Removal of hygroma on the wrist - cost of surgery and rehabilitation

Characteristics of the neoplasm

Often a tumor on the hand appears on the back of the hand and consists of tendons and interarticular connective tissues that fill with exudate. The lump on the hand grows slowly and painlessly, so in the early stages the patient does not notice it. Depending on the size of the cyst and the pain syndrome, the specialist prescribes treatment, during which he uses various methods. Synovial neoplasms in this area are as follows:

Hygromas formed in the area of the wrist joint. They protrude strongly from the back of the hand. Rarely, patients report minor pain.
Hygroma on the palm. It is located in the middle of the palm, slightly offset towards the thumb. Only in a small percentage of people it appears in this particular place.
Hygroma can appear on the fingers, most often on the back side in the middle phalanx or on the interphalangeal joint. There is tension in this area and persistent pain.
Hygromas at the base of the fingers. They are small in size, but they are very painful.

Hygroma removal

Hygroma of the wrist and wrist joint

Hygroma of the wrist and wrist joint is a benign tumor (cyst) that forms near the wrist joint or wrist. It is an elastic capsule filled with a viscous, jelly-like liquid.

Often, hygroma on the wrist or in the area of the wrist joint is not an independent disease. Its appearance is due to the following reasons:

Excessive physical activity

Injuries to the wrist and wrist joint

Sports overload

Professional activities associated with monotonous hand movements (hairdresser, programmer)

Chronic inflammation of synovial (periarticular) cavities

Symptoms of hygroma During the initial stages of the disease, as a rule, hygroma is small in size, remains unnoticed for quite a long time and does not cause pain. Over time, it may increase in size and cause moderate pain in the wrist joint.

Clinical symptoms of hygroma disease:

Visible round formation under the skin near the joint (can be located on either the dorsal or palmar side, Fig. 1 and 2)

Dull, nagging pain in the area of the wrist joint, mainly in the projection of the space-occupying lesion

Manifestations of sensitivity disturbances are possible if the formation is of significant size and puts pressure on the nerve fibers (depending on the location of the hygroma)

Less commonly, changes in the skin over the space-occupying lesion

Removal of hygroma of the wrist and wrist joint:

Conservative

Operational

To choose a treatment method for this disease in a particular patient, consultation with a specialist is necessary. When examining and carefully collecting anamnesis, to select a specific treatment method, the doctor is guided by the following principles:

Determines the size and localization of a space-occupying formation (hygroma)

Finds out the cause of the disease

Establishes the clinical nature of the disease

Conservative treatment of this disease, detected in the early stages, includes the following methods:

Complex physiotherapeutic treatment for the area of mass formation (hygroma)

Puncture of the hygroma and suction of the gel-like contents from its cavity (Fig. 3)

Introduction of glucocorticoid hormones into the cavity

In rare cases, crushing of the hygroma until it opens

Wearing a specialized brace

All of the above methods are quite effective, but have one drawback: the capsule (bag) of the hygroma does not disappear anywhere and does not dissolve. Thus, with repeated damage or mechanical stress, a relapse of the disease is possible. To avoid recurrence of the disease, you need to follow preventive measures:

avoid excessive stress on the joint

do physical therapy

see a specialist

Many people do not pay any attention to hygroma and live with it all their lives. But if a person is concerned about how they look, if there is discomfort and pain in this area, then one should think about surgery. A serious indication for surgical intervention is the rapid and sometimes sudden growth of hygroma. The larger its size, the more difficult it is to remove.

Surgical treatment of hand hygroma

Don’t believe it if someone claims that excision of a hygroma is a trivial operation and takes no more than five minutes. In fact, this is a delicate and painstaking work that requires the skillful hands of a specialist. There are localizations of hygroma in which the likelihood of serious complications is high - you can injure a nerve or artery. It is very important to isolate the hygroma completely from the surrounding tissues to the junction of its base with the joint.

If the operation is not performed properly, the outcome of the treatment will look favorable for the first two to three months, but then the surviving remnants of the hygroma will heal, it will restore its tightness and begin to accumulate fluid again.

