Hygroma what is it

A hygroma or ganglion is a benign tumor in the form of a cyst (ICD-10 code), inside which a serous viscous fluid accumulates, resembling a muddy, jelly-like substance with interspersed mucus in consistency. Cysts near small joints, such as a finger hygroma, do not contain blood impurities, and in large ones (knee, ulnar, shoulder, ankle, wrist) it is present along with cholesterol crystals. The neoplasm is always located next to the joints, in density it varies from soft to dense cartilaginous.

Why does hygroma appear? Until the end, this has not yet been determined. There are two possible options:

  1. Hereditary predisposition.
  2. The consequence of repeated injuries.

Hygroma – what is it, how does the disease proceed? Without inflammatory processes, but it looks ugly, delivering primarily aesthetic inconvenience. The pains begin to bother only if the formation grows strongly or is located near the nerve endings. Sometimes a violation of sensitivity is possible. Hygroma does not pose any danger to the life and health of the patient. They never transform into malignant tumors.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Hygroma of the joint

In most cases, the localization of joint hygroma is as follows:

    It is localized in the wrist from the back of the hand on the back transverse ligament. The wrist cyst is easily visible under the skin if it is located above the ligament. If the cyst is under the ligament, then it becomes noticeable when the hand in the wrist is strongly bent. Cases are cons >

Tendons

Indeed, the development of this disease is directly related to both the joint and the tendon. Hygroma of the tendon or ganglion of the joint is one and the same concept. If the joint is injured, then the joint (synovial) fluid expires outside the synovial bag and accumulates in the capsule, eventually becoming thick and viscous. The ganglion capsule and the maternal cavity of the joint are interconnected by the anastomosis.

The capsule cells are degeneratively degenerated, metaplasia occurs, which is supposedly the cause of the disease. As a result of metaplasia, spindle-shaped and spherical cells appear. A capsule is built from the former, the latter are filled with fluid, which subsequently flows into the intercellular space. The cavity is not completely emptied; in any case, degenerative tissues remain there, which then begin to grow again. Conservative treatment is ineffective in connection with frequent relapses.

Causes

According to available clinical data, the causes of hygroma are:

  • frequent injury to joints and tendons;
  • chronic bursitis and tendovaginitis;
  • wearing improperly prostheses, uncomfortable shoes.

It is believed that hereditary factors occupy a leading place in this list, and women after the birth of a child fall ill about three times more often than men. Most cases of morbidity occur at a young age of up to 30 years. Children and older people are not threatened with periarticular nodular formations (although there are exceptions), but in pregnancy a hygroma often torments a woman.

Symptoms

As mentioned above, the hygroma does not manifest itself in any way until it is small, but if the formation begins to grow, then patients complain of dull pain in the joint area. This happens because an enlarged capsule at the site of the anastomosis begins to delay the synovial bag, especially during physical exertion. The nearby vessels and nerve endings are compressed.

Symptoms of hygroma are as follows:

  • The sensitivity of the skin is impaired. Perhaps numbness (paresthesia) or, on the contrary, increased sensitivity to skin soreness (hyperesthesia).
  • Neuralgic pains.
  • Venous congestion.
  • Thickening and roughness and redness of the skin at the site of cyst formation.

It is necessary with extreme caution to treat hygroma on the fingers, on the knee, forearm – these are places of increased trauma. The shell of the bag as a result of a blow or a fall can open, and the contents will leak for a long time to the outside or into the surrounding tissue, increasing the risk of developing other hygromas. In the worst case, wound infection, suppuration, and other adverse effects occur. Can a hygroma resolve itself? No, therefore, it is definitely necessary to treat a hygroma if it causes inconvenience.

Hygroma – treatment

Before prescribing treatment for hygroma, a diagnosis should be made to exclude the likelihood of a malignant tumor, as well as to differentiate the ganglion from aneurysm of the artery and sore abscess. For examination of the arteries, it is best to undergo magnetic resonance imaging with contrast. The doctor will probably ask you to do an X-ray or an ultrasound scan. It is possible to treat ganglia with conservative methods, if it is possible for a long time to provide peace of the wrist or leg so that the synovial bag is not injured once again.

