A ganglion or hygroma is a small sac of fluid that often occurs near joints and tendons. Inside the ganglion there is usually a viscous, sticky, transparent, colorless liquid, similar to jelly. Depending on their size, hygromas may feel like dense nodules or spongy balls to the touch.
Hygromas or ganglia are very common on the dorsum of the wrist, but there are cases known.
Hygromas are less common in other places:
- at the base of the fingers on the palmar surface, here they are felt like small peas;
- at the end of the finger, near the base of the nail plate, such hygromas are also called mucosal cysts;
- near the knee joint and at the ankle;
- on the foot.
Hygromas are more common in women than in men. Most often, hygromas are found in people aged 20-40 years. Hygromas are found very rarely in children under 10 years of age.
Symptoms of ganglion or hygroma
- a tumor or ball that is soft to the touch, which can either increase or decrease;
- sudden swelling in the area of the hygroma;
- hygroma may appear and disappear again for a while;
- sometimes several hygromas are formed in one place at once, but usually they are interconnected deep in the tissues;
- some painful sensations may occur in the hygroma, especially after injury;
- sometimes the pain is chronic and can get worse with movement;
- If the hygroma is associated with a tendon, the affected muscle usually feels weaker. For example, a finger cannot fully move if there is a hygroma at its base.
In the photo below you can see a picture taken with an ultrasound of a hygroma.
Ultrasound hygroma
Causes of hygroma
- Injury, sudden movement, taking an unnatural position.
- Regular, uniform load on the joint.
- Wearing tight shoes for a long time.
- Hereditary connective tissue diseases.
- Self-treatment of arthrosis or arthritis.
Hygromas also form against the background of other diseases. These include tenosynovitis (inflammation of the inner lining of the muscle tendon sheath) and bursitis (inflammation of the synovial membranes in the joint area).
Most often, hygromas are diagnosed in athletes. In this case, they are caused by injuries and severe stress on the joints. Programmers, pianists, seamstresses and people of other professions, which are based on daily, repeated repetition of monotonous actions, are also prone to these formations. Tendon ganglia are also diagnosed in people with increased body weight; in this case, they are most often localized in the foot area.
Causes of hygroma
The exact cause of a hygroma or ganglion remains unknown. According to available data, trauma can lead to rupture of the joint capsule, resulting in protrusion of the synovial membrane along with the joint fluid beyond its boundaries. As a result, a hygroma is formed, which becomes noticeable upon examination.
There is also an opinion that hygroma can develop regardless of the presence of a traumatic agent as a result of primary weakness of the tendon sheaths of the muscles and articular apparatus, which can lead to protrusion of their walls and the formation of hygroma.
Conservative treatment
At the initial stage, treatment of the ganglion can be conservative.
Observation . Because a ganglion is a non-tumorous growth that may disappear over time, if it's not bothering you in any way, your doctor may suggest that you just keep an eye on it to make sure there's nothing unusual going on with it.
Immobilization . Ganglia often increase in size with physical activity, which can put pressure on nerves and cause pain. Immobilization of the wrist joint can relieve these symptoms and reduce the size of the ganglion. After pain relief, the doctor may recommend a set of exercises aimed at strengthening muscles and restoring range of motion.
Puncture and aspiration of contents . If the ganglion is the source of severe pain and limitation of movement, fluid from the ganglion can be removed. This procedure is called aspiration.
The skin around the ganglion is numbed with local anesthetic, the cyst is punctured with a needle and the fluid is removed with a syringe.
Aspiration usually brings only a temporary effect, since the “root” of the cyst or its connection with the joint or tendon sheath does not disappear. The ganglion in this respect resembles a pesky weed that constantly grows back because its root remains in the ground. Therefore, after aspiration, the ganglion appears again in many cases.
Aspiration is most often performed for ganglia located on the dorsum of the wrist.
During aspiration, the fluid filling the cyst is removed.
Surgery
If conservative measures do not cure the problem, your doctor may recommend surgical treatment. The operation involves excision of the ganglion.