Closed extensor finger injury

Avulsion of the digital extensor tendon from its insertion at the base of the nail phalanx, the most common type of subcutaneous tendon rupture, occurs when the finger is sharply flexed while the tendon is actively contracting. Such separations are observed when playing basketball, in pianists, and in urologists (when it is difficult to remove the prostate gland with a finger). Not infrequently, tendon rupture may be accompanied by separation of a triangular fragment from the base of the phalanx.

The nail phalanx bends towards the palmar side. It is not possible to actively straighten it.

Choosing a treatment method for closed injury to the extensor finger

Surgical treatment in fresh (up to 7–10 days from the moment of injury) cases is rarely indicated. During this period, conservative treatment is used in the form of various fixations.

There are several options for fixing this damage:

Classic plaster - cheap, but not reliable and completely inconvenient

A homemade splint (cut from a syringe) - neat, simple, but unfortunately with the help of such a splint we will not get the main principle of treatment - hyperextension, which is characteristic and necessary for the distal joint

Fixators from orthopedic stores, despite a fairly wide range of sizes, are very difficult to choose in most cases the required size, and they often fall off (which is categorically contrary to the treatment of this pathology)

An excellent method of fixation, almost invisible and convenient in everyday life, can be a pin passed through the joint.

There can be many ways, and the result is usually satisfactory, because in fact this extensor, as a rule, grows to the terminal phalanx if fixation is performed correctly. And the fixation should be quite long, from 6 to 8 weeks.

Despite the fact that with timely treatment and the use of correct immobilization, sometimes it is necessary to perform an operation (in case of old damage and in the absence of fusion after removal of immobilization) - to hem the extensor. There are several options here too:

Tenodermodesis is when the tendon is sutured through and through the skin. Externally it looks very rough and not aesthetically pleasing

Fixation with mini anchors, a more elegant method, but also more expensive

Transosseous fixation of the tendon with special threads

In any case, it is better to strengthen the extensor suture with a temporary knitting needle.

The treatment of these diseases is carried out by a hand surgeon, traumatologist-orthopedist Marina Nikolaevna Dalova, and if necessary, one of the leading hand surgeons in our region, Sergey Vladimirovich Vinnik, is involved.

Stenosing ligamentitis or trigger finger

Stenosing ligamentitis or trigger finger is a pathological condition when the finger of the hand is fixed in a bent position. The cause of this condition is the formation of a thickening on the digital flexor tendon, which prevents the tendon from entering the osteofibrous canal. In addition, the annular ligament of the tendon itself may thicken, which leads to disruption of its movement.

In a normal state, the tendon easily slides in the tendon sheath that surrounds it during flexion and extension of the finger. When the tendon is inflamed, when the finger is bent, it comes out of the vagina, but when the tendon is greatly increased in volume or “knots” are formed on it, it loses the ability to easily enter when the finger is straightened back. In order to straighten the finger, a person has to make efforts to move the swollen tendon into the vagina.

In most cases, this disease does not have any obvious cause. Predisposing factors may include rheumatoid arthritis, diabetes, gout, or minor trauma.

Diagnosis of this disease is carried out on the basis of clinical symptoms, medical history, and examination of the patient.

You need to see a doctor if:

The finger is fixed in a bent position, and there is pain when straightening (signs worsen after prolonged immobility, for example after sleep)

The finger or joint is swollen, possibly numb, and a lump has appeared in this area - a “bump” or “ball” (severe sensitivity is detected upon palpation at the base of the finger)

You feel pain and your finger clicks when straightened

Conservative treatment of the disease “stenosing ligamentitis”

The initial treatment for the disease “stenosing ligamentitis” is the use of conservative therapy, which includes local hormonal therapy in combination with physiotherapy (phonophoresis, electrophoresis with hydrocortisone or fermenkol). This helps eliminate painful symptoms, including the problem of trigger finger.

