What is it and why does it appear
Hygroma is formed when synovial fluid emerges through a defect in the joint capsule or tendon sheath, which gradually thickens and becomes enclosed in a dense sheath. The result is a formation that communicates with the joint with a narrow leg, which is why it can either increase or decrease. The exact cause of the defect is often unknown. Repetitive monotonous movements and stress on the hand, previous injuries and sprains, as well as degenerative changes in small joints contribute. Hygromas are more common in young and middle-aged women, but are possible at any age, including childhood.
- Release of synovial fluid through a capsule defect
- Thick jelly-like contents
- Connection with joint or tendon sheath
- Repetitive stress on the hand
- Injuries and sprains
- Arthrosis of small joints
What it looks like and where it happens
A typical hygroma is a smooth, round formation under the skin, densely elastic, often painless, ranging in size from several millimeters to several centimeters. The skin over it is not changed and moves freely. The most common location is the dorsum of the wrist, followed by the palmar side of the wrist, the base of the fingers, the dorsum of the foot and the ankle joint area. The size can change noticeably: increase after exercise and decrease at rest. Pain appears when the formation presses on the nerve or is located in a place of constant friction, and on the fingers of the hygroma at the nail phalanx the nail sometimes becomes deformed.
- Round, densely elastic formation under the skin
- The skin over it is unchanged
- The dorsum of the wrist is the most common location
- Palmar side of wrist and base of fingers
- Dorsum of the foot and ankle area
- Change in size under load
- Possible deformation of the nail when localized on the finger
Diagnostics
Most often, the diagnosis is obvious upon examination: the typical location, shape and mobility are quite characteristic, and simple transillumination with a light source shows that the formation is filled with fluid, unlike solid tumors. Ultrasound of soft tissues confirms the fluid nature, determines the size and connection with the joint or tendon, and also helps to exclude other formations: lipoma, aneurysm, enlarged lymph node, tendon sheath tumor. MRI is rarely prescribed - in case of atypical location, deep location or doubts about the diagnosis. X-rays may be needed to evaluate the condition of the joint.
- Inspection and palpation
- Translucent light source
- Ultrasound of soft tissues
- Ultrasound of the wrist joint
- MRI with an atypical picture
- X-ray of the joint according to indications
Treatment
If the hygroma does not hurt, does not grow or interfere, it is permissible to simply observe: some of the formations decrease or disappear on their own. In case of complaints, the first step is usually puncture with removal of thick contents and subsequent fixation with a bandage, but after this the formation often appears again, since the membrane and communication with the joint remain. The most reliable method is surgical excision along with the membrane and pedicle: relapses after this are much less common. The operation is performed on an outpatient basis under local anesthesia, after which a period of gentle treatment is required. Separately, it is worth mentioning about self-medication: the hygroma should not be broken, pressed or pierced on its own - this leads to relapse and the risk of infection.
- Observation in the absence of complaints
- Puncture with content aspiration
- Fixation with a bandage after puncture
- Surgical excision with sheath and pedicle
- Reducing monotonous load on the hand
- Categorical refusal to break and self-puncture
- Recovery period after surgery
Prevention and what doesn't work
There is no reliable prevention because the exact cause of the capsule defect is unknown. It is wise to reduce the monotonous load on the hand, take breaks when working at the computer for long periods of time, properly organize the workplace and use wrist support if necessary, and also strengthen the muscles of the forearm. Popular folk methods do not work and can be harmful: compresses with copper, alcohol rubbing, ointments for resorption, and especially the old method of crushing with a book or blow - it injures the tissue, often leads to re-formation and can cause suppuration. Any manipulations should be performed by a doctor after confirming the diagnosis.
- Breaks during prolonged brush work
- Proper organization of the workplace
- Strengthening the forearm muscles
- Weight-bearing wrist brace or support
- Refusal to break or crush the formation
- Refusal of compresses and ointments as a method of treatment
- Examination by a doctor for growth and pain