Together with the ganglion or hygroma, a part of the altered joint capsule or tendon sheath, which is the root of the cyst, is usually removed. However, even after complete removal of the ganglion, there is a small chance that it will form again.
Excision of a cyst or hygroma is usually an outpatient operation, i.e. patients go home on the day of surgery after a short period of observation in the recovery room. After the operation, you may experience some pain and discomfort, and there may be some degree of swelling in the area of the operation. You will be able to return to normal physical activity 2-6 weeks after surgery.
Diagnosis of hygroma
Most often, it is not difficult to diagnose hygroma. Hygromas are clearly visible upon examination, have a spherical shape and are located in typical places. If the hygroma is connected to the tendon sheath of the muscle, then it will move up and down when it contracts.
If there is doubt about the diagnosis, the hygroma can be punctured. For these purposes, the doctor performs a puncture after anesthesia. If a jelly-like transparent viscous liquid is detected, the diagnosis is confirmed.
Hygroma puncture is usually performed under ultrasound control.
Ultrasound (US) plays an important role in the diagnosis of hygroma. It allows you to confirm the diagnosis of hygroma, since a hygroma is a cyst with walls and a cavity filled with fluid. Ultrasound allows you to distinguish hygroma from tumors, for example, lipomas and atheromas, which have a dense structure. Ultrasound also allows you to evaluate which vessels are suitable for the hygroma and their diameter.
In some cases, it is recommended to do an MRI of the affected area. MRI is a very informative research method, as it allows you to determine in detail the size and location of the hygroma.
How does hygroma appear?
Tendon sheaths are sheath-shaped; they surround the tendons of the long muscles in the area of the joint or bony prominence and are designed to facilitate the sliding of the tendons.
The vaginal cavities are filled with fluid. When the walls of the tendon sheath are damaged, fluid spills into nearby tissues. Hygromas can be single-chamber or multi-chamber. The latter appears as a result of several effusions of serous fluid, which can be localized in one or several areas. According to the structure of the ganglia, they are divided into the following types:
- Isolated.
The spilled liquid is in a confined space and does not have a connecting “bed” with the tendon sheath, which is filled with its own substance.
- Anastomosis.
A new cavity is formed, the fluid of which moves freely from it to the tendon sheath and back.
- Valve.
The serous fluid completely moves to a new location. A barrier formed in the tissue, called a valve, prevents it from returning to the empty vagina.
Such pathologies can occur in almost any joint, but most often occur in places such as:
- wrist joint;
- popliteal area;
- feet;
- fingers and toes.
According to statistics, these cystic formations are most often diagnosed in women aged 20–30 years.
Treatment of hygroma
Hygroma usually causes aesthetic discomfort and interferes with movement. Sometimes hygroma can hurt. Therefore, they try to get rid of hygroma.
It must be said that hygroma cannot disappear on its own. There are cases when hygroma decreased in size and even disappeared for some time, but invariably returned again.
Self-medication with hygroma usually does not give good results and can even be dangerous.
Self-medication methods for hygroma that should not be practiced:
- crushing hygroma;
- breaking up the hygroma;
- piercing a hygroma with a needle and more.
The fact is that trauma to the hygroma will not lead to its disappearance, but can lead to damage to other structures, the growth of the hygroma itself, as well as to its inflammation. Piercing a hygroma with a needle can lead to purulent inflammation, and this is dangerous since the hygroma is often associated with a muscle or joint.
Treatment of hygroma with punctures in a doctor’s office with the introduction of a sclerosant or hormone into its cavity should also not be practiced. Although such methods have been described and are often used, they do not give reliable results. Hygroma usually recurs after some time. At the same time, this method of treatment can cause undesirable changes in the tissues themselves, including salts that can be deposited in the hygroma capsule, which lead to its close fusion with adjacent tissues, and makes the hygroma itself as dense as a stone. Such a hygroma will be difficult to remove in the future.
Why is a hygroma (tendon ganglion) dangerous?