Very often, during conservative treatment, it is suggested to use injections of drugs into the affected area, but, as a rule, this causes degeneration of the surrounding tissues. In addition, various complications may occur with this treatment. For example, if the drug is injected directly into the thickness of the tendon, it may rupture, as the tendon in this place begins to degenerate. If you inject the medicine into the area of the circular neurovascular bundle, you can get quite painful sensations along the course of this circular nerve.

Therefore, in our clinic, if conservative treatment of stenosing ligamentitis (or trigger finger) is possible, we use the following treatment:

Taking hormonal external medications in combination with physiotherapeutic procedures

The use of non-steroidal anti-inflammatory drugs by injection into distant parts of the body or in the form of tablets, powders and capsules

Elimination of any loads on the affected arm or, if necessary, splinting of the injured limb (the most painful finger) for the duration of conservative therapy

If within two weeks, despite performing the entire complex of indicated procedures, there is no relief and the trigger finger syndrome is not eliminated, surgical intervention is performed.

Surgical treatment for trigger finger

Surgical treatment consists of cutting the thickened annular ligament or cutting the wall of the first extensor canal. The operation completely solves the existing problem:

Relieves painful sensations

Completely removes latching

Allows you to return to normal life in the shortest possible time

This is a fairly simple operation, after which there are practically no complications.

Causes

The following reasons for the appearance of neoplasms have been established:

Congenital weakness of the articular apparatus and loose tissue structure.
Consequences of any injury.
Complications after inflammatory processes in tissues and joints.
Diseases of the joints of various etiologies.
Systematic traumatic occlusion of hand joints.
Endocrine disorders in the human body.
Rarely, a hygroma on the arm appears after surgery on this part of the body.

Athletes and those who constantly perform monotonous movements with their hands suffer most from such tumors.

Most often, a cyst forms on the wrist joint due to frequent loading of the ligaments, which leads to rapid wear of the joint and the development of pathology.

Causes of hygroma

Previous injuries and operations of tendons and joints.
Hereditary factor. According to observations, diseases often have a “familial” character.
Belonging to the female gender. According to statistics, women get sick about 3 times more often than men. Hygromas are also rarely observed in children or the elderly.
Physical stress on the hand, both increased and normal, but repeated many times (for example, professional for musicians, drivers, etc.).

Diagnostics

An experienced orthopedic surgeon needs only one glance at the tumor to determine its type. To avoid relapses, it is necessary to conduct a thorough examination and identify the cause of the hygroma. The following methods are most often used for diagnosis:

X-ray examination to identify the nature of the tumor and exclude cancer.
An ultrasound examination that clarifies the location of the cyst.
MRI.

Such diagnostic measures allow the doctor to further identify the structural features of the patient’s joints and determine how to treat the disease so that it does not return again.

X-ray is used to diagnose hygroma

Illustrations

Hygroma on the palmar surface of the wrist
Hygroma on the dorsum of the wrist
Hygroma on the foot
Hygroma of the finger
Hygroma of the index finger
Hygroma on the nail phalanx of the finger
Ultrasound and radiographic (inset) images of wrist hygroma
Morphological specimen of wrist hygroma

Hygroma on the hand

The symptoms of the disease depend on the size of the cyst. The neoplasm can be either single or multicapsular, i.e., consisting of several autonomous cysts filled with sterile liquid. Most hygromas in the early stages do not cause physical discomfort, and the patient notes that a lump appears on the arm after the tumor begins to grow and compress the blood vessels. If the cyst does not hurt and is soft and mobile to the touch, then there is no inflammation.

As the tumor grows, compression of blood vessels and nerve endings occurs, which provokes the appearance of persistent and pulsating pain not only when moving the hand, but also at rest.

The pain often radiates to the elbow joint or shoulder. Patients often note swelling of the soft tissues and roughening of the surface of the skin over the cyst.

Rarely does it open due to injury, then redness and swelling of the soft tissues are added to the general unpleasant symptoms. This condition will not go away on its own, and the patient will need the help of a specialist.

If the cyst has burst, you should definitely show your hand to a doctor.

