based upon symptoms/function impairment - nothing if not bothering the patient - percutaneous rupture - surgical excision; leaves scar

MSK Swellings Flashcards by S B

Hx points for MSK swelling

When did it appear; gradually or suddenly?

Any history of trauma?

Is it painful?

Is the size increasing, staying the same or does that fluctuate?

Is the patient unwell in any way? (Systemic symptoms)

Do they have or have they had any other similar swellings?

What functional problems does it cause?

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examination features of swelling

site/size/shape
generalised (ill defined) 
discreet (well defined)
mobile or fixed
temp
transluminable
local lymphadenopathy

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Hx of infections

systemic upset
pyrexia
trauma - break in skin
co-morbities

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Ex of infections

calor
dolor
rubor
tumor

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what is cellulitis

inflammation an infection of soft tissues

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Sx of cellulitis

generalised swelling rather than a discreet lump 
pain
swelling
erythema 
septic

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organisms of cellulitis

beta haemolytic streps

staph

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Mx of cellulitis

Rest + Elevation
Analgesia
Splint if very sore
Antibiotics; penicillin or flucloxacillin

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what is an abscesses

discreet collection of pus

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presentation of abscess

defined and fluctuant swelling
erythema, pain
history of trauma e.g.bite, IVDU

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Mx of abscess

surgical incision
DRAINAGE
‘if there’s pus, let it out’

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what is septic arthritis

orthopaedic emergency
bacterial infection of a joint
- either traumatic or haematoginous

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why is sceptic arthritis an orthopaedic emergency

due to the possibility of irreversible damage to hyaline articular cartilage

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presentation of septic arthritis

Acute monoarthropathy
Refuse to weight bear
Swelling
Systemic upset
Raised WCC + inflam markers

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Ix for septic arthritis

synovial fluid gram stain and culture
X-ray
US - for effusion

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Mx for septic arthritis

Aspirate the joint
Joint washout/debridement
IV antibiotics (empirical or specific)

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what swellings can occur around the joints

Ganglia - esp Baker’s cyst
Bursitis
Gout
Rheumatoid nodules

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whats is a ganglia

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

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what are appearance of ganglia

Discreet, round swellings

Non-tender

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Mx of ganglia

based upon symptoms/function impairment

nothing if not bothering the patient
percutaneous rupture
surgical excision; leaves scar

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what is not recommended for ganglia treatment

aspiration

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what is a baker’s cyst

a ganglion of the popliteal fossa

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appearance of baker’s cyst

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

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Mx of baker’s cyst

non-operative

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what is bursitis

Inflammation of the synovium lined sacs that protect bony prominences and joints

complications of bursitis

can become secondarily infected and form an abscess

Mx of bursitis

NSAIDs/Analgesia Antibiotics Incision and drainage (secondary infection) Excision - for chronic cases

what is a common bursitis

bunion

what causes gout

elevated urate causes a deposition of uric acid crystals in joints

presentation of gout

Severe pain, Red, hot, swollen joint | Sometimes mistaken for septic arthritis

what is seen in an aspirate of gout

Negatively birefringent monosodium urate crystals

what are rheumatoid nodules

Appear around joints in rheumatoid patients | associated with repetitive trauma

presentation of rheumatoid nodules

Chronic, more severely affected RA patients, rheumatoid factor +ve

what is seen in the histology of rheumatoid nodules

intense inflammatory changes

Mx of rheumatoid nodules

do not respond to DMARDs excise if problematic (scar vs nodule) recurrence high

where are bouchard's nodes seen and associations

proximal IPJ i.e. closer to your Body less common OA or RA

where are Heberden's nodes seen and their associations

distal IPJ - think outer Hebrides more common OA only

what is Dupuythren's disease

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

what are the features of Dupuytren's disease

bands are collagen type III | abnormal palmar fascia

what does D.Disease resultin

digital flexion contractures | NOT a disease of flexor tendons

what finger is commonly affected in D.disease

ring finger

Mx of D.disease

dependant on functional impediment Needle fasciotomy - single band Limited fasciotomy - removal of bands Dermofasciectomy + graft - removal of the band, adherent/contracted skin and covering graft

Firm, discreet swelling, usually on volar aspect of digits - diagnosis?

giant cell tumour of tendon sheath

what are the two types of giant cell tumours of the tendon sheath

localised - common | diffuse - uncommon, associated with Pigmented villonodular synovitis

what is a giant cell tumour

benign | regenerative hyperplasia with inflammatory process

Mx of giant cell tumour of tumour sheath

leave alone if no functional issue surgery - marginal excision

what are lipomas

benign neoplastic proliferation of fat that are subcutaneous

presentations of lipomas

``` Can be discreet or less well defined (if very large) Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes ```

Mx of lipoma

based on symptoms can be left alone surgical excision

what surgical techniques are used in excisions to reduce risk of scars

S-shaped incision | Langer's lines

what are osteochondromas

benign lesion derived from aberrant cartilage from the perichondral ring

what are the two types of osteochondromas

solitary osteochondromas | multiple hereditary exostosis (MHE)

where do osteochondromas commonly occur

near the knee | distal femur/proximal tibia

description of osteochondromas

cartilage capped ossified pedicle

is there a potential for malignant change in osteochondromas

yes but a small potential | more chance in MHE

presentation of osteochondromas

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

Mx of osteochondromas

close observation | surgical excision

Ix for osteochondromas

X-rays

what is an Ewings sarcoma

malignant primary bone tumour of the endothelial cells in the marrow 2nd most common malignant bone tumour worst prognosis 10-20 y.o

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

Tx for ES

radio and chemo sensitive

what is a sebaceous cysts

originate at hair follicles and fill with caseous material (keratin)

Presentation of sebaceous cysts

Slow growing, painless, mobile discreet swellings Face/Neck/Trunk Can become infected

Mx of sebaceous cysts

excision if required

what is myositis ossificans

abnormal calcification of a muscle haematoma

Hx of MO

trauma | initial soft swelling >> hardness develops over several weeks

Ix for MO

Xray | MRI

Mx for MO

Observation | Intervene if symptoms demand

MSK Swellings Flashcards

(68 cards)