Swelling in the Leg

Swelling in the Leg

1. Anatomy of the thigh

   • Posterior Compartment
     • Biceps femoris
     • Semi-tendinosus
     • Semi-membranosus
     • Nerve: Sciatic
   • Anterior Compartment
     • Flexors
       • Iliopsoas
       • Pectineus
       • Sartorius
     • Extensors
       • Quadriceps femoris
     • Nerve: femoral
   • Medial Compartment
     • Gracialis
     • Adductor longus
     • Obturator externus
     • Nerve: Obturator
   • Proximal Tibia and Fibula
   • Patella

2. Bone Development

   • The process of bone formation is called ossification
     • Intramembranous Ossificiation
     • Endochondral Ossification

3. Tumors in bone and cartilage

   • Primary bone tumors
     • Benign
       • Osteoma
       • Chondroma
       • Rhabdomyoma
     • Malignant
       • chondrosarcoma
       • Osteosarcoma
       • Rhabdomyosarcoma
   • Differences
   • Bone forming tumors
     • Osteoma
     • Osteoblastoma
     • Osteoid Osteoma
     • Osteosarcoma
       • Malignant tumor of mesenchymal cells characterized by direct formation of osteoid or bone matrix by direct formation of osteoid or bone matrix by the tumor cells
         • Primary osteosarcoma
           • Most common malignancy in children
           • Males > females
           • mutations in retinoblastoma gene, P53
           • Sites
             • lower end femur
             • upper end tibia
             • proximal humerus
             • proximal femur
           • Skip lesions
             • They represent areas of an osteosarcoma that are not connected to the primary tumor
         • Secondary osteosarcoma
           • Common in old age
           • Sites
             • flat bones > long bones
           • existing bone lesions
             • Paget’s disease of bone
             • Bone infarct
             • Chronic osteomyelitis
           • Metastatic bone tumors
             • These areas have a rich slow blood supply in their red marrow which makes it the perfect site for the growth of metastatic tumor cells
               • proximal femur
               • proximal humerus
               • Axial skeleton which includes vertebral column, pelvis, ribs, skull
       • Histology
   • Management
     • Surgery
       • Limb Saving Surgery
         • Limb sparing surgery is the procedure of removing the cancer without removing the affected arm or leg and the replacement with prosthetic or other bone
         • Complications
           • Infection
           • Prosthetic Fracture
           • Pathologic fracture
       • Amputation
         • Amputation is a type of surgery where a surgeon removes part or all of a limb and replaces it with a prosthetic device
           • Complications
             • Phantom Pain
             • Depression
             • Skin Breakdown
       • Consent
         • Capacity for consent
           • Make a free choice
           • Understand the consequences
           • Understand the complications and risks
           • Being aware of the procedure
     • Chemotherapy
       • the use of drugs to treat cancer
         • Types
           • Neo-Adjuvant Chemotherapy: administration of antineoplastic drugs prior to surgery to shrink the tumor size and decrease it’s vascularity.
           • Adjuvant Chemotherapy: the use of antineoplastic drugs when surgery or radiation has eradicated the primary tumor
           • Primary Chemotherapy: the use of antineoplastic alone for metastic or inoperable tumors
         • Complications
           • Nausea and vomiting
           • Loss of appetite
           • Hair loss
           • Mouth sores
     • Radiotherapy
   • Psychological Aspects
     • Emotional Reaction

4. Physical Examination

   • Look
   • Feel
   • Move
   • Special Tests
     • Thomas Test
     • Trendelenberg's sign
   • Imaging tests
     • X-rays
     • MRI
     • CT Scan
     • PET Scan
     • Radioisotopic
     • Diagnosis
       • Biopsy
         • Needle Biopsy
         • Open biopsy

5. Grading and Staging

   • Grading
     • its explains the level of aggressiveness of a tumor based on the cytologic features of the tumor cells
       • mitotic activity
       • nuclear pleomorphism
       • degree of differentiation
   • Staging
     • Assessment of the spread of the malignant tumor in the body based on clinical and radiographic finding
       • Imaging tests
       • Laboratory tests
       • Pathology reports
   • Other systems
     • TNM System

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