On the foot

This pathology on the leg can appear on various large or small joints. Manifestations also depend on where exactly the pathology develops:

Knee hygroma, also known as Baker's cyst. Formed as a result of long-term arthrosis or rheumatoid arthritis. Possibly development due to untreated hematomas. If the hygroma of the knee joint is not treated in time, it can reach a size of 10 cm;
Pathology of the foot. Such formations that appear with flat feet quite often become the cause of the development of capsular cysts of the sole. They are very dense and at the same time immobile. They are often mistaken for bone spurs;
On the ankle. Appear against the background of injuries. Symptoms include compression of the nerves (the vessels are not compressed due to the developed circulatory system), which causes a decrease in motor activity, as well as sensitivity of the foot;
On the toe. At first it is a painless formation, which is compressed while walking. This leads to injury, and over time to the appearance of increasing pain. The skin over the hygroma also begins to turn red, swelling appears, and at times, fever. A slight increase in its size leads to compression of nerves and blood vessels.

Hygroma of the elbow joint

The reasons for the appearance of elbow hygroma are not much different from the reasons for the formation of a cyst in another area of the body. Hygroma of the elbow joint in humans often appears as a consequence of injury or a complication due to inflammation of the joint. If a person has to perform monotonous activities every day, the risk of developing a cyst increases.

Ulnar hygroma is dangerous because when it grows, there is a high risk of compression of the median nerve and the final segment of the brachial artery.

An elbow cyst looks like a fluid-filled skin sac on the joint. If the neoplasm is mobile and there is no pain, then most often it does not cause any inconvenience to the patient.

Hygroma

Hygroma
Hygroma is a benign cystic tumor consisting of a dense wall formed by connective tissue and viscous contents. The contents resemble a transparent or yellowish jelly in appearance, and in nature they are a serous liquid mixed with mucus or fibrin. Hygromas are associated with joints or tendon sheaths and are located near them. Depending on the location, they can be either soft, elastic, or hard, resembling bone or cartilage in density.

More often develop in young women. They make up approximately 50% of all benign tumors of the wrist joint. The prognosis for hygromas is favorable, however, the risk of relapse is quite high compared to other types of benign tumors.

Hygroma of the shoulder joint

Hygroma of the forearm is rare, but is the most unpleasant neoplasm in terms of its symptoms and degree of danger. Compression of the nerves and tissues close to the joints during the growth of the cyst provokes not only pain and swelling of the tissues, but is also fraught with compression of large arteries. As the tumor grows, the patient has to experience constant pain from habitual movements. Sometimes a cyst in the forearm is accompanied by swelling, which spreads to the shoulder and neck area. In this area, a cyst appears due to a systematic negative effect on the joint.

Hygroma of the shoulder is quite rare

Anatomy and mechanism of formation

There is a widespread point of view that hygroma is a common protrusion of an unchanged joint capsule or tendon sheath with subsequent infringement of the isthmus and the formation of a separately located tumor-like formation. This is not entirely true.

Hygromas are indeed associated with joints and tendon sheaths, and their capsule consists of connective tissue. But there are also differences: the cells of the hygroma capsule are degeneratively changed. It is assumed that the root cause of the development of such a cyst is metaplasia (degeneration) of connective tissue cells. In this case, two types of cells arise: some (spindle-shaped) form a capsule, others (spherical) are filled with liquid, which is then emptied into the intercellular space.

That is why conservative treatment of hygroma does not provide the desired result, and after surgery there is a fairly high percentage of relapses. If at least a small area of degenerative tissue remains in the affected area, its cells begin to multiply and the disease recurs.

Pathology treatment methods

Treatment of hygroma on the hand or in the area of any joint begins with determining the method of removal: surgical or conservative. The latter implies the use of one of the following methods:

crushing;
glucocorticoid blockade.

Glucocorticoid blockade

Glucocorticoid blockade is the most effective method for removing small tumors in the early stages of development. The method is not suitable for tumors larger than 1 cm. Doctors often suggest using puncture, since it is more effective than surgery. How is a hygroma punctured:

Using a sterile syringe, the doctor punctures the tumor and removes its contents.
Without removing the needle from the bladder, a glucocorticoid drug is injected into its cavity.
A sterile tight bandage and orthosis are applied.

