Wrist hygroma treatment methods, symptoms, causes

Hygroma is a cyst with dense walls filled with fluid. The tumor is always located in the joint area, since the walls of the tumor are the synovial membrane of the joint. Visually, the cyst looks like a tumor-like formation, but does not carry an oncological danger.

However, hygroma leads to other complications: the tumor impairs the function of the joint, provokes chronic inflammation, interferes with the proper functioning of the tendons, limits the motor activity of the hand and is an aesthetic defect. Of course, every patient will not experience all of the above-described adverse effects - depending on the location of the hygroma, it causes certain inconveniences.

If in your case a hygroma was diagnosed, which does not interfere with everyday life, this does not mean that it does not need to be treated. It is better to eliminate the pathology at an early stage of development, when the tumor is small and can be easily removed. However, the disease has various causes and treatment of wrist hygroma should include the elimination of the provoking factor, which determines the long-term result of therapy.

Diagnosis of pathology

Diagnosis of hygroma begins with examination and palpation of the formation. Obtaining information about how the tumor appeared, as well as palpation determination of its properties, provides the specialist with basic information. An ultrasound examination of the tumor allows us to say with certainty that the existing tumor is a hygroma.

Also, when a hygroma is diagnosed, the patient is prescribed an X-ray examination of the hand and wrist joint to determine the condition of the surrounding bone structures. In controversial cases, CT or MRI of the wrist may be used.

Conservative treatment methods

Treatment of wrist hygroma without surgery includes the use of anti-inflammatory ointments and physical therapy. Using similar methods, it is possible to ensure that the hygroma decreases in size due to the resorption of the liquid contents. However, the walls of the cyst remain unchanged, and nothing prevents them from refilling with fluid. In addition, today foreign clinics offer many minimally invasive methods of treating hygroma, in particular laser evaporation, which allows you to quickly get rid of the pathology without complications or relapses.

Hygroma (Bursal cyst, Synovial cyst, Tendon ganglion)

Initially, a small localized tumor appears in the area of the joint or tendon sheath, usually clearly visible under the skin. Usually hygromas are single, but in some cases simultaneous or almost simultaneous occurrence of several hygromas is observed. There are both very soft, elastic, and hard tumor-like formations. In all cases, the hygroma is clearly demarcated. Its base is tightly connected to the underlying tissues, and the remaining surfaces are mobile and not fused to the skin and subcutaneous tissue. The skin above the hygroma moves freely.

When pressure is applied to the area of the hygroma, acute pain occurs. In the absence of pressure, symptoms may vary and depend on the size of the tumor and its location (for example, proximity to nerves). There may be constant dull pain, radiating pain, or pain that appears only after intense exercise. In approximately 35% of cases, hygroma is asymptomatic. Quite rarely, when the hygroma is located under the ligament, it can go unnoticed for a long time. In such cases, patients consult a doctor because of pain and discomfort when bending the wrist or trying to grasp an object with their hand.

The skin over the hygroma can either remain unchanged or become rough, acquire a reddish tint and peel off. After active movements, the hygroma may increase slightly, and then decrease again at rest. Both slow, almost imperceptible growth and rapid increase are possible. Usually the size of the tumor does not exceed 3 cm, but in some cases hygromas reach 6 cm in diameter. Self-resorption or spontaneous opening is impossible. At the same time, hygromas never degenerate into cancer; the prognosis for them is favorable.

Certain types of hygroma

Hygromas in the area of the wrist joint usually occur on the back side, along the lateral or anterior surface, in the area of the dorsal transverse ligament. As a rule, they are clearly visible under the skin. When located under a ligament, a tumor-like formation sometimes becomes visible only with strong flexion of the hand. Most of these hygromas are asymptomatic and only some patients experience minor pain or discomfort when moving. Less commonly, hygromas appear on the palmar surface of the wrist joint, almost in the center, a little closer to the radial side (thumb side). The consistency can be soft or densely elastic.

On the dorsum of the fingers, hygromas usually arise at the base of the distal phalanx or interphalangeal joint. The skin over them stretches and thins. A small, dense, round, painless formation is determined under the skin. Pain appears only in isolated cases (for example, with a bruise).

On the palmar side of the fingers, hygromas are formed from the flexor tendon sheaths. They are larger than the hygromas located on the back side, and often occupy one or two phalanges. As the hygroma grows, it begins to put pressure on numerous nerve fibers in the tissues of the palmar surface of the finger and the nerves located along its lateral surfaces, therefore, with such localization, severe pain is often observed, reminiscent of neuralgia in nature. Sometimes, upon palpation of the hygroma, fluctuation is detected. Less commonly, hygromas occur at the base of the fingers. In this section they are small, the size of a pinhead, painful when pressed.

