The occurrence of hygroma provokes injuries and excessive stress. The ailment is often asymptomatic, however, pain with movements and a significant cosmetic defect may appear. Typically, a cyst is easily diagnosed clinically, but in some cases an ultrasound or MRI is required. The disease is only treated promptly.
What is a hygroma?
Hygroma (aka ganglion) is a tumor formation that appears in the joints. Statistics insist that women are mainly affected by the disease. However, many researchers believe that hygroma appears regardless of the gender of the patient.
Also controversial is the attribution of hygroma to tumor processes. Given the fact that the neoplasm occurs only around the joints, while not malignant (not malignant), many clinicians consider the hygroma a pseudotumor.
Hygroma is a dense capsule of the cyst type, filled with liquid (not for nothing that the Greek “hygroma” literally translates as “liquid tumor”). The walls of the capsule are formed by dense connective tissue, and the contents are represented by a serous fluid resembling “lemon jelly”. When palpating, the consistency is often pasty, but it is also hard, imitating cartilage or bone tissue.
Similar pseudotumors appear around small joints of the upper and lower extremities. This feature of localization is associated with a possible cause of their occurrence. So, hygroms are considered to be detached periarticular bags, which are normally designed to absorb movements in joints.
However, studies have shown that hygroma capsule cells are altered (metaplastic or degenerate). One part of the cellular composition is responsible for strengthening the walls of the neoplasm, and the second – for the production of contents (fluid).
Such degenerated cells (like cancer cells) can infinitely provoke the emergence of new hygroma, which leads to frequent relapse of the disease. For the same reason, conservative (non-surgical) treatment is powerless.
Why does it appear?
The exact causes of hygroma are still not known. However, among the provoking factors, there are:
- Hereditary predisposition (the likelihood of a neoplasm is 3 times higher in families where the ailment previously occurred);
- Anatomical features of the body (weak ligamentous apparatus or superficial location of tendons, which leads to the frequent appearance of hygroma in women);
- Increased loads on the joints (weight lifting, sports, difficult manual labor);
- Trauma to the joints of the upper and lower extremities (in 30% of cases, the appearance of a pseudotumor was preceded by damage to the bones and their joints);
- Inflammatory diseases of the joint structures (ligaments and their bed – tendonitis, tendovaginitis; periarticular bags – bursitis, etc.).
The emergence of a specific professional activity may contribute. Thus, neoplasms are often observed among pianists, office workers, writers, seamstresses, conductors, runners and cooks. Young mothers who are forced to rock the baby in their arms for a long time are also affected by the disease.
Occasionally, improperly selected shoes become the cause of cysts on the foot. In this case, the etiological factor is the constant pressure of the footwear on the periarticular region.
Varieties of hygrom
Theoretically, similar pseudotumors can occur on any part of the body where connective tissue is present. However, the most common locations are periarticular regions. So, hygromas are found on the free ends of the upper and lower extremities.
The “favorite” localization of neoplasms is the wrist (back and palmar surfaces), the ulnar zone, the joints of the fingers or the armpit. Less commonly, cysts appear on the lower extremities: the foot, as well as around the ankle and knee joints.
One of the options for the disease is considered to be a hygroma of the head. There is a tumor under the hard shell of the brain, which is why the neoplasm is called subdural (from the Latin “fool” means “hard”). A similar cyst is determined in the form of a limited accumulation of cerebrospinal fluid – cerebrospinal fluid.
The hygroma is manifested by a tight-elastic or dense tumor-like formation protruding above the surface of the skin. As a rule, these are single cysts, their multiple occurrence is rarely observed.
The size of the disease varies from 3 to 6-7 cm in diameter. At the same time, tumor volumes often increase with significant loads and decrease at rest. Usually, the neoplasm is clearly demarcated from adjacent tissues: its base is tightly soldered to the limb, while the skin and fat layer around remain mobile.
Symptoms of hygroma are scarce: pain at rest rarely occurs. Sometimes pain appears when palpating the tumor or during movements in the joint. In some cases, the cyst can exert pressure on the neurovascular bundles of the arm or legs, which leads to severe pain spreading to the limb; as well as circulatory disorders (the skin becomes pale and cold).
Sometimes the disease is localized under the ligamentous apparatus, because of which its occurrence remains unnoticed for a long time. In such cases, the only manifestations of the disease can be pain during movements of the limb, as well as redness or peeling of the skin over the affected area.
Tumors in the wrist can be localized on the back, palmar, as well as lateral surfaces. Pain with this form of hygroma is rare, usually the main complaint is the aesthetic discomfort of patients. So, the disease manifests itself as a noticeable tumor on the rear of the hand. In this case, the cyst remains visible (especially during movements), even if it is located under the ligaments.
Hygroma in the palm of the hand is often associated with the vaginas (beds) of the flexor muscle tendons. Usually these are small, solid tumors that are often confused with cartilage or bone. There is no pain syndrome: discomfort or slight pain may appear when you try to wrap your hand around an object (a glass, bottle or handrail in public transport).
