Hygroma of the wrist joint of the hand: danger, symptoms and treatment

General information

Hygroma - what kind of disease is it?
Hygroma (synonymous with tendon ganglion) is a soft tissue benign cyst-like neoplasm of the musculoskeletal system, originating from the membrane of the synovial elements of the tendon sheaths (tendon hygroma) or the articular capsule. Hygromas do not become malignant. The size of the hygroma varies within 0.5-5 cm, less often - up to 7-10 cm. The cystic cavity is filled with viscous synovial fluid with admixtures of fibrin protein/mucus, can have one/several chambers and be either isolated from the joint or have message to him. It is important to understand that hygroma is an organ-specific cyst, which always forms in the immediate vicinity of the joint and is not found in any tissues/organs. As the hygroma develops, its contents “thicken” because, with the same volume of fluid, the content of fibrin, protein and mucus increases. Accordingly, small hygromas contain a thicker jelly-like mass, and larger ones contain liquid contents mixed with fibrin threads, blood, and cholesterol .

Hygroma code according to ICD-10: M71.3. Hygromas are a fairly common type of tumor, occurring in almost 24.0% of cases of pathological formations of synovial membranes. Wide localization of hygromas, frequent relapses, the occurrence of specific symptoms manifested by pain, trophic disorders, dysfunction and parasthesia, as well as the formation of cosmetic defects make this problem especially relevant. At the same time, the frequency of occurrence of hygromas of different localizations varies significantly. Thus, cysts on the hand (hygromas of the dorsal surface of the wrist joint) make up about 48% of all calls for tumor-like formations. Hygromas on the fingers, palmar surface of the wrist joint, on the foot, knee/ankle joints are less common. They appear in both women and men of working age (20-50 years), but more often in women. Hygromas rarely occur in children under 10 years of age. Hygromas are frequent companions of rheumatic diseases.

As a rule, hygromas are single neoplasms, but in some cases there are several hygromas that arose simultaneously/or almost simultaneously. Cases of spontaneous disappearance of hygromas are extremely rare, which is apparently due to a decrease in the production of intra-articular fluid due to limited load on the joint.

Medications

Medicinal ointments are used only in the first stages of the disease. In these cases, they can cope with the disease.

Medicines:

• Vishnevsky ointment. It has a low cost and has a resolving effect. Apply to the tumor twice a day.
• Traumeel. Another effective remedy for benign neoplasms. Apply a large layer of ointment to the damaged area and wrap it with a bandage.
• Chondroxide ointment. The method of application is similar to that described above.
• You can apply iodine to the hygroma at night. They do this until complete recovery.

Medicines should be selected individually depending on the patient's condition. Treatment without surgery is possible, but it does not always bring the desired results.

Pathogenesis

There is no unified theory of the pathogenesis of ganglia. The most substantiated to date and confirmed by electron microscopic studies is the theory of metaplastic development of the ganglion. Trauma to the connective tissue (direct/indirect) of the joint/tendon causes metaplastic restructuring of the cellular elements of the tissue with the formation of small intracapsular cysts in its structure, the inner surface of which is lined with highly differentiated active mesenchymal cells producing an amorphous substrate ( mucin ). The second type of cells are morphologically forming cells, which are located in the deep layers of the ganglion wall with characteristic signs of degeneration common to all tissue cells of a cartilaginous and connective tissue nature.

Thus, the leading role in the pathogenesis of these neoplasms belongs to free radical destruction (destruction) of connective tissue, caused by insufficient enzymatic activity of the antioxidant defense system in connective tissue formations and, to a certain extent, inferiority of the morphological structures of synovial formations.

Education point

One of the ways to get rid of hygroma in the shortest possible time is the option of puncture - a specialist inserts a needle into the formation and aspirates its contents. This is a quick treatment option that does not require hospitalization or any major costs. The cyst decreases in size and collapses, but there is still a possibility of its return, since the walls of the formation remain.