In the distal (far from the center) part of the palm, hygromas also arise from the flexor tendon sheaths. They are small in size and high in density, so upon examination they are sometimes confused with cartilaginous or bone formations. At rest they are usually painless. Pain appears when trying to tightly grasp a hard object, which can interfere with professional activities and cause inconvenience at home.

On the lower extremity, hygromas usually appear in the foot area (on the dorsum of the metatarsus or fingers) or on the anterior outer surface of the ankle joint. As a rule, they are painless. Pain and inflammation can occur when the hygroma is rubbed with shoes. In some cases, pain appears due to the pressure of the hygroma on a nearby nerve.

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.

Hygroma removal

Causes of hygroma formation and symptoms of the disease

The etiology of the development of this pathology is not fully understood. However, there are basic assumptions for the formation of hygromas, such as:

excessive loads on the joints, as well as frequent trauma to the distal bone joints;
hereditary predisposition to connective tissue diseases;
increased secretion of synovial fluid (for example, in autoimmune diseases);
other inflammatory processes of articular elements or nearby tissues (bursitis, tenosynovitis).

A synovial cyst (hygroma) is most often localized on the dorsum and palmar surface of the wrist, less often on the foot, in the area of the phalanges of the fingers and other joints. Visually, at the initial stage of development, the formation resembles an oval protrusion the size of a pea, which gradually increases, has a soft, densely elastic consistency and over time can significantly increase in volume. The skin over the formation remains unchanged.

Typically, the development of hygroma is not accompanied by pain or any discomfort (if you do not take into account the appearance). However, in an advanced form or with long-term development of the pathology, an inflammatory process of the synovial cyst can be observed, which is accompanied by pain, swelling of the tissues, numbness of the distal parts due to local disruption of innervation and blood circulation.

Diagnosis of the disease

To make a diagnosis, a traumatologist performs a visual examination and palpation of the affected area.

However, in some cases, in order to exclude diseases with similar clinical manifestations (secondary manifestations of rheumatoid arthritis (Heberden’s and Bouchard’s nodes), fibromatous formations, small lipomas, molluscum contagiosum, ecchondromas, osteomas, osteosarcomas), additional methods for determining the morphological structure of the formation will be required:

Ultrasound – allows you to clearly differentiate and structure formations of non-osseous origin from cysts, as well as perform topical preoperative preparation;
- one of the most informative research methods for bone formations, providing an accurate amount of information about the pathological process;
X-ray is the most common and inexpensive method of examination to determine the nature of the bone abnormality;
puncture biopsy - performed by an oncologist in cases of suspected malignant tumor.

Surgical treatment of hygroma

In the absence of contraindications and the topical location of the formation is clarified, the doctor proceeds to surgically remove the hygroma. This operation can be divided into the following stages:

preparation for surgery: processing of the surgical field, marking the future surgical approach;
carrying out anesthesia. Most often, local anesthesia is used, but in difficult cases, with a deep formation with access to the joint or articulation of the bones of the wrist, general anesthesia is used;
depending on the size of the formation and the depth of its occurrence, the doctor can first pump out the serous fluid from the synovial cyst and then excise it, or remove the entire hygroma along with the contents. An important point is the complete removal of the hygroma capsule. Incomplete removal of the capsule may cause recurrence of the pathology and lead to reoperation. The removed material must be sent for histological examination to exclude any possible oncological pathology;
the doctor inspects the postoperative wound with careful hemostasis (stopping bleeding) and layer-by-layer restoration of the tissues dissected during access;
step-by-step treatment of the surgical wound with an antibacterial solution with sutures (sutures are removed after 14 days);
fixation of the joint (stabilization of the operated joint) with a splint bandage for a period of 1 to 2 weeks.

After removal of the hygroma, subsequent treatment is carried out on an outpatient basis, under the supervision of an operating doctor. If necessary, the doctor can prescribe a set of rehabilitation measures.

During the rehabilitation period, it is extremely important to limit the load on the operated limb segment. After removing the sutures and splints, in order to prevent the adhesive process of contracture, which can lead to a decrease in the function of the operated area, it is recommended to perform special gymnastic exercises (physical therapy) under the supervision of specialists, as well as undergo an appropriate course of physiotherapeutic treatment: magnetic therapy, laser therapy, phonophoresis with hydrocortisone, UVT therapy. Sanatorium-resort treatment of diseases of the musculoskeletal system is also considered an effective method of rehabilitation.

Laser treatment of wrist hygroma

Laser removal of benign cystic lesions is an excellent solution for patients who want to avoid extensive surgery. For people with hygroma, laser removal can also be used.

After the fluid is removed from the cyst, the doctor inserts a laser sensor through an incision several millimeters long and seals the cavity. The laser beam ensures strong adhesion of the walls, which eliminates relapse in this very place. It is important to note that if, after treatment of the pathology, hygroma on the wrist appears again, then there may be some serious provoking factor, which should be discussed with a specialist.

