Common Musculoskeletal swellings Flashcards Preview

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Flashcards in Common Musculoskeletal swellings Deck (60):
1

Generalised or discreet swelling?

Ill defined / well defined

2

What type of swelling is cellulitis?

Generalised

3

Which organisms cause cellulitis?

Beta haemolytic strep and staphylococci

4

Presentation of cellulitis?

Pain, swelling, erythema
Spectrum: Minor problem – septic

5

Presentation of abscess

Defined and fluctuant swelling
Erythema, pain
History of trauma (eg. bite, IVDU)
Spectrum: Minor problem – septic

6

Organisms causing spetic arthritis?

Staph aureus/strep/E. coli

7

Bacterial infection of a joint e.g. septic arthritis

Traumatic (joint penetration)
Haematoginous spread

8

Presentation of septic arthritis

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

9

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

Septic arthritis

10

Management of septic arthritis

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

11

What are ganglion?

Outpouchings of synovium lining of joints and filled with synovial fluid

12

Appearance of ganglia

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

13

Management of ganglia

Nothing
NOT aspiration
Percutaneous rupture
Surgical excision

14

Where would you find a baker's cyst?

Popliteal fossa

15

Presentation of baker's cyts

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

16

Which type of cyst may be associated with OA?

Baker's cyst

17

Bursitis

Inflammation of the synovium lined sacs

18

Management of bursitis

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

19

Symptoms of bursitis

Symptoms of bursitis may include localized tenderness, pain, edema, erythema, or reduced movement. Pain is aggravated by movement of the specific joint, tendon, or both.

20

Which condition is associated with purine rich food, alcohol, dairy?

Gout

21

What may rheumatoid nodules be associated with?

Repetitive trauma

22

Do rheumatoid nodules respond to DMARDs?

No :(

23

Management of rheumatoid nodules

Excision if problematic but recurrence high

24

Histology of rheumatoid nodules

Intense inflammatory changes

25

Rheumatoid factor positive in rheumatoid nodule presentation?

Yesh

26

What causes Bouchards/Heberden's nodes?

Bony spurs due to chronic trauma

27

Which are more common, Bouchards or Heberdens?

Heberdens

28

Which conditions would you fins bouchards and heberdens nodes in?

Bouchards: OA/RA
Heberdens: OA

29

Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia

Dupuytren's disease

30

Which type of collagen makes up the bands in Dupuytren's disease?

Collagen type III

31

Dupuytren's disease

Progressive disease resulting in digital flexion contractures
Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia
Bands are primarily collagen type III
Avascular process involving O2 free radicals
It is NOT a disease of the flexor tendons

32

Avascular process involving O2 free radicals?

Dupuytren's disease

33

Excessive MYOFIBROBLAST proliferation and altered collagen matrix composition leading to thickened and contracted PALMAR FASCIA?

Dupuytren's disease

34

Which 3 factors contribute to Dupuytrens?

-Genetic predispostion
-Environmental factors
-Local and global protein expression

35

Method of inheritance of Dupuytrens

Autosomal dominant with variable penetration

36

Environmental factors contributing to Dupuytren's disease

Alchohol, diabetes, trauma

37

Factors predisposing to Dupuytren's disease

Genetic predisposition:
Autosomal dominant with variable penetration
Common in northern Europe; men > women

Environmental factors:
Alcohol, diabetes and trauma

Local and global protein expression:
Multiple protein expression enzymes up-regulated and down-regulated

38

Traeatment for Dupuytren's disease

Needle fasciotomy
Collaginase injection
Limited fasciectomy
Dermofasciectomy + graft

39

PVNS

Pigmented villonodular synovitis (PVNS) is a joint disease characterized by inflammation and overgrowth of the joint lining

Associated with diffuse giant cell tumours of the tendon sheath

40

Giant Cell Tumour of the Tendon Sheath

2 types: Localised (common) Diffuse (uncommon; assoc. with PVNS)
Regenerative hyperplasia with inflammatory process
Benign
Presentation:
Firm, discreet swelling, usually on volar aspect of digits
Can occur in toes
May or may not be tender

41

Management of giant cell tumour of the tendon sheath

Leave alone if no functional issue!
Surgical excision:
Usually marginal excision, i.e. not complete as adherent to tendon sheath
Incidence of recurrence

42

Where would an osteochonroma most likely occur?

Near the knee
Distal femur / proximal tibia metaphyseal regions

43

Presentation of osteochondroma

Painless, hard lump
Symptoms with activity (pain from tendons; numbness from nerve compression)

44

Why might you feel numbness during activity if you have an osteochondroma?

Osteochondroma might compress nerves

45

Managment of osteochondroma

Management:
Close observation
Surgical excision

46

Which cells does a Ewings sarcoma originate from?

Endothelial cells (E for Ewings, E for endothelial)

47

Ages affected by Ewings sarcoma?

10-20

48

Ewing's Sarcoma

Malignant primary bone tumour of the endothelial cells in the marrow
2nd most common bone tumour
Worst prognosis
Most common age 10 – 20 years

49

Ewing's Sarcoma Presentation

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

50

Should you be suspicious of night pain in bone?

Yes, investigate early and ask about duration of symptoms
Could be Ewing's sarcoma :(

51

Management for Ewing's sarcoma

Management:
Poor prognosis
Surgical excision problematic
Often radio- and chemo-sensitive

52

Why is Ewing's sarcoma called the great mimc?

Can present as a hot, swollen, tender joint/limb with raised inflammatory markers
-Can mimic infection
-Be suspicious of night pain and duration of symptoms, investigate early

53

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

54

What is a lipoma?

Benign neoplastic proliferation of fat
Often subcutaneous

55

Management of lipomas

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

Balance of removal vs scarring

56

Where do sebaceous cysts occur?

Head, neck, trunk
Strictly speaking this is a dermatological condition
Mentioned only for completeness
Originate at hair follicles and fill with caseous material (keratin)

Presentation:
Slow growing, painless, mobile discreet swellings
Can become infected

Management: Excision if required

57

Where do sebaceous cysts occur?

Hair follicles
Think head, neck, trunk

58

Myositis ossificans?

Abnormal calcification of a muscle haematoma
is a benign process characterised by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes.

59

Abnormal calcification of a muscle haematoma?

Myositis ossificans
is a benign process characterised by heterotopic ossification usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes.

60

If you are going to intervene in myositis ossificans, e.g. with surgery, how long to you have to wait and why?

Must wait until maturity of ossification otherwise risk of recurrence 6-12 months