Foreign experts have improved the technique of puncturing the cyst and added the final stage - the introduction of sclerosant. A special substance glues the walls of the hygroma, which determines the 100% absence of recurrence of pathology in a given place.

Other quick methods of therapy include the technique of crushing the formation. However, this manipulation is not modern and can disrupt the function of the joint and cause inflammation. In addition, after crushing the hygroma, the tumor recurs in more than half of the cases.

Classification

Hygroma is divided according to several characteristics. According to localization, hygromas are distinguished on the hand (dorsum of the hand, fingers), wrist (palm side of the wrist/dorsum of the wrist), elbow, face, armpit, knee joints (Baker's cyst), ankle joints, sole.

Based on their structure, they are divided into: single-chamber (exists in the form of one cavity), two-chamber (consists of two cavities) and multi-chamber hygromas.

According to the degree of isolation there are:

• Isolated hygroma (the hygroma cavity is isolated from the joint capsule).
• Hygroma with valve. The tumor and the joint are connected to each other through a “valve”. This structure allows new fluid to enter the tumor (during physical activity), which promotes the growth of the tumor.
• Hygroma with anastomosis. It is distinguished by the presence of a channel between the tumor and the joint, through which a one-way flow of liquid contents from the tumor into the joint capsule occurs (as in the figure).

Types of hygroma by degree of isolation

Clinical picture

The lump is clearly palpable and may hurt when walking

Hygroma, which affects the tendons of the foot, does not develop unnoticed. It is accompanied by symptoms characteristic of the disease.

Most often, the tumor is detected visually by patients. They begin to worry when they find a cyst on their body measuring 15 mm or more.

Initially, hygroma resembles a banal swelling of soft tissues, due to which they seem to protrude slightly under the skin.

Obvious symptoms of illness appear at the stage when the cyst increases to 10 mm. At this point, patients begin to complain of the following symptoms:

1. Feeling the lump under the skin.
2. The presence of clear boundaries of the tumor.
3. The appearance of pain when pressing on the tumor.

If hygroma affects the blood vessels, then loss of sensation in the foot and a change in its temperature due to blood stagnation are added to the general symptoms.

Hygroma can have different localization

Causes

The causes of hygroma have not been reliably established. However, the main risk factors have been identified that are highly likely to provoke the formation of hygroma. These include:

• Hereditary predisposition (hygromas appear more often in relatives).
• Constant high load on the tendon/joint (performing monotonous work - laundresses, typists, pianists, cooks, seamstresses, athletes - tennis players, track and field athletes, football players).
• Frequent injury to joints/tendons.
• Chronic diseases of the tissues of the tendon sheaths of the muscles/articular capsule of inflammatory origin ( bursitis , tendonitis , tendovaginitis ).
• Operations on joints.
• Wearing uncomfortable shoes.
• Metabolic disorders (metabolic/endocrine disorders).

Symptoms

Clinically, hygroma is defined as a sedentary formation, round in shape and elastic consistency, not fused with surrounding tissues, mostly painless on palpation. The skin over the hygromas is thinned and acquires dark shades. When the cyst becomes inflamed, the skin becomes swollen and turns red. Regardless of the location, the spectrum of clinical manifestations is the same, with the exception of some specificity due to the localization of the cyst.

The main sign that determines the severity of clinical symptoms is the size of the hygroma: the larger the size of the cyst, the more severe the symptoms and the more varied the complaints. Hygromas of small size, as a rule, do not manifest clinical symptoms and do not cause any particular inconvenience. Complaints in such cases are mainly about the non-aesthetic appearance, especially if the cyst is located on a visible area of ​​the body.

As the hygroma grows, symptoms appear due to compression of adjacent tissues, nerves and blood vessels, most often manifested by constant nagging pain, which intensifies with intense work of the joint in the area of ​​which the hygroma is located. That is, if it is a cyst of the knee joint, the pain intensifies when walking/running/standing for long periods of time; with hygroma of the wrist joint - the pain intensifies with circular movements in the joint (when stirring sugar in tea/cream in a bowl), lifting heavy objects.

