joint hygroma - Causes, Symptoms and Treatment .MF .
Hygroma - accumulation of serous-mucous or serous-fibrinous fluid in the cavity or newly formed periarticular bursa, which has the form of tumor formation.
Schematic representation hygroma
Hygroma can proceed according to the type of dropsy of the bursa inflammation without the express, but in some cases propotevayuschaya into the lumen of the bursa fluid has seroplastic or hemorrhagic (bloody) character.In the case where hygroma develops bursa located surfactant, its walls are thickened, uneven density cartilage often acquire and soldered to surrounding tissues.If the hygroma develops deeply situated bursa, its walls do not reach significant thickness and not soldered to surrounding tissues.
In phase serous inflammation noted the appearance of lymphoid and lymphocytic infiltrates (accumulation of tissue cellular elements of macrophage and lymphoid systems), as well as individual growth of connective tissue in the inner layer of the wall of the bursa.Also, sometimes there are foci of hemorrhage
In phase proliferative granulation inflammation (juicy tissue bright red color, with a grainy surface, growing in wound healing and inflammatory foci) are beginning to line the interior surface of the bursa and form villous proliferation, thereby forming cords, jumpers and pockets that divide the cavitybags on an isolated cell.Small
hygroma usually contained inside a thick mass, and large - serous fluid with blood clots and it, as well as cholesterol crystals and so called rice bodies.
hygroma appear due to chronic bursitis (inflammation of the mucous bags mainly in the joints) or chronic tenosynovitis (inflammation of the tendon sheath - connective tissue membranes surrounding the tendons), provided that the inflammatory process is accompanied by abundant propotevanie of small blood vessels protein-richliquid.As a rule, hygroma may develop on areas of the body that are constantly exposed to regular trauma, or prolonged pressure that occurs in people of certain professions or as a result of wearing poorly fitted shoes, prostheses, etc.. D. In connection with this hygroma observed mainly in bursadisposed surface and therefore more prone to mechanical stress, for example, on the back surface of the wrist and on the rear side of the foot.So, quite often hygroma wrist occurs in women after childbirth, due to the fact that they start to regularly take the child in his arms, thus impacting their wrist.However, most often found in men hygroma.
The clinical picture depends on the size of hygroma.Patients with small hygroma, as a rule, do not complain.As the size of hygroma appears dull pain in the respective bursa due to its stretching and growing during exercise.In the case of compression hygroma neurovascular bundles join hyperesthesia (increased sensitivity of the skin) and paresthesia (sensation of skin numbness, pins and needles and with other diseases of the nervous system, peripheral vascular disease), neurological pain and venous congestion.
When viewed from above the skin smooth and agile hygroma and hygroma when appearing on the soil caused by chronic occupational trauma, skin is often thickened and rough to the touch.In the absence of inflammation in the wall of the bursa with palpation (feeling) is defined as the hygroma maloboleznennoe partially displaces formation rounded, having a smooth surface and soft-elastic consistency.In case of hyperkeratosis (excessive thickening of the horny layer of the skin due to prolonged pressure, friction) and proliferative changes in the wall of the bursa hygroma may become dense and inactive.In some cases it is possible to determine the presence of transmission waves from one side of the substrate light staccato beats your other hand on the opposite side of the wall hygroma (fluctuation phenomenon).
Appearance hygroma wrist
When hygroma spontaneous dissection or autopsy of her as a result of external traumatic effects observed long hygroma delivery contents through the opening.
In some cases, accidental or intentional injury of hygroma opening to the outside does not occur it the synovial membrane and the fluid is forced into the joint cavity;can break the shell hygroma emptying its contents into the surrounding tissue.Upon such crushing shell hygroma it eventually regains its integrity and becomes leak, this leads to the fact that hygroma again fills with fluid, sometimes crushed hygroma one place can occur a few.
In the case of adverse developments in the field, has been traumatized hygroma, it may be an inflammatory reaction, until the development of festering accession infection.This clinical picture is characterized by classic local and general signs of inflammation.
survey and laboratory diagnostics hygroma
If the hygroma has a typical localization is the surface, its diagnosis is usually not difficult.
Differentiate hygroma accounts with the ganglion, natёchnym abscess, aneurysm artery, benign and malignant neoplasms (tumors).
Laboratory examination in uncomplicated hygroma has no self-diagnostic value.If required hospitalization for the purpose of the planned surgery on the hygroma appointed general clinical laboratory tests (complete blood count (KLA), urinalysis (OAM), blood glucose, blood chemistry (LHC), the research on hepatitis, syphilis, HIV)necessary to exclude contraindications to surgery.
At the beginning of the disease is possible to use conservative methods of treatment, the purpose of which is possible only if a long release from the physical labor associated with constant traumatization of the affected bursa.Conservative treatment is reduced to the application of heat, paraffin and mud applications, X-ray and ultraviolet radiation.Perhaps the use of repeated punctures hygroma with aspiration (suction) of its content, as well as the introduction into the lumen of glucocorticosteroids, then you need to be sanctioned by a compression bandage.
Conservative treatment in a large number of patients are ineffective, since, in spite of the temporary success, often relapse hygroma.
most effective treatment hygroma is surgical intervention (bursectomy), indications for which are:
1. Pain, especially when driving in the joint;
2. Limitations of joint flexion and load it;
3. The rapid increase in the size of hygroma;
4. Cosmetic defect (aesthetically pleasing).
Surgery is performed under regional anesthesia in an outpatient setting and the duration is about 30 minutes.In the course of the operation stands hygroma capsule to the space posts its legs with joint and completely removed along with the contents.Stitches, which are removed 7-10 days after surgery.For large size and complex localization hygroma surgery is performed under general anesthesia in a surgical hospital.
Stage surgical removal hygroma: isolation capsule hygroma
Prevention hygromas reduced to the implementation of measures so as to avoid a regular trauma of joints during the course of employment, as well as to the treatment of diseases that can lead to the appearance hygromas(chronic bursitis, chronic tendovaginitah).
Surgeon Kletkin ME