With all the diversity and popularity of conservative methods of treatment, they are ineffective, the disease recurs. The most popular methods of conservative treatment are:

  • physiotherapy;
  • warming up;
  • healing mud;
  • paraffin wraps;
  • ultraviolet irradiation;
  • puncture with removal of fluid;
  • x-ray therapy;
  • corticosteroid injections and hormonal ointments.

Hygroma

Hygroma: what is it?

Hygroma is a benign volumetric cystic mass filled with serous fluid, sometimes mixed with fibrin. Hygroma is always located next to the joint, most often wrist or ankle.

Hygroma is a fairly common type of benign neoplasms; they make up about half of the total number of neoplasms of the wrist. Hygromas are especially often recorded in young women. In children, the elderly, hygroma practically does not occur.

Hygromas do not pose a threat to life, never become malignant, often do not cause any complaints. However, they can cause discomfort, become inflamed, and therefore often resort to surgical removal of the hygroma.

Causes

Hygroma is not a protrusion of the wall of the articular bag, the connective tissue capsule of formation has a slightly different composition. Due to degenerative changes, the hygroma is not amenable to conservative treatment and cannot be completely leveled without surgical intervention.

It is believed that the formation of hygroma is promoted by constant mechanical stress and physical stress on the tendon or joint. That is why they are often associated with a profession. For example, brush hygroma is often found in pianists, hairdressers, whose hands are constantly exposed to stress, and hygroma on the leg can form during standing work, in athletes. The connection between the occurrence of hygroma and physical influences explains their more frequent localization on the limbs, especially on their distal parts (foot hygroma, hands).

Hygroma can form as a result of chronic bursitis or tendovaginitis. There is also a theory of a hereditary predisposition to forming a hygrom. This is proved by the frequent cases of their appearance within the same family. Perhaps this is due to the structural features of connective tissue, inherited.

What does a hygroma look like?

Hygroma is a rounded smooth formation with clear boundaries, located in the joint or tendon, clearly palpable and often visible under the skin. In most cases, single hygroma, it is very rare to see several hygroms in the same anatomical region. The size of the formation usually does not exceed 3 cm, often much less. In rare cases, there are large hygroma, up to 6 cm in diameter.

The consistency of hygroma can be soft or hard – it all depends on the thickness and density of the connective tissue capsule. Usually, the formations are easily displaced, since they are not connected with the skin and subcutaneous fat, but their base is always connected to the tendon. Under loads, hygromas can increase in size, and then decrease again. If the hygroma is located under the ligament, then it can be completely invisible. The skin over the hygroma rarely changes, redness and peeling occur only with inflammation or frequent injury.

The main point in the classification of hygroms is their localization. Most often they are located distally on the limbs. Each localization has its own characteristics.

  • Hygroma on the wrist is much more common than others. It is located next to the wrist joint, mainly on the back side in the transverse ligament. If the cyst is under the ligament, then in the usual position of the brush it is not visible, only with strong bending. In other cases, the hygroma is clearly visible. The patient may be disturbed by minor pain or discomfort during movements, but most often there are no complaints. Hygromas also occur on the palmar surface, they are located closer to the thumb.
  • Hygroma on the fingers most often occur on the back surface, near the interphalangeal joints, at the bases of the distal phalanges. Usually they are small, clearly visible under the skin and do not cause any sensations. On the palmar surface, hygroma are large, can be 2 phalanxes, in addition, they compress the nerves and blood vessels, which leads to severe pain. Hygroma at the base of the fingers is very rare. They are usually very small, painful only with pressure.
  • Hygroma on the leg is most often localized in the area of ​​the foot, on its dorsal surface, near the ankle joint. The course is usually asymptomatic. Pain can occur when wearing uncomfortable shoes or the pressure of a hygroma on a nearby nerve.