When the tumor is large and there is strong compression of adjacent vessels and nerves, there is a disturbance in sensitivity and a decrease in the range of movements in areas of the body more distant from the affected joint. For example, with a large hygroma on the wrist, the sensitivity/mobility of the entire hand is impaired, which can manifest itself in the form of hyperesthesia (increased sensitivity of the skin) and even light touches are painful and unpleasant or paresthesia (feeling of numbness of the skin/pins and needles). A large hygroma, in addition to sensory disturbances, can cause constantly present neuralgic pain due to pressure on the nerve fiber and venous congestion caused by deterioration of blood microcirculation in different areas of the body located further from the affected joint. Let us consider the features of the clinical manifestation of hygroma depending on its location.

Hygroma on the hand

Hygroma of the elbow joint

Hygroma of the elbow joint is located in the area of ​​the elbow joint on the lateral surface of the forearm/shoulder. The size of the neoplasm varies from 1 to 5 cm and can have a soft or hard consistency. Most often a single education. The skin in the area of ​​the hygroma may not change, or if it is large, it may become rough, acquire a purple tint and peel off. Clinically manifested by limited mobility in the elbow joint, a feeling of discomfort when bending/extending the arms, and constant pain. Inflammation/suppuration of the hygroma is possible. Causes aesthetic discomfort.

Hygroma of the wrist

Hygroma of the wrist joint of the hand

It is formed in the area of ​​the wrist joint of the hand on both the outer and inner sides of the wrist.

With a small hygroma (up to 3 cm), if it is single-chamber and does not compress blood vessels and is not located in the area of ​​the plexus of nerve fibers, the symptoms are in most cases smoothed out and the pain is moderate. The neoplasm is soft in consistency with clearly defined boundaries. When the disease just begins to develop, a small, clearly visible hygroma appears under the skin, which gradually grows. If you press on it, intense pain will occur. If you do not contact it, the pain may be moderate or absent altogether.

For larger sizes, there is a dull, constant pain in the hand, radiating to various areas of the hand. The pain increases after intense physical activity and stress on the joint and subsides during the period of rest. The skin over the hygroma may change: become thicker, redden, and peel. If the tumor compresses the nerve endings, disturbances in the sensitivity of the skin on the hand may occur. When blood vessels are compressed, there is a feeling of numbness and “pins and needles.”

Hygroma of the hand

Hygroma on fingers

A neoplasm on the hand can occur on any joint of the hand, both on the palm and back, however, the most common option is a hygroma on the finger, which can be either single on one finger or multiple. Less commonly, hygroma occurs on several fingers of the hand at once - see photo of hygroma on a finger.

When the hygroma is localized on the palmar surface, the symptoms are more pronounced due to the high innervation of this part of the body.

Hygroma of the palmar surface of the hand

Accordingly, the occurrence of a tumor on the side of the palm in most cases is accompanied by compression of the nerve fibers and the presence of a more pronounced pain syndrome in the area, which can radiate along the nerve fiber. The pain is pressing. The tumor can be relatively soft or hard in consistency and have varying degrees of mobility. The function of the finger adjacent to the tumor often suffers.

A cyst on the finger is accompanied by similar symptoms. The finger may become numb and lose sensitivity. As the tumor enlarges, finger function suffers and the skin changes color. Due to the high functionality of the hand and frequent trauma to the tumor, inflammation may develop in the adjacent tissues. Accordingly, this is a visible cosmetic defect.

Hygroma on the leg

Hygroma on the leg has many locations and can practically form near the serous bursa of any joint of the leg.

Hygroma of the knee joint (Baker's cyst)

Baker's cyst (synonymous with popliteal hernia) is often a consequence of rheumatism ( rheumatoid arthritis ), deforming arthrosis, or a complication of intra-articular hematomas/chronic synovitis of the knee joint. Often the neoplasm grows into the popliteal region and reaches 8-10 cm. A small cyst does not manifest itself in any way, only minor pain may be present during physical activity. Due to the deep location of the cyst and its comprehensive surrounding by muscles and ligaments, the mobility of a small tumor can rarely be determined.

