Exostoses are called osteochondral neoplasms, mainly forming on long tubular bones, including the arms, and less often on flat bones. They are mainly found in children and adolescents, although sometimes they are diagnosed in adults. Exostoses or osteochondromas are benign tumors and are often asymptomatic. But they always require observation, and, if necessary, treatment, since they can not only provoke the occurrence of vascular and neurological complications, but also become malignant.
Reasons for appearance
As for synovial cysts, the reasons for their occurrence are different:
- Arthritis, osteoporosis;
- infectious diseases;
- joint instability;
- injuries;
- congenital predisposition.
The exact causes of the formation of ganglia and hygromas have not been established, however, according to statistics, young girls with joint hypermobility are at risk. It is most likely to assume that this is due to the shell being too weak and the difference in the pressure of the joint fluid in different positions.
Features of hand exostoses
The free part of the upper limb or the arm itself is formed:
- humerus;
- bones of the forearm - radius and ulna;
- bones of the hand - wrist bones, metacarpals and finger bones (phalanx).
Exostosis can form on each of them. But the long tubular bones are most often affected: the humerus, ulna and radius. In this case, osteochondroma is usually located in the joint area, which supports the theory that it is formed from a displaced part of the epiphyseal plate. Before the process of skeletal formation is completed, which usually occurs between 18 and 25 years, it is a layer of hyaline cartilage located immediately behind the epiphysis (head) of the tubular bone. Its cells constantly divide, causing the bone to grow in length.
As they move away from the epiphyseal plate, old cartilage cells are replaced by osteoblasts. As a result, dense bone is formed. Such areas are called bone metaphyses and it is in them that exostoses are usually found. After the completion of the formation of the skeleton, the epiphyseal plates are replaced by thin epiphyseal lines, and the process of formation of new cartilage cells stops. This is called the closure of growth zones. Therefore, osteochondromas are mainly first diagnosed in children and adolescents, and more often during the period of active growth - at 8-16 years.
In this case, exostoses go through the same formation path from cartilaginous formation to ossification. And their characteristic feature is the presence of a cartilaginous cap on the surface of the growth.
Since the metaphyses of the bones are located immediately behind the epiphyses, the presence of osteochondroma of the joint is often said. In hand this is:
- the shoulder joint, damage to which occurs due to the formation of exostosis in the area of the proximal epiphysis of the humerus or on the glenoid cavity of the scapula;
- the elbow joint, which is affected by the formation of exostosis at the distal epiphysis of the humerus or proximal epiphysis of the ulna or radius;
- small joints of the hands formed by the metacarpal, carpal bones and phalanges of the fingers.
Most often, exostosis is found in the elbow and shoulder joints. On the bones of the hand, such neoplasms form much less frequently.
In this case, exostosis of the arm bone can be either single (solitary) or only one of many present on other bones of the skeleton. In the latter case, they speak of the presence of multiple exostotic chondodysplasia, which is hereditary. This disease can lead to various complications, but the most dangerous is the malignancy of osteochondromas, which is observed 10 times more often than with solitary exostosis of the forearm, shoulder, etc.
How do hygromas and ganglia appear?
A bulge forms on the wrist joint, which is best visible when the arm is flexed. The skin over the tumor moves quite easily, but the formation itself cannot be moved away. If the hygroma is of an impressive size, then movements in the articular part are significantly limited. Also, the “bump” puts pressure on the tendons and nerves, which will cause pain. In some cases, hygromas go away on their own and do not require treatment. Ganglia grow from tendons and are a rather dense growth, which mainly grows at the base of one of the fingers. However, they are very small and rarely larger than a grain of rice. However, when clenching a fist and other movements, they can cause severe pain. The shape of the nail plate changes. As a rule, this type of synovial cyst occurs in old age as a consequence of arthrosis.
What signs accompany bone pain?
Depending on the cause of the pathology, pain may be accompanied by other symptoms. In the case of a severe bruise, not only does the pisiform (or other) bone on the wrist hurt, but there is also swelling of the affected area and limited movement of the hand. When a dislocation or fracture occurs, the pain is especially acute and the joint becomes deformed.
Carpal tunnel syndrome is accompanied by numbness and weakening of the hand. Burning and tingling may occur, especially at night and in the morning, and swelling is likely after sleep.
Tendinitis manifests itself as a characteristic crunching sound in the joint. It becomes difficult for the patient to grasp objects with the affected hand.
With carpal tunnel syndrome, in addition to pain in the bone, a pregnant woman may experience itching, burning, tingling, and trembling in her fingers. These symptoms occur primarily at night.