Laser treatment of wrist hygroma provides patients with the following benefits:

speed and ease of implementation;
no introduction of drugs or foreign materials into the body;
no need to stay at the clinic;
quick return to work, which is possible the very next day;
minimal risk of complications and relapses.

After eliminating the hygroma, a bandage is applied to the wrist for 7 days, and then the limb is fixed with an elastic bandage for a short period. An elastic bandage can only be used at night if this activity interferes with work or embarrasses the patient.

Hygroma on the wrist: treatment methods

Hygroma of the wrist joint manifests itself as a feeling of limited range of motion in the problem area, and some pain may be present. In addition, from an aesthetic point of view, hygroma causes psychological discomfort to the owner. In the treatment of this formation, both conservative methods and surgical intervention are used.

Conservative treatment

Currently, in 85% of cases, surgical methods are used to treat hygroma, but conservative therapy is used for a certain group of patients.

The following methods of conservative treatment of hygroma are distinguished:

Puncture. This is the most common option for conservative therapy; this method is used in the presence of pus. A puncture is made, after which the contents of the hygroma are extracted with a syringe. Next, an antiseptic solution is injected into the cavity. Several treatments may be required. Since the hygroma capsule remains, relapses are possible after puncture.
Sclerotherapy. At the first stage, this method is similar to the previous one, however, after extracting the contents, a special enzymatic solution is introduced into the cavity of the hygroma, which promotes the destruction of the capsule. The method is more effective compared to conventional puncture, but is more expensive. Sclerotherapy is not suitable for large hygromas.
Blockade using glucocorticoids. This method is used only in cases where the diameter of the formation does not exceed 1 cm. Local anesthesia is performed, a puncture is made, the contents of the capsule are removed, the cavity is washed, after which a solution of a glucocorticoid drug (for example, Diprospan) is injected inside. Next, a bandage is applied for several weeks to immobilize the joint. During this period, the walls of the capsule stick together, and the area is overgrown with scar tissue.
Crushing. This method is characterized by significant pain, a high probability of complications and low efficiency, therefore it is not used today.
Physiotherapeutic methods. Physiotherapy is used both separately and in combination with other techniques. Methods such as ultraviolet irradiation, mud therapy, ultrasound, magnetic therapy, etc. are used.
Ethnoscience. There are folk recipes for herbal compresses (based on cabbage leaves, wormwood, celandine, etc.), but they should only be used in combination with basic treatment; they do not get rid of hygroma on their own. You must first obtain medical advice.

Indications for surgery

Surgical intervention is the most reliable method of treating hygroma.

The operation may be indicated:

with an aesthetic defect;
with joint pain, stiffness of hand movements;
when squeezing blood vessels and nerve endings;
with the formation of pus;
with intensive growth of hygroma.

Surgical methods

In medical practice, the following methods are used to remove hygroma:

Excision. The surgeon makes an incision over the surface of the formation, and both local and general anesthesia can be used. The hygroma is carefully removed through the hole, sutures, an aseptic bandage and plaster are applied. Sutures are usually removed on the tenth day. Since the hand area contains a large number of nerve endings and blood vessels, the surgeon must have the proper competence. After surgery, you may need to consult a chiropractor during the recovery period.
Instrumental removal. This is a more modern technique; using instruments, an inconspicuous incision is made on the side of the formation. This technique allows for less trauma to the area and minimizes the appearance of the scar.
Laser removal. In this method, after cutting the area, the hygroma is not removed with a scalpel, but is burned out with a laser. The use of a laser reduces the likelihood of trauma to blood vessels and nerves during surgery.

Hygroma on the wrist often occurs with increased stress on this area, which often happens in people leading an active lifestyle.
It is best to contact a medical facility in the early stages of the disease, when the size of the tumor is not yet too significant. Timely treatment will help you recover as soon as possible and reduce the risk of relapse. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Surgical intervention

Laser treatment of wrist hygroma in Germany is the most acceptable method, but in some patients it is still necessary to undergo extensive surgery, which is determined individually. For certain structural features of the hand, treatment of the wrist should be performed using full-fledged surgery.

Surgical treatment of wrist hygroma in German clinics is carried out as follows:

the specialist makes an incision over the hygroma, the length of which depends on the size of the formation;
Having carefully separated the surrounding tissue, the doctor excises the cyst from the synovial membrane of the joint and places sutures on the exit hole;
Having checked that the joint cavity is closed hermetically, the doctor sutures the edges of the wound and applies a sterile bandage;
the wrist joint is fixed in a stationary state with a special orthopedic design.

During recovery, the patient must comply with the main condition - to limit the mobility of the joint as much as possible in order to create conditions favorable to healing. During the first two weeks, the fixation device should be worn constantly, and for the next 2-3 weeks it can be worn at night. The sutures after the operation are removed on the 7-8th day, but the patient does not have to stay close to the clinic all this time - the sutures can be removed by a surgeon at the clinic at the place of residence.

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