Baker's cyst

As the hand of the knee joint grows, characteristic signs appear - a mobile tumor with clear edges is palpated under the knee, painful on palpation, complaints of constant aching pain in the joint, which subsequently spread to the muscles of the lower leg, and can sometimes radiate to the thigh. A large Baker's cyst often prevents full flexion of the knee, and with forced flexion, symptoms of compression of the tibial/peroneal nerve/popliteal artery appear. The patient feels weakness in the calf muscles. During walking and other activities, stiffness appears in the joint, and less commonly, swelling and numbness of the limb.

It becomes a problem to bend the leg at the knee and perform basic movements (climb/descend stairs, sit down/stand up). Compression of blood vessels contributes to the appearance of congestion in the veins and the development of thrombosis , thrombophlebitis , and trophic ulcers . When the cyst suppurates, there is a risk of developing arthritis .

Hygroma of the foot

It can appear near any joint of the foot, but is more common at the ankle and on the outside of the phalangeal bones. Less common on the toe and plantar part of the foot.

Photo of foot hygroma

Facial hygroma

A neoplasm on the foot interferes with walking and wearing shoes, due to which the cyst is subjected to pressure and often presses on the nerve endings in the area of ​​its formation, which is accompanied by constant pain, redness and peeling of the skin over the cyst. In addition, hygroma located in the foot area is subject to frequent injury with the release of liquid contents. In this case, there is a high risk of infection with the development of an inflammatory process (redness of the skin, swelling, nagging pain appears).

A more rare localization of hygroma is the face. Hygroma of the face is mainly formed in the area of ​​the temporomandibular joint.

The symptoms of facial hygroma are identical, however, with its large size, pain occurs when chewing food. In addition, the location of the hygroma on the face is always psychological discomfort.

Subdural hygroma

This localization is relatively rare. Subdural hygromas are accumulations of serous fluid/cerebrospinal fluid in the subdural space, causing compression of the medulla.

Subdural hygroma of the brain

They can develop in isolation or in combination with intracranial hematomas, brain contusions, hemorrhage in the subarachnoid space, fractures of the skull bones, which, accordingly, determines the polymorphism of their clinical symptoms. Damage to the arachnoid membrane (unilateral/bilateral) is more common in the area of ​​the Sylvian fissure. The volume of subdural hygroma varies between 40-200 ml. The contents of the subdural hygroma are represented by colorless/bloody cerebrospinal fluid. The symptom complex is determined primarily by the size of the hygroma, the main manifestations of which are:

• A short primary loss of consciousness, after leaving (a few hours/days) - paroxysmal intensifying headaches with a meningeal tinge ( photophobia , irradiation of pain to the cervical-occipital region/eyeballs). Headache may be periodically accompanied by vomiting.
• Disturbances in mental activity of the frontal-callous syndrome type (disorientation in place/time, euphoria, decreased criticism, speech impairment, fine motor skills) supplemented by the appearance of psychomotor agitation.
• There is often a convulsive component (from clonic seizures to generalized epileptic seizure).
• Gradual development of secondary, wave-like, deepening disturbances of consciousness. Chronic subdural hygromas that develop in childhood, in contrast to acute/subacute forms of hygroma, form capsules that can be large in size, and their clinical picture is determined by the level of brain compression.

Treatment methods

To make an accurate diagnosis, fluid is taken from the hygroma using a puncture. Sometimes it is possible to cure a hygroma with the help of several punctures with the elimination of all the fluid. A more radical treatment for hygroma is excision of the ganglion.

The operation to remove hygroma is performed under local anesthesia and has an average duration of 25 minutes. In more advanced cases, hygroma removal is performed under anesthesia. Removal of hygroma can be carried out using laser and endoscopic techniques. The laser is superior to traditional treatment not only in efficiency, but also in the fact that traces of surgery are less noticeable.

