Case 21 Tophus
Case 21
Tophus
What happened ? Swelling elsewhere on body ?
Shoe Wears –
Worn outerside of sole
Alignment of
Great toe
Attitude of
Ankle / Lower extremity - no any
particular
Look foot from
Front , Side and Back on standing position
Swelling
over Ist MTP joint around 3 ,3 cm
Skin over medial border of Ist MT head –red ,
swollen ,shiny
Medial Arch maintained
and no too many toes from back
Gait – limping
See hand , elbow , ear pinna , ankle
Ask patient to
sit and feet out of bed – see the sole of feet
Feel - Temperature
increased
Swelling – site , size, surface , consistency ,
border , mobile , tender, pulsation , skin pinchable or not , transillumination
Always first superficially then deep for
bony palpation .
Heel ,malleoli , other metarasal bones on feet
,small toes then first metatarsal ,Great toe
Sessamoid complex, medial eminence , First
Metatarsophalnageal joint at last – non tender ,
Lymph node
Movement – toe – 2 planes
Always not to
miss comment on LLD – DEVELOP A HABBIT TO THINK ON THIS
Ligamentous
Instability check if it is there
Digital Senstion
, Capillary refill to say that the great toe is well perfused and has intact
sensory innervation .
Ankle and
Subtalar Motion
DPA / PTA
Impression – Hard lesion overlying
Ist MTP Joint possibly Gouty Tophus ,
Soft tissue tumor
Cystic lesion overlying
Ist MTP joint possibly Cold
Abscess
Haematoma
– Trauma /Blood Dyscriasis
Investigation
USG
Aspiration
of fluid and study under Microscopy
Negatively
Birefringent Crystals under polarized light is suggestive of Gouty Tohpus
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