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Updated: Jun 22 2021

Nodular Fasciitis

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  • summary
    • Nodular Fasciitis is a common, fibrous, soft tissue lesion that usually occurs in the upper extremities of young people.
    • Diagnosis is made with MRI studies showing a deep-seated inhomogeneous mass with nodularity along the fascial planes. Biopsy shows short irregular bundles and fascicles in a dense reticulum network.
    • Treatment is usually marginal surgical resection. 
  • Epidemiology
    • Incidence
      • most common fibrous soft tissue lesion
      • half of the cases occur in the upper extremities
    • Demographics
      • males and females equally affected
    • Anatomic location
      • volar forearm, back, chest wall, head and neck
  • Presentation
    • Symptoms
      • may be painless or painful
        • painful in half of patients
      • often rapidly enlarging mass over 1 to 2 weeks
      • lesions 1 to 2 cm
  • Imaging
    • Radiograph
      • usually normal
    • MRI
      • shows deep seated inhomogeneous mass
      • nodularity with extension along the fascial planes
      • avid enhancement with gadolinium
      • most commonly is superficial but can occur intramuscularly or along the superficial plane
  • Histology
    • Classic characteristics are
      • short irregular bundles and fascicles
      • dense reticulum network
      • small amounts of mature collagen
  • Treatment
    • Operative
      • marginal resection
  • Differential
      • Differential of Nodular Fasciitis
      • Treated with marginal excision
      • Nodular fasciitis (soft tissue)
      • o
      • Periosteal chondroma
      • o
      • Neurilemoma (soft tissue)
      • o
      • Epidermal inclusion cyst
      • o
      • Glomus tumor
      • o
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QID 219581 (Type "219581" in App Search)
A 72-year-old female presents to the clinic with worsening left knee pain. She has attempted NSAIDs, physical therapy, and multiple corticosteroid injections, however her pain is recalcitrant to conservative measures. She has a fixed coronal plane deformity with minimal correctability and a 15-degree flexion contracture on exam. Weight-bearing radiographs are demonstrated in Figures A and B. After discussion, the patient agrees to proceed with total knee arthroplasty (TKA). Which of the following should be considered when performing total knee arthroplasty in this patient?
  • A
  • B

Pie-crusting the medial collateral ligament utilizing an 18-gauge needle

6%

62/986

Resect less distal femur than the surgeon’s typical standard TKA protocol

32%

314/986

Releasing the fascial septum between the peroneus longus and extensor digitorum longus

46%

451/986

Performing a staged, medial-opening high tibial osteotomy 6 months prior to TKA

6%

63/986

Using a cruciate retaining implant to minimize overall constraint and improve range of motion

9%

87/986

  • A
  • B

Select Answer to see Preferred Response

Pathology | Nodular Fasciitis
  • Pathology
  • - Nodular Fasciitis
4:49 min
3/17/2022
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