Symptoms of Hygroma

About a third of cases of hygroma are asymptomatic, without causing any discomfort. The most common symptom of a hygroma is pain, but it is sharp and strong only with pressure. More often the pains are dull, mild, aggravated by the load on the joint, can radiate along the peripheral nerves located next to the hygroma. Nerve compression can cause sensory disturbances (paresthesia, numbness), and motor functions of the limbs. For example, with a hygroma on the hand (on the wrist, fingers) it can be difficult to pick up and hold objects. If the hygroma presses on the vessel, then swelling may occur as a result of venous stasis.

If you find yourself having similar symptoms, consult a doctor immediately. It’s easier to prevent the disease than to deal with the consequences.

Hygroma: where does that come from?

7 July 2016, 7: 02

On one of the usual, unremarkable days, you suddenly notice with surprise at the back of your hand, just below the base of your thumb, a strange formation. A small ball, as if soft enough, but elastic to the touch, painful when pressed hard, seems to roll under the skin. Do not rush to get scared, this is not fatal, although rather unpleasant: with a considerable degree of probability it can be assumed that you have a hygroma, a cystic tumor of a benign nature. However, to differentiate education and make a final diagnosis can, of course, only be a doctor.

Since hygromas are closely related by origin to joints and tendons, theoretically they can form anywhere where the latter are. However, most often they occur at the ends of the upper and lower extremities, for example, on the back of the wrist of the hands or in the region of the ankle joint on the legs. There are also known cases of a hygroma on the back of the palms, on the arch of the foot and on the sole, on the fingers and toes, on the knee joint, but they are much less common.

Hygroma is a capsule with a fairly dense wall, filled from the inside with jelly-like contents from serous fluid with inclusions of mucus or fibrin. With its “leg” base, this cyst communicates with the joint bag or tendon sheath. Depending on the place of occurrence, soft and elastic hygroma are found, however, there are also more dense ones resembling cartilage or bone tissue. It is also known that soft hygromas can become denser over time due to the growth and thickening of the capsule wall. The “positive” quality of true hygroms, so to speak, is that they never degenerate into malignant neoplasms.

On the causes of the formation of hygroma, various assumptions are made. It is noted that in most cases they occur in young women aged 20-40 years, in women hygroma are formed 3 times more often than in men. A hereditary predisposition to the formation of hygroms was also revealed: if a member of the family had this tumor earlier, the chances of acquiring this neoplasm increase. Often with a “trigger” for the formation of a hygroma, there are all kinds of injuries and inflammatory processes such as bursitis (inflammation of the joint bag) and tenosynovitis (inflammation of the inner sheath of the tendon of the muscle).

It has long been known that hygroma is often found in people who are forced to perform uniformly repeated movements in the process of work. Based on this, hygroma can be considered a professional disease of musicians and packers, conveyor workers and cooks, seamstresses and laundresses.

Currently, various scientists put forward three main theories about the causes of hygroma:
– inflammatory;
– tumor;
– dysmetabolic.

From the inflammatory theory it follows that as a result of the inflammatory process in the joint bag or tendon sheath, there is a violation of the integrity of the epithelium lining them, producing a specific secret. At first, the membrane becomes thinner, then a scar of connective tissue cells forms at this point. However, the connective tissue does not have the necessary elasticity and cannot constantly withstand the increase in pressure inside the joint bag or tendon sheath under stress. Over time, the wall in this place begins to “blow out” outward, a part of the fluid from the joint bag or tendon sheath pours into the newly formed chamber, the bridge between the chambers contracts and a hygroma forms.

Such a theory would fully explain the cause and mechanism of hygroma formation, if not for one small “but”: part of the cell walls of the hygroma capsule is degeneratively altered. There is an assumption that it is metaplasia (degeneration) of connective tissue in the place of the scar that causes the formation of hygroma. Moreover, often hygroma also occurs without a previous inflammatory process, that is, metaplasia can also occur directly on the epithelial cells of the articular bag or tendon sheath. Hence the second, tumor theory of the origin of hygroma.

