Hygroma of the joint - Causes, symptoms and treatment. MF.

Hygroma - an accumulation of serous-mucous or serous-fibrinous fluid in the cavity of a paracentral or newly formed synovial bag, which has the appearance of a tumor-like formation.

Schematic image of hygroma

Hygroma can flow like a dropsy of synovial bag without pronounced inflammation, but in some cases the fluid that swims into the lumen of the synovial bag has a serous-fibrinous or hemorrhagic( bloody) character. In the case when the hygroma develops in the synovial bag, located superficially, its walls are thickened, uneven, often acquire a density of cartilage and are soldered to