The patient is required to wear the orthosis for two months. During this time, the cyst cavity sticks together and grows together. If the orthosis is not worn, the emptied hygroma will fill with fluid again.

Glucocorticoid blockade helps with small hygromas

Crushing

It is often performed by patients independently at home, so it can be classified as a traditional medicine method. Most patients do not know the dangers of such a procedure. The hygroma ball is crushed with a flat, blunt object. When squeezed, fluid from the cyst begins to pour into the adjacent tissue. Over time, the exudate resolves.

But often patients note the appearance of inflammation, accompanied by purulent complications. Phlegmon is often accompanied by a relapse of the disease.

Surgery

It is performed only if the cyst interferes with the normal functioning of the joint or interferes with the patient’s quality of life. The operation to remove tumors is performed under local anesthesia. After removal, the patient must wear an orthosis for several months, this will eliminate the risk of relapse.

Surgical removal is used for hygromas that interfere with normal functioning

Laser removal

Laser treatment of tumors is performed under local anesthesia and the excision technique is completely identical to the surgical removal of hygroma. The only difference is in the choice of tool. The doctor carefully separates healthy tissue from the tumor and removes the hygroma. The exit hole is sutured, a sterile bandage and orthosis are applied.

Complications

Why is hygroma dangerous? The most common complication is purulent tenosynovitis, which leads to impaired functioning of the affected area.

Damage to the shell of the formation leads to leakage of the liquid filling outward or into nearby tissues. Subsequently, the shell will be restored and will entail the appearance of new formations, most often in larger quantities.

When to see a doctor

A traumatologist-orthopedist or surgeon treats hygroma. You can make an appointment with any of these specialists at JSC “Medicine” (clinic of Academician Roitberg) in the center of Moscow near the Mayakovskaya metro station. The clinic has a wealth of experience and treats each patient individually. Reception is conducted only by first-class specialists of international level. You can make an appointment by phone, using the feedback form on Satta or with the administrators at the clinic: 2nd Tverskoy-Yamskaya Lane, 10.

Drug treatment

If the tissue surrounding the tumor is inflamed and swollen, medications are used. If the swelling is caused by purulent inflammation, then surgical intervention cannot be avoided. The use of antibiotics is prescribed only after surgery to minimize the risk of relapse and destroy residual foci of infection.

If the neoplasm is small, the doctor may prescribe the use of some local medications that will help the hygroma resolve. Most often, doctors prescribe Vishnevsky ointment or Diprospan.

"Diprospan" will help the hygroma resolve

Treatment

Treatment at the onset of the disease is reduced to the use of heat, mud and paraffin applications, iontophoresis with iodine, ultraviolet irradiation and radiotherapy. Repeated punctures of G. with suction of the contents and subsequent administration of a 25 mg hydrocortisone suspension and application of a pressure bandage are effective. Such treatment is successful only under the condition of long-term release from work associated with constant trauma to the affected synovial bursa. When G. suppurates, puncture it, aspirate the pus, and administer antibiotics; if necessary, the G. is opened, the synovial bursa is scraped out with a sharp spoon, followed by drainage of the wound.

In case of unsuccessful or unstable results of conservative treatment, surgery is indicated (in the “cold” period) - bursectomy - complete excision of the synovial bursa.

ethnoscience

If the tumor is small in size and does not cause any discomfort, then you can use folk remedies:

Alcohol compress. Medical alcohol or strong moonshine are used as a base. Sterile gauze is soaked in alcohol and placed on the cyst. Cover it with polyethylene or thick fabric. The compress is left for several hours, applying it until the hygroma disappears. It is necessary to alternate therapy and rest days.
Celandine. You need to take the juice of fresh celandine, dip gauze in it and apply it to the sore spot. Wrap the top in plastic and leave overnight. Celandine is applied until the neoplasm disappears.
Cabbage leaf. Its juice contains a large amount of antioxidants and antitumor substances. You need to take a fresh cabbage leaf and wrap it around the sore spot, covering it with a thick cloth for several hours. The procedure is repeated until the disease goes away.

