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MSK - Coggle Diagram

- - - - osteoid osteoma
        
        presentation
        
        intense pain, typically at night
        
        relieved by NSAIDs
        
        management
        
        removal
      - osteoblastoma
    - - osteosarcoma
        
        presentation
        
        increasing unexplained pain
        
        analgesics eventually ineffective
        
        may be related to exercise
        
        deep boring ache
        
        worse at night
        
        loss of function
        
        limp
        
        reduced joint movement
        
        difficulty weight-bearing
        
        swelling
        
        diffuse
        
        starts off vague, may enlarge rapidly once it reaches a noticeable size
        
        warm
        
        venous congestion
        
        pressure effects
        
        neurovascular
        
        pressure on bowel/bladder
        
        reactive joint effusion
        
        usually at end of long bone
        
        systemic effects
        
        weight loss
        
        anorexia
        
        low grade pyrexia
        
        complications
        
        pathological fracture
        
        pain prior to fracture
        
        management
        
        don't rush to fix, as may require augmented treatment first, so traction/splintage first
        
        not weight-bearing
        
        can be treated conservatively, esp. if patient frail
        
        management
        
        chemotherapy
        
        surgery to excise tumour
        
        limb salvage if possible (poorly performed biopsy or pathological fracture may make this impossible)
        
        one long bone operated on at a time
  - - - enchondroma
      - osteochondroma
    - - chondrosarcoma
  - - - fibroma
    - - fibrosarcoma
      - malignant fibrous histiocytoma (MFH)
  - - - haemangioma
      - aneurysmal bone cyst
    - - angiosarcoma
  - - - lipoma
    - - liposarcoma
  - - - Ewing's sarcoma
      - lymphoma
      - myeloma
  - - - giant cell tumours
        
        prognosis
        
        locally destructive
        
        rarely metastasise
    - - renal
      - management
        
        prevent pathological fractures with routine bone scans
        
        secondaries identified
        
        radiotherapy
        
        secondaries ≥ 2.5 cm
        
        prophylactic internal fixation
        
        Mirel's Scoring System (MSS)
        
        1 for upper limb/mild pain/blastic lesion/third maximum cortical destruction on XR
        
        2 for lower limb/moderate pain/mixed lesion/third to two thirds maximum cortical destruction
        
        ≥8
        
        1 more item...
        
        3 for peritrochanteric/functional pain/lytic lesion/more than two thirds maximum cortical destruction
        
        early chemo/deep XR therapy decreases bone turnover
      - breast
      - thyroid
        
        esp. follicular
      - complications
        
        pathological fracture
        
        spinal
        
        management
        
        decompression & stabilisation usually required
      - epidemiology
        
        25x more common than primaries
        
        likely if patient > 50
        
        most common sites
        
        vertebrae
        
        proximal femur
        
        pelvis
        
        ribs
        
        sternum
        
        skull
      - investigation
        
        smoker
        
        CXR & sputum cytology
        
        examine
        
        osteosclerotic
        
        PR
        
        PSA
        
        solitary & very vascular
        
        IV pyelogram
        
        US/MRI
        
        angiography
        
        embolise within 48 hrs of excision
        
        qFIT
        
        endoscopy
        
        barium studies
        
        carcinoembryonic antigen markers for GI tract tumours
        
        CT chest/abdo/pelvis
        
        < 4 yrs old
        
        MRI head for neuroblastoma
      - melanoma
  - - - presentation
        
        pain
        
        may be activity related
        
        may be at rest/at night
        
        later on
        
        weight loss
        
        malaise
        
        mass
        
        rapidly growing
        
        hard
        
        fixed
        
        craggy surface
        
        indistinct margins
        
        non-tender
        
        recurrence after excision
      - cortical destruction, with poorly defined transition zone between bone & lesion (permeative growth); onion-skinning/sunburst pattern of periosteal reactive new bone growth (Codman's triangle)
    - - presentation
        
        may present with activity related pain if large enough to weaken bone
    - - vascular tumour
        
        embolisation via angiography, before internal fixation
    - - XR
        
        clear margins with surrounding rim of reactive bone; cortical expansion/stretch if aggressive
      - staging
        
        isotope bone scan
        
        often negative in myeloma
  - - - mass
    - - presentation
        
        mass
        
        more than 5cm
        
        deep to fascia
        
        fixed
        
        hard
        
        indurated
        
        recurrent after excision
    - - urgent MRI
        
        specific MRI signals
        
        haematoma
        
        pigmented villonodular synovitis
      - XR for calcifications (synovial sarcoma) & phleboliths (haemangioma)
  - - - pseudoaneurysms
      - AV malformations
    - - staging secondaries
    - - benign tumours with multiple lesions & high bone turnover
        
        osteochondroma
        
        enchondroma
        
        fibrous dysplasia
        
        histiocytosis
    - - after complete work up
        
        bloods
        
        FBC
        
        LFTs
        
        U&Es
        
        XR
        
        affected limb
        
        chest
  - - - response
        
        surgery may be indicated