Tumors on the fingers appear more often on the nail phalanges or at the level of the interphalangeal joints. Hygroma is formed both on the back and on the palmar sides. However, in the latter case, neoplasms are characterized by a large volume, which can cover one or even two phalanges. Palmar finger hygroma is often accompanied by pinched nerve endings with the development of severe soreness.
Cysts in the knee area are typical for professional athletes, people with an active lifestyle and patients suffering from arthritis or arthrosis. Often, hygromas are located on the back of the knee joint (in the popliteal fossa). The tumor is accompanied by tangible pain, as well as difficulties in bending the knee.
Similar forms appear on the outer surface of the ankle, as well as on the rear of the foot and in the area of the fingers. Often an ailment tight shoes provoke constant pressure on the foot. Hygroma is often painful, and repeated rubbing with shoes leads to inflammation of the surrounding tissues or joint structures.
Hygroma under the dura mater is formed due to craniocerebral trauma, after removal of intracranial hematomas or spontaneously due to a sharp decrease in pressure in the cranium. In children, the disease appears for no reason or due to inflammation of the meninges – meningitis. As a rule, subdural hygroma is accompanied by a bursting headache, fainting, as well as visual and hearing impairment. Mental disorders sometimes appear: behavioral disorders, hallucinations, etc.
Usually, a comprehensive survey with the determination of causal factors, examination and palpation of the neoplasm is enough to make a preliminary diagnosis of hygroma. However, to exclude concomitant pathologies, final diagnosis and preoperative examination, they carry out:
- Ultrasound examination, which allows you to visualize cystic formation, determine the nature of the contents, the presence of vessels feeding the tumor, etc. The method is considered the “gold standard” because of the information content, simplicity and speed of execution, as well as safety and low cost.
- Magnetic resonance imaging, which eliminates malignant tumors, as well as assess the structure of the wall of the hygroma and its contents. The disadvantage of this method is its high cost.
In some cases, patients undergo a puncture (puncture) education with a fence of its contents. The resulting liquid is examined to exclude inflammatory or cancer.
In the course of these studies, other pathologies are screened out: tumors from adipose tissue (lipomas), sebaceous gland cysts (atheromas) and skin, as well as neoplasms from bones and cartilage.
How is hygroma treated?
Hygroma treatment occurs in a surgical or trauma unit.
Previously, doctors practiced conservative therapy: the tumor was kneaded and crushed. Often, the contents of the cyst were pumped out, filling the cavity with special sclerosing (gluing) substances. Physiotherapeutic procedures, mud therapy and compresses were often prescribed. However, these methods were ineffective, and the recurrence rate of hygroma with such treatment was more than 90%.
Today, the only way to help with hygroma is surgery. Usually, patients resort to surgical treatment with a significant cosmetic defect, severe pain, limiting the amount of passive and active movements in the joint, and rapid enlargement of the cyst.
The rapid growth of the disease is an absolute indication for surgical intervention, because excision of a large tumor can lead to a number of difficulties. So, displacement of nerves, blood vessels and ligaments is possible, due to which the technique of operation is much more complicated.
Course of operation
The patient is given local anesthesia (the surgical field is anesthetized, and the patient remains conscious). A tourniquet is placed on the limb above the site of surgical intervention (to reduce blood flow, blood loss, and also better visualization of pathological tissues).
Hygroma is secreted and excised with the capsule. It is important to remove all altered connective tissue in order to prevent subsequent relapses of the disease. A final revision (examination) of the wound is carried out to exclude small cysts. The formed cavity is washed and sutured, strengthening with local structures (a certain two-layer “sandwich” of fasciae is created, called duplicate). At the same time, drainage is left in the wound cavity – a graduate for discharge, which is removed after two days.
A pressure bandage is applied to the postoperative wound, after which the arm is immobilized – a plaster bandage or orthosis is installed.
The surgery itself lasts up to half an hour, the sutures are removed after a week, and complete recovery and active movements are possible already on the tenth day after treatment.
Among the alternative methods distinguish:
- laser heating with the destruction of hygroma. It is worth noting that the laser beam does not harm healthy cells;
- endoscopic removal, which is carried out by special equipment. The advantage of the method is low invasiveness and a small incision.
In order to prevent the appearance of hygroma, it is necessary:
- Pay attention to all changes in the periarticular tissues, especially their inexplicable proliferation;
- Avoid increased loads on the joints (weight lifting, excessive athletic activity, difficult manual labor);
- To prevent trauma to the joints of the upper and lower extremities;
- Diagnose and timely treat inflammatory diseases of the joint structures (ligaments and their bed – tendonitis, tendovaginitis; periarticular bags – bursitis, etc.);
- Correctly select the size of the shoe, giving preference to orthopedic models.
These items are especially relevant for people at risk for the appearance of hygroma: women; family members where the ailment previously occurred; representatives of specific professions (pianists, office workers, writers, seamstresses, conductors, runners and cooks).
Secondary prevention (when the disease has already developed) is to prevent injuries and ruptures of the hygroma, i.e. its complications. The latter often lead to inflammation and re-occurrence of cysts.
Hygroma is an absolutely benign neoplasm that rarely leads to severe symptoms. However, the enlargement of the cyst and its possible traumatization require timely and complete excision.
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