of the tendon sheath?

Answer 27

Regenerative hyperplasia with inflammatory process

Question 28

How do giant cell tumours of the tenon sheath present?

Answer 28

Slowly enlarging Firm, discreet swelling usually on volar aspect of digits Can occur in toes May or may not be tender

Question 29

What is an osteochondroma?

Answer 29

Benign tumour most commonly occuring near the knee Distal femur/ proximal meaphyseal reagions Occurs in adolescence as an outgrowth of the physis Cartilage capped ossified pedicle

Question 30

What are the chances of malignant change in osteochondroma?

Answer 30

1%

Question 31

What are the chances of malignant changes in multiple heridetary exostosis?

Answer 31

5%

Question 32

How will an osteochondroma present?

Answer 32

Painless, hard lump Sympotms with activity (pain from tendons, numbness from nerve compression) Rarely can be due to fracture

Question 33

How are osteochondromas managed?

Answer 33

Close observation | Surgical excision

Question 34

What is an ewings sarcoma?

Answer 34

Malignant primary bone tumour of the endothelial cells in the marrow

Question 35

Who does ewings sarcoma affect?

Answer 35

Most common in ages 10-20 | Most common location is diaphysis of long bones and pelvis

Question 36

How will ewings sarcoma present?

Answer 36

Great mimic: hot, swollen, tender joint or limb with raised inflammatory markers Mimics infection

Question 37

How is ewings sarcoma managed?

Answer 37

Poor prognosis Surgical excision problematic Often radio and chemo sensitive

Question 38

What is a lipoma?

Answer 38

Benign neoplastic proliferation of fat | Often subcutaneous

Question 39

How will a lipoma present?

Answer 39

``` Can be discreet or less well defined Slow growin and painless Can be large Characteristic consistency No overlying skin changes ```

Question 40

How is a lipoma managed?

Answer 40

Based on symptoms Can be left alone Surgical excision commonly causes more harm than good

Question 41

What is a sebaceous cyst?

Answer 41

Originates at hair follices and fills with keratin Slow growing, painless, mobile discreet swellings Can become infected

Question 42

How is a sebaceous cyst managed?

Answer 42

Excision if required

Question 43

What is myositis ossificans?

Answer 43

Abonormal calcification of a muscle haematoma

Question 44

How is myositis ossificans managed?

Answer 44

Obseravtion Intervene only if symptoms deman Must wait until maturity of ossification other wise risk recurrence (6-12 months)