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Tendon disorders Tenosynovitis/tendinitis is probably a misnomer as the histological data support neither pathology in many cases. It often occurs as a result of injury or overuse or is secondary to inflammatory disease. Rest, anti-inflammatory medication and p...

The hindfoot and ankle Ankle arthritis The definitive operative treatment for arthritis of the ankle will usually be in the form of total ankle replacement (TAR) or - more commonly arthrodesis (fusion); the latter is often carried - out via an open approach b...

The midfoot The midfoot comprises the cuneiforms and the cuboid and related joints. Midfoot arthritis The aetiology is usually not known but the risk factors include microtrauma, rheumatological causes, flat foot, Lisfranc or similar injuries (which may have be...

Tumours The most common benign tumours of the foot are ganglia, giant cell tumour and angioleiomyomas ( Figure 41.10 ); these tumours may need surgical excision. Pigmented villonodular synovitis is a locally aggressive condition found in the ankle and is diag...

Ulceration and amputation Ulceration can lead to major morbidity and amputation ( Figure 41.13 ). Ulcers need to be treated urgently , and when ulcer healing has occurred the aim should be to keep the foot ulcer free. NICE guidelines detail optimal management ...

BONE TUMOURS Tumours found in bone are classified according to their morphological appearances. These include: /uni25CF metastatic carcinomas; may show histological features of their tissue of origin; James Ewing , 1866–1943, Professor of Pathology , Cornell ...

Biopsy A biopsy is performed only when local staging investigations have been completed. Because removal of the biopsy track is an important principle in the treatment of sarcomas, and specialist pathology is required, biopsies should be performed either in, ...

Chondrogenic tumours These tumours produce chondroid matrix and include a wide range of benign and malignant tumours. Osteochondroma ( Figures 42.14 and 42.15 ) is a benign cartilage-capped bony projection, thought to originate - - from the physis. The bony p...

EVALUATION AND INVESTIGATION OF THE PATIENT WITH A SUSPECTED BONE OR SOFT-TISSUE TUMOUR The diagnosis and treatment of patients with primary bone and/or soft-tissue tumours requires a high index of suspicion, appropriate and prompt investigation, and early r...

EVALUATION AND INVESTIGATION OF THE PATIENT WITH A SUSPECTED BONE OR SOFT-TISSUE TUMOUR The diagnosis and treatment of patients with primary bone and/or soft-tissue tumours requires a high index of suspicion, appropriate and prompt investigation, and early r...

Haematopoietic tumours Malignant haematopoietic tumours that commonly present in orthopaedic clinics are either solitary plasmacytoma/multiple myeloma (arising from plasma cells; Figure 42.2 ) or lympho mas (arising from lymphoid cells). Haematopoietic tumours...

History and examination It is important to take a thorough history , including a pain history . Non-mechanical and/or night pain, particularly in the young adolescent, is a concerning symptom and a primary bone tumour should be suspected. Relief with non-ster...

INTRODUCTION Musculoskeletal tumours include primary and secondary benign and malignant tumours of bone and soft tissue. The most common malignant tumours in bone are metastatic carci nomas ( Figure 42.1 ). Advances in oncological treatment mean that the numb...

Learning objectives List the symptoms and signs associated with a • musculoskeletal tumour Understand why a patient with a suspected • musculoskeletal tumour should be referred to a specialist centre for staging, biopsy and multidisciplinary management Underst...

Metastatic bone disease Most tumours that metastasise to bone are carcinomas. Some times, despite further investigations, the primary tumour is never found: these patients are described as having ‘carcinoma of unknown primary’. However, with advanced diagnost...

Osteogenic tumours These tumours characteristically produce osteoid or bony matrix, which may be seen on imaging studies or on histo logical examination. Osteoid osteoma ( Figures 42.11 and 42.12 ) is a benign bone-forming lesion that is small but very painful...

Others Simple (unicameral) bone cyst ( Figure 42.20 ) is a membrane-lined cavity filled with serous fluid within a bone. It usually occurs in the proximal long bones of children. Asso - ciated thinning of the cortex of the bone can lead to fracture. Such fractur...

PRINCIPLES OF TREATMENT Primary bone tumours Benign Most latent and active benign bone tumours that need treat - ment are treated by intralesional curettage. Packing of the cavity with a graft or bone substitutes is usually not required. Simple bone cysts can...