From the Guidelines
The patient should undergo an urgent x-ray of the affected site to assess for any signs of bone destruction, new bone formation, periosteal swelling, or soft tissue swelling, as recommended by the UK guidelines for the management of bone sarcomas 1. The initial approach should include a detailed history taking, focusing on when the lump appeared, how quickly it grew, associated symptoms, and any relevant medical history. A comprehensive physical examination should follow, assessing the lump's size, consistency, mobility, tenderness, and examining nearby lymph nodes.
- The patient's symptoms of a lump and associated pain and swelling could represent various conditions ranging from benign infections or cysts to more serious conditions like abscesses or malignancies.
- While awaiting diagnosis, symptomatic relief can be provided with NSAIDs like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for pain and inflammation, as suggested by the american cancer society/american society of clinical oncology breast cancer survivorship care guideline 1.
- Applying ice packs for 15-20 minutes several times daily may help reduce swelling.
- Depending on the clinical findings and x-ray results, further diagnostic tests may be necessary, including ultrasound, CT scan, MRI, or biopsy for definitive diagnosis, as outlined in the uk guidelines for the management of soft tissue sarcomas 1.
- It's crucial not to delay seeking medical attention, and the patient should be referred to a specialist or a bone sarcoma centre if necessary, to exclude any potential malignancies and provide appropriate treatment.
From the Research
Patient Presentation
The patient presents with a lump on the right knee, described as a 1/2 egg in size, with an onset date of 5/29. The skin over the lump is of normal color and is not warm to the touch. The patient reports a pain level of 4/10 and denies any fever or known trauma.
Differential Diagnosis
Given the patient's presentation, possible causes of the lump and associated pain include:
- Osteoarthritis (OA) [ 2 ]
- Patellofemoral pain [ 2 ]
- Meniscal tears [ 2 ]
- Achilles tendinopathy is less likely given the location of the pain, but it is a possible consideration for knee pain in general [ 3 ]
Next Steps
The next steps in managing the patient's condition include:
- Conducting a thorough physical examination to assess for signs of inflammation, tenderness, and limited range of motion
- Obtaining a detailed medical history to identify any potential underlying conditions or risk factors
- Considering imaging studies, such as X-rays or an MRI, to further evaluate the lump and surrounding tissue
- Developing a treatment plan based on the underlying cause of the lump and pain, which may include:
- Conservative management with exercise therapy, weight loss, and education for OA [ 2 ]
- Hip and knee strengthening exercises, foot orthoses, or patellar taping for patellofemoral pain [ 2 ]
- Conservative management with exercise therapy for meniscal tears [ 2 ]
- Pain management with acetaminophen or NSAIDs, such as ibuprofen, as needed [ 4 , 5 , 6 ]