Removal of hygroma of wrist joint

Hygroma of the wrist joint is called a hollow benign neoplasm of rounded shape, developing in the tissues adjacent to the joint capsule. The cavity of the hygroma is filled with exudate, which includes mucin and fibrin. Sometimes the neoplasm can fuse with the underlying tissues (nerve endings and periosteum).

Causes of development and clinical manifestations of the disease

The hygroma of the wrist joint is a fairly common neoplasm of the wrist. More often it occurs in children up to 10-11 years old and adults from 20 to 45 years. The high-risk group includes athletes (tennis players), professional musicians, typist secretaries, copywriters, seamstresses.

The main factors provoking the onset of the disease are:

• hereditary predisposition;
• inflammatory diseases of the wrist joint;
• post-traumatic states (a new growth in statistics occurs in the outcome of almost every fourth injury);
• significant overload of the wrist joint as a result of sports activities or professional necessity are the cause of every fifth case of the disease.

Symptomatology

Clinically, the hygroma manifests itself in the form of a round, slightly painful formation of a dense consistency, 6 centimeters, with palpation in some cases, you can determine the fluctuation (movement of the contents of the cavity at pressing). A large cyst can exert pressure on the neurovascular bundle of the wrist, which leads to the development of numbness and impaired sensitivity of the skin in this area.

Indications and contraindications to surgical methods of treatment

Indications

Absolute medical indications for the removal of hygroma are:

• presence of severe pain syndrome;
• rapid progression of the neoplasm;
• impaired motor activity in the wrist joint;
• the appearance of functional disorders associated with impaired blood circulation as a result of compression of the neurovascular bundle or nearby tissues;
• aesthetic defect (with a large size of the neoplasm the brush looks unaesthetic).

Contraindications

The use of surgical methods of treatment has several contraindications:

• oncological diseases;
• diseases of the endocrine system (diabetes mellitus, obesity of the third degree);
• immunodeficiency states;
• herpetic and inflammatory formations on the skin of the wrist;
• period of pregnancy and lactation;
• menstrual bleeding (in this case, surgical intervention is postponed for 4-5 days).

Methods for removing hygroma on the wrist

There are several types of surgical treatment. Before choosing one of them it is necessary to carefully evaluate all the advantages and disadvantages of the methodology.

Crushing

Crushing is an old method, practically not used in modern medicine, but its application sometimes It is justified (with small tumors with a thin capsule, the patient's unwillingness to undergo an operative interference).Some patients crush the cyst on their own, unaware that after a while it will reappear, because with this method of treatment the risk of relapse is approaching 90%.

The essence of the technique is that under pressure, the hygroma envelope ruptures and its contents are poured into the tissues surrounding the neoplasm. The synovial fluid is sterile, so it can not cause the development of an inflammatory process in the tissues surrounding the hygroma. The edges of the shell begin to coalesce some time after crushing, and at this point a repeated accumulation of liquid begins.

Puncture (or blockade)

The application of hygroma puncture is possible only as long as the size of the tumor does not exceed 10-11 millimeters.

Technique of manipulation

Intervention is performed under local anesthesia.

The wall of the hygroma is pierced by a syringe with a thick needle through which the contents of the cavity are pumped out. The needle from the puncture is not pulled out, only the syringe changes, with its help a glucocorticoid drug (diprospan) is injected into the cavity.

The joint is fixed with a pressure bandage and an orthesis for 5-6 weeks, in order that the edges of the devastated neoplasm are adhered and fused. Abandonment of orthosis at this time can lead to the development of relapse of the disease.

Surgical removal of the wrist of the wrist

Operative intervention is performed under local anesthesia under stationary conditions and takes about half an hour. In order to reduce the risk of postoperative complications, it is necessary that the surgery be performed by a doctor specializing in brush surgery.Indications for the use of this method of treatment are a significant violation of the functionality of the joint and aesthetic brush.

During operation, the hygroma capsule is removed along with the leg and contents before it is connected with the joint bag. Then the wound is sutured, the sutures are removed for 7-11 days, depending on the course of the postoperative period.For at least five weeks, the patient should wear an orthosis, to prevent the development of relapse.

Laser Removal

To date, there are two methods of removing hygroma by means of a laser:

1. Open surgery- is the dissection of the skin over the neoplasm, the destruction of the hygroma with the help of high temperature, treatment of the subcutaneous space and suturing the wound.
2. Arthroscopic method- for the operation to be performed this method requires special equipment. The essence of the technique is to remove the hygroma through small punctures by means of two puncture needles. Through one needle, the tumor is destroyed by a laser lightguide, and after the second, the remaining liquid is sucked out.

After surgery, the bandage and fixation of the hand with a plaster bandage or orthosis.

Cost of surgical intervention

The cost of surgical treatment depends on the region of residence, the clinic and the competence of the doctor. The price of surgery includes consultation of a doctor, diagnostic studies, anesthesia, surgical intervention.

Rehabilitation period

The rehabilitation period takes from 4 to 6 weeks. At this time, it is necessary to avoid the load on the damaged joint, for which the hand is fixed with an orthosis or plaster bandage.After removing the bandage, you must carefully proceed with the development of the joint.

Possible complications after removal

Postoperative complications include the development of puffiness and the release of purulent exudate from the wound. They develop with improper treatment of the cavity and wound immediately after the operation, if the dressing regimen is not followed and the brush is not immobilized.

In addition, complications include relapse of the disease, which can develop for the following reasons:

• incomplete removal of the hygroma capsule;
• lack of suturing the cavity inside;
• refusal of immobilization.

What can happen if you do not remove the wrinkle of the wrist

If you do not remove the hygroma in time, it continues to develop and can lead to a disruption in the functional characteristics of the limb, the development of an aesthetic defect, the appearance of permanent severe pain.

Experts argue that with a small tumor volume in 40% of cases, it can dissolve independently, if you do not load the joint and perform conservative treatment.

With any method of treatment, there is a risk of a secondary appearance of the hygroma. But going to the doctor and following his recommendations will help to avoid this.