Lump or mass (musculoskeletal)

Rationale

Lumps or masses are a common cause for consultation with a physician. Musculoskeletal lumps or masses represent an important cause of morbidity and mortality.

Causal Conditions

(list not exhaustive)

1. Arising in soft tissue
   1. Infectious (e.g. furuncle, abscess)
   2. Inflammatory (e.g., tophus, rheumatoid nodule)
   3. Noninflammatory (e.g., lipoma, xanthoma, synovial cyst)
   4. Neoplastic (e.g., melanoma, Kaposi sarcoma, leiomyosarcoma)
2. Arising in bone
   1. Congenital (e.g., osteochondroma)
   2. Infectious (e.g., osteomyelitis)
   3. Inflammatory (e.g., joint changes from rheumatoid arthritis, psoriatic arthritis, Osgood-Schlatter disease)
   4. Noninflammatory (e.g., osteophyte)
   5. Trauma (e.g., callus from fracture, fracture)
   6. Neoplastic (e.g., Ewing sarcoma, metastatic disease)
3. Arising in nerves
   1. Congenital (e.g., neurofibroma)
   2. Infectious (e.g., leprosy [Hansen disease])
   3. Benign (e.g., neuroma, sarcoid granuloma, schwannoma)
   4. Neoplastic (e.g., malignant peripheral nerve sheath tumour)

Key Objectives

Given a patient with a musculoskeletal lump or mass, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, they will distinguish benign lumps or masses from those that are malignant.

Enabling Objectives

Given a patient with a musculoskeletal lump or mass, the candidate will

1. list and interpret clinical findings, including those derived from an appropriate history and physical examination with particular attention to features suggestive of sarcoma;
2. list and interpret critical clinical investigations, including laboratory and radiological studies if indicated and, in particular, those that indicate the patient requires a biopsy;
3. construct an effective initial management plan, including determining whether the patient requires specialized or urgent diagnosis and treatment.