Diagnosis of hygroma

Usually the diagnosis is made on the basis of anamnesis and characteristic clinical manifestations. To exclude osteoarticular pathology, radiography may be prescribed. In doubtful cases, ultrasound, magnetic resonance imaging or puncture of the hygroma is performed.

Ultrasound examination makes it possible not only to see the cyst, but also to evaluate its structure (homogeneous or filled with liquid), determine whether there are blood vessels in the wall of the hygroma, etc. The advantages of ultrasound are simplicity, accessibility, information content and low cost.

If nodules are suspected, the patient may be referred for magnetic resonance imaging. This study allows you to accurately determine the structure of the tumor wall and its contents. The disadvantage of the technique is its high cost.

Differential diagnosis of hygroma is carried out with other benign tumors and tumor-like formations of soft tissues (lipomas, atheromas, epithelial traumatic cysts, etc.) taking into account the characteristic location, consistency of the tumor and the patient’s complaints. Hygromas in the palm area sometimes have to be differentiated from bone and cartilage tumors.

Treatment of hygroma

Hygroma is treated by surgeons, traumatologists and orthopedists.

In the past, attempts were made to treat hygroma by squashing or kneading. A number of doctors practiced punctures, sometimes with the simultaneous injection of enzymes or sclerosing drugs into the cavity of the hygroma. Physiotherapy, therapeutic mud, bandages with various ointments, etc. were also used. Some clinics still use the listed methods, but the effectiveness of such therapy cannot be called satisfactory.

The percentage of relapses after conservative treatment reaches 80-90%, while after surgical removal, hygromas recur in only 8-20% of cases. Based on the statistics presented, the only effective treatment method today is surgery.

Indications for surgical treatment:

Pain with movement or at rest.
Limitation of range of motion in the joint.
Unaesthetic appearance.
Rapid growth in education.

Surgical intervention is especially recommended for rapid growth of hygroma, since excision of a large formation is associated with a number of difficulties. Hygromas are often located next to nerves, vessels and ligaments. Due to the growth of the tumor, these formations begin to shift, and its isolation becomes more labor-intensive. Sometimes surgery is performed on an outpatient basis. However, during the operation, the tendon sheath or joint may be opened, so it is better to hospitalize patients.

The operation is usually performed under local anesthesia. The limb is bled by applying a rubber tourniquet above the incision. Bleeding and injection of anesthetic into the soft tissue around the hygroma allows you to more clearly define the boundary between the tumor formation and healthy tissue. In case of complex localization of hygroma and large formations, it is possible to use anesthesia or conduction anesthesia. During the operation, it is very important to isolate and excise the hygroma so that even small areas of altered tissue do not remain in the incision area. Otherwise, the hygroma may recur.

The tumor-like formation is excised, paying special attention to its base. The surrounding tissues are carefully examined and, if detected, small cysts are isolated and removed. The cavity is washed, sutured and the wound is drained with a rubber graduate. A pressure bandage is applied to the wound area. The limb is usually fixed with a plaster splint. Immobilization is especially indicated for large hygromas in the joint area, as well as for hygromas in the fingers and hand. The graduate is removed 1-2 days after the operation. The sutures are removed within 7-10 days.

In recent years, along with the classical surgical technique of excision of hygroma, many clinics have been practicing its endoscopic removal. The advantages of this method of treatment are a small incision, less tissue trauma and faster recovery after surgery.

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Wrist hygroma: treatment without surgery with folk remedies (reviews)

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Definition of disease

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Causes

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Types of hygroma

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Symptoms and diagnosis of the disease

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Treatment methods

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Choosing a treatment method

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Physiotherapy and electrophoresis

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Home treatment

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Relapse Prevention

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Hygroma often occurs when blood vessels are compressed
Tumor. This theory is based onDistributing the weight evenly bysoaking the gauze insert,removing the fixing bandage
Treatment with folk remedies
Is a consequence of such a tumor. It does not affect one or a joint” (gonarthrosis), then

For the whole night, skill is required and manifested with its help. But with butter (100 and gradually water

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