The tumor theory says that at some point the cells in a particular area of ​​the joint bag or vagina of the tendon begin to quickly and uncontrollably divide, the “excess” tissue can grow inward or outward, which causes the formation of a hygroma. In favor of this theory is the fact that with surgical removal of the hygroma, relapse is observed in about 20% of cases, the hygroma is formed again. This happens due to the fact that degeneratively altered tissues were not completely cleaned and again went into growth.

The dysmetabolic theory of the formation of hygroms suggests that, for certain diseases, the balance between the production of synovial (intra-articular) fluid by the epithelial cells of the articular bag and its absorption by them is disturbed. As a result, the fluid becomes too much and the pressure inside the joint bag is constantly increasing. At a certain point, like the formation of a hernia, the wall bulges outward and a hygroma forms.

In approximately 35% of cases, initially the hygroma proceeds without severe symptoms. Patients find under the skin in the area of ​​the joint or tendon vagina a small rounded formation, usually single, of varying degrees of hardness. Hygroma is always clearly delimited: the base of the tumor is connected with the place of growth, and the rest of the capsule is not fused with either subcutaneous tissue or skin that moves freely over the tumor. With a strong press on the hygroma, sharp pain occurs. The remaining symptoms can either be completely absent or occur after an intense load, periodic “shooting” or constant aching pain in the area of ​​the hygroma is also possible. All this depends on the size of the tumor and its location, in particular, on compression of the nerve endings. The skin above the hygroma can remain unchanged, redness, peeling and roughness of the skin are also possible. After an intense load, the hygroma can increase in size due to the additional flow of part of the contents from the joint bag or tendon sheath, then after the outflow at rest, it will return to its previous form.

More often, the hygroma grows slowly, its size does not exceed 3 cm. However, sometimes a rapid tumor growth is observed and it can reach 6 cm in diameter. Alas, spontaneous hygromas do not open and do not “dissolve.”

Diagnosis of hygroma is made on the basis of a survey of the patient, clinical manifestations and the characteristic places of occurrence, sometimes radiography is performed. To differentiate the diagnosis, if in doubt, an ultrasound scan, MRI or puncture is prescribed followed by a biopsy of the contents of the hygroma (to exclude the possibility of error and separate the hygroma from lipoma, atheroma, epithelial traumatic cyst, cartilage and bone tumors).

In the relatively recent past, they tried to treat hygroma by crushing or kneading. In the “black” medical humor, there was even a joke that for the treatment of hygroma you need only two volumes of the Big Medical Encyclopedia: put one on, the second slam. Also used were punctures with the introduction of enzymes into the tumor cavity, physiotherapy, mud therapy, prolonged application of dressings with “absorbable” ointments. Unfortunately, practice shows that you can really get rid of the hygroma only surgically – the percentage of relapses with conservative methods of treatment is 80-90%.

If the hygroma is small and does not cause the patient unpleasant sensations, quite often the doctors themselves advise her not to touch it. But the presence of pain (during movement, and especially at rest), rapid tumor growth and compression of surrounding tissues, limited joint mobility are already indications for surgical intervention.

As a rule, hygroma removal is performed under local anesthesia after sedation, general anesthesia is used for large tumors with an unsuccessful location. The technique of the operation includes a diagonal or circular incision of the skin at the location of the hygroma, a thorough separation of the tumor from the surrounding tissues. Then, two clamps are applied to the “leg” of the hygroma and an incision is made between them – this allows you to remove the entire capsule without contaminating the wound with its contents. Several sutures with absorbable suture are applied to the remaining “stump”. Then, after an audit of the surrounding tissues for the presence of concomitant small cysts, the wound is sutured, a drainage is inserted for 1-2 days and a pressure bandage and a plaster cast are applied.

The most important thing during the operation to remove the hygroma is to extract it completely, otherwise the remaining tissue fragments will give a relapse, which is observed in about 20% of cases.

In recent years, the endoscopic method of removing hygroma has become popular as less traumatic and requiring a shorter period of rehabilitation.

I sincerely wish this “joy” to pass you by. Good health to all!

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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