However, those people who are afraid of surgery can try conservative methods of therapy. They are prescribed if the hygroma becomes inflamed and painful.

Medication correction

Drug treatment is indicated for patients with inflammation of hygroma, which develops due to compression of surrounding tissues. This happens when the joint or synovial vagina on which the tumor grows becomes inflamed.

If the inflammatory process is aseptic, then drug correction can be done.

The following symptoms will indicate such a reaction:

• Pain in the area of ​​the hygroma, which is present on a constant basis.
• Increase in body temperature to subfebrile levels.
• Slight limitation of limb mobility.
• No signs of suppuration. The skin remains unchanged.

If the inflammation is purulent, then the patient requires the help of a surgeon. In addition, he is prescribed antibiotics, which are necessary to completely destroy the source of infection.

The following signs indicate a purulent process:

• Intense pain in the affected area.
• Increase in body temperature to high levels.
• Restricted joint or tendon mobility.
• A skin defect through which bacteria have entered the tumor.

Treatment methods for aseptic inflammation:

Before starting treatment, you should consult your doctor. The doctor will select an adequate dose and indicate the duration of treatment.

[Video] Doctor Egorov - hand hygroma. Get rid of it easily!

Physiotherapy for the treatment of hygroma

Physiotherapy allows you to get rid of aseptic inflammation of the tumor:

Performing hygroma puncture

The puncture allows you to reduce the size of the tumor for some time, but it will not be possible to completely get rid of it. This procedure is carried out if the hygroma hurts, but due to some circumstances the person cannot undergo surgery.

First, the patient’s skin is treated with a disinfectant composition, after which a needle is inserted into the cyst at an angle of 30 °C. The fluid is aspirated until the swelling completely subsides. To slightly reduce the risk of re-development of hygroma during puncture, it is possible to administer sclerosing solutions. However, it is impossible to guarantee a 100% positive effect. With this treatment, there is an increased likelihood that the injected composition will enter the cavity of the joint or tendon sheath. This can lead to the formation of adhesions and limitation of limb movements.

The puncture can be performed not only for therapeutic purposes, but also for diagnostic purposes, as it allows one to study the fluid that filled the cyst.

Tests and diagnostics

Diagnosis of hygroma in most cases does not cause difficulties and is based primarily on physical examination data and patient complaints. If necessary (for differential diagnosis), instrumental studies may be prescribed:

• Plain radiography (if bone formations are suspected).
• Ultrasound examination (to determine the structure of the cyst - boundaries, homogeneity, intensity of blood supply).
• Magnetic resonance imaging.
• Diagnostic puncture (cytological/biochemical examination of fluid).

Prevention

To prevent hygroma, you must follow a number of rules:

• Prevention of possible damage to joints, reasonable loads when playing sports and lifting/moving heavy objects. If it is impossible to avoid increased loads, use a special corset or fixing bandage on the wrists.
• Maintain muscle/ligament elasticity by performing daily stretching exercises. Daily physical activity is enough.
• Treatment of diseases (purulent tendevitis/bursitis) that create a risk of hygroma.
• A balanced diet that includes fresh vegetables, leafy greens, fish, bran, wholemeal bread, dairy products, olive oil, and dietary meats.
• Taking chondroprotectors/vitamin-mineral complexes to strengthen cartilage tissue.

List of sources

• Babich I.I., Chepurnoy G.I. Treatment of hygroma in children // Surgery. - 1989.-No.11.-P.79-82.
• Kushch N.L., Khudyakov A.E. Hygromas of the wrist joint in children // Surgery. -1991.-No.8.- P. 114-117.
• Recurrent hygroma (tendon ganglion) - diagnosis and treatment / Anokhin A.A., Anokhin P.A. // Medical and pharmaceutical sciences - 2013 - No. 3.
• Ashkenazi A.I. Surgery of the wrist joint. Moscow, 1990. P.273-327.
• Usoltseva E.V., Mashkara K.I. Surgery for diseases and injuries of the hand. Leningrad, 1986. pp. 174-176.