In acute arthritis, the pain syndrome is pronounced, swelling and redness occur at the site of the lesion, and body temperature often rises. With chronic arthritis, the symptoms are smoothed out, which is why the patient may not see a doctor for a long time, leading to destruction of the joint. Arthrosis is characterized by gradually increasing pain in the bone, limited mobility, and painful sensitivity to pressure. A crunching or clicking sound is heard in the affected joint. Without treatment, the pain increases and the hand gradually loses mobility.
With Kienböck's disease, pain is felt around the clock and intensifies during manual work or when pressing on the affected bone.
In the case of hygroma, at first the person does not feel pain, but simply notices that a tumor is growing on the outer or inner side of the wrist (it seems that the bone is enlarging). The skin in this area gradually becomes darker, denser, and when moving the wrist, the bone begins to ache. When the hygroma reaches a large size, periodic tingling occurs in the palm, the patient cannot fully move the hand.
Complications.
It is not recommended to open the lump at home due to the high risk of complications. Since when a cyst is injured, fluid can be pressed into the joint cavity and surrounding tissues. After this, the ganglion sheath fuses and it fills up again. Sometimes, in place of one crushed one, several hygromas are formed at once. There is also the possibility of inflammation, as well as suppuration and infection. It is highly not recommended to carry out this operation yourself, due to very negative consequences.
Diagnostics
The main diagnostic method is x-ray in 2 projections. The images visualize only the bone part of the tumor in the form of a neoplasm with clear boundaries and connected by a thin stalk or thick base to the mother bone. Thinning of the cortical bone is also observed, and the osteochondroma itself often has a “cauliflower” appearance due to areas of calcification in the cartilaginous cap.
The cartilage cap itself is not visible on x-rays, although its size is important in determining the likelihood of malignancy. Normally, the thickness of the cartilage layer should not exceed 1.5-2 cm. Therefore, in controversial cases, as well as in children with a high growth rate of osteochondroma, CT or MRI is often additionally prescribed. As a result, it is possible not only to accurately visualize the cartilage cap and measure its parameters, but also to determine the location of the neurovascular bundle, as well as assess the condition of the shoulder, elbow joint or hand. This makes it possible to develop optimal treatment tactics.
Treatment.
If the synovial cyst is small and does not cause significant inconvenience, then the doctor suggests not disturbing the tumor - they often disappear on their own, leaving no complications behind. However, if the situation is more serious, then conservative treatment or surgical intervention is prescribed - it all depends on the clinical picture. Basically, during treatment, the contents are pumped out and a bandage is applied. In some cases, a substance is injected into the hygroma to prevent its further growth. It is worth noting that the success rate of this procedure is about 50%; if it is performed incorrectly, violations occur, including in the joint cavity. The conservative method usually involves massage, diet, taking vitamin complexes, and antiviral therapy. If the condition is neglected, the specialist recommends resorting to a radical method - removal through surgery. In this case, only those types of ganglia and hygromas that have not disappeared on their own and are not amenable to conservative treatment methods are subject to surgery.
For accurate diagnosis and effective treatment of hygroma and other diseases of the hand and joints, contact our clinic!
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Bruises of the hand
Classic contusion of the soft tissues of the hand occurs very often in the practice of traumatologists. It is accompanied by redness of the tissue, moderate pain and swelling, and a local increase in temperature. and no serious treatment is required in this case. Specialists limit themselves to local anesthetics that help quickly relieve swelling and relieve pain.
If, in addition to a bruise, a violation of tissue integrity is detected, it is necessary to use antiseptics, and, if necessary, antibacterial agents. This will prevent the spread of infection. In some cases, it is necessary to immobilize the limb until the diagnosis is clarified.
The quality of primary antiseptic treatment directly affects the purity of infectious complications. Many patients do not pay attention to the need to disinfect the injury site before meeting with a traumatologist. After treatment with an antiseptic and applying a bandage, it is recommended to apply dry cold to reduce the risk of bleeding and the formation of a large hematoma.
Rehabilitation after hand injuries
Rehabilitation is a mandatory stage in the treatment of hand injuries. Rehabilitation measures may include physiotherapeutic techniques, massage, spa therapy, physical therapy, warming compresses, and the use of medicinal ointments. The patient’s motor activity and quality of life in the future depend on the effectiveness of rehabilitation. It is forbidden to subject the hand to increased physical stress in the first months after the end of treatment.
In our Clinic in Yaroslavl you will receive the necessary assistance with hand injuries of any complexity. We are ready to answer all your questions and provide high-quality information support.
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Epidermal inclusion cyst
An inclusion epidermal cyst is a cavity inside the bone, lined with stratified squamous keratinizing epithelium. It is most often a consequence of penetrating trauma, during which epithelial cells enter the bone tissue. This type is more common in the finger bones and skull and may not manifest itself in any way, and pathological fractures are rare.