The neoplasm itself is not dangerous. However, as it grows, it begins to cause attacks of pain, usually occurring after loading the corresponding joint. In some cases, depending on the location and size, the hygroma begins to compress the blood vessels and nerve bundles. This can lead to the following complications:
- Paresthesia
- a sensitivity disorder, expressed in numbness, burning, tingling.
- Hyperesthesia
- This is a manifestation of pain, increased sensitivity to touch.
- Venous stagnation
- obstruction of blood outflow, worst case scenario. This can lead to the formation of thrombosis, dilation of veins and capillaries, swelling and cyanosis of tissues.
In these cases, immediate treatment is required. In other situations, the tendon ganglion is removed for aesthetic reasons.
Ganglion of the wrist and hand
Content:
- Description
- Cause
- Symptoms
- Medical examination
- Treatment
Ganglia (jelly-like cysts) are the most common formations in the hand area. They are not cancerous and in most cases are harmless. They are found in different places, most often forming on the dorsal surface of the wrist. However, they do require a diagnostic ultrasound examination of the wrist or hand - make an appointment by clicking here .
Ganglia are filled with fluid; in a short time they can appear, disappear or change in size. In many cases, a jelly cyst does not require treatment, but it always requires a medical examination.
However, if the cyst is painful, impairs mobility, or is a cosmetic defect, there are several treatment options.
Description
The most common location of the ganglia, as already mentioned, is the dorsal surface of the wrist.
The ganglion protrudes from the joint, resembling a balloon on a string. It grows from tissues surrounding the joint, such as ligaments, tendon sheaths and synovial membranes. Jelly cysts can occur in various joints of the hand and wrist, both on the dorsal and palmar side, as well as in the area of the tip joints of the fingers and at their base.
The ganglia vary in size and in many cases they enlarge as wrist activity increases. At rest, the nodule usually shrinks.
Cause
It is not completely known what causes the formation of a jelly-like cyst. It most often occurs in young people aged 15 to 40 years, more often in women than in men. Ganglia are common in professional gymnasts who deal with constant stress on the wrist. Most likely, this is a reaction of the tendon sheath, synovial membrane and ligament sheath to stress (swelling and increased formation of fluid occurs, creating a bulge in the tissue and forming a ganglion).
A jelly cyst that develops further into the interphalangeal joint - also called a mucous cyst - is usually associated with inflammation of the joint in the finger area and is more common in women aged 40 to 70 years.
Symptoms
Most ganglia are shaped like a distinct nodule, but smaller cysts may remain hidden under the skin (latent ganglion). Although many jelly cysts do not cause any symptoms, they can impinge on the nerve running through the joint, causing pain, tingling and muscle weakness. Less commonly, a ganglion can cause a conflict with a tendon or put pressure on a bone. Such conditions are an indication for treatment.
Large cysts, even if they are not painful, can be a cosmetic defect and are also an indication for surgery.
Medical examination
►Medical interview and examination
During your first visit, Dr. Paradovsky will discuss with you the current state of the disease and its symptoms. May ask questions about how long ago the cyst appeared, whether it changed its size and how painful it is.
Pressing in the area of change will allow the doctor to determine sensitivity in the area of the cyst. Because the cyst is filled with fluid (or a thick, jelly-like substance), it is transparent. The doctor may use a flashlight to see if the cyst is visible.
►Diagnostic imaging
Ultrasound or MRI (magnetic resonance). These diagnostic imaging studies better show the soft tissue that the ganglion belongs to. Sometimes magnetic resonance imaging or ultrasound is needed to visualize a hidden ganglion that is not visible to the naked eye, or to distinguish a jelly cyst from other types of neoplasms. Ultrasound also allows for puncture, aspiration, and precise injection of the drug into the ganglion lesion. Read more about ultrasound and watch ultrasound videos - click here.
X-ray. This test provides images of hard structures such as bone. Although an X-ray will not show a jelly cyst, it can be used to rule out other conditions, such as arthritis or bone cancer.
Treatment
►Conservative treatment
The initial treatment for most ganglia is nonsurgical.
- Observation . Because the ganglion is not cancerous and may go away on its own if it is not painful, your doctor may recommend waiting and monitoring it to make sure no alarming changes occur.
- Immobilization . The activity usually causes the ganglion to become larger and increases pressure on the nerves, causing pain. A wrist brace or stabilizer may reduce discomfort and may help shrink the cyst. As the pain begins to subside, your doctor may recommend exercises to strengthen your wrist and increase your range of motion.
- Aspiration . If the ganglion is causing pain or restriction of activity, fluid can be drained from the cyst. This procedure is called aspiration. In our clinic, the procedure is always performed under ultrasound guidance to ensure precision. The area around the cyst is anaesthetized, and the cyst is pierced with a needle so that the fluid can be removed. Aspiration does not remove the ganglion because its "root", that is, the connection to the joint or tendon sheath, is not removed when the fluid is suctioned. The ganglion, like a weed, will grow again unless its root is removed. In many cases, the cyst returns after the aspiration procedure. Aspiration is most often indicated in cases where the ganglion is located on the dorsum of the wrist.
►Surgical treatment
The doctor may recommend surgery if symptoms do not resolve with conservative treatment, or the ganglion reappears after aspiration. The procedure for removing the ganglion is called excision.
During surgery, the cyst is removed along with the affected joint capsule or tendon sheath, which are the “root” of the ganglion. However, even after removal of the cyst, there is a small risk of recurrence.
Ganglion excision is an outpatient procedure, and the patient can return home after a short observation in the recovery room. After surgery, the patient may experience tenderness and discomfort, and swelling may occur. Typically, return to normal activity is possible 2-6 weeks after the procedure.
Related topics:
- Carpal tunnel syndrome (carpal tunnel syndrome)
- De Quervain's syndrome (wrist pain above the base of the thumb)
- Stem Cell Therapy
Folk remedies
Photo: bagiraclub.ru
As stated earlier, the most effective way to treat hygroma is surgical removal, which significantly prevents a person from encountering this problem again. On the Internet you can find various folk recipes that promise to get rid of the troubling problem forever. But you shouldn’t believe them; it’s better to consult a doctor in a timely manner, who will suggest the most effective method of treatment.
The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.
Symptoms
Photo: inethuddle.com
First of all, a person pays attention to the appearance of a subcutaneous lump, which is why they seek help from a doctor. In most cases, the formation is soft in consistency, less often it has a dense consistency and has a smooth surface. The size ranges on average from 3 to 5 cm. Usually, hygroma, apart from cosmetic discomfort, does not cause any concern, including no pain. As the formation increases in size, a slight compression is felt, which causes discomfort. Painful sensations occur when the hygroma affects nearby nerves. If the formation is located on a joint, minor mobility impairments in this joint are noted.
Most often, hygroma occurs on the wrist (mainly on the back side, less often it affects the side of the wrist). If the hygroma is located under the ligament, the person will not immediately notice the formation that has appeared, since it can only be detected with strong flexion of the hand. Therefore, wrist hygroma is often asymptomatic and does not cause any discomfort. The formation is fused to the underlying tissues, but not to the skin. Therefore, the skin remains mobile in relation to the formation. When the hygroma is localized on the palmar surface, pain may occur. This is due to the large size of the formation, which is less pronounced on the dorsal surface, which leads to compression of nearby nerves. Less commonly, formations can be found on the fingers. In such cases, the favorite localization is the distal phalanges of the finger. These formations reach small sizes, the skin over it is stretched and thinned. Pain is often absent and can only occur when the area is rubbed.
Hygroma of the foot also occurs. Frequent localization is the dorsum of the foot or the anterior outer surface of the ankle joint. Considering that shoes are a strong traumatic factor in relation to education, pain often occurs. Also, the appearance of pain may be associated with an effect on nearby nerves. This happens when the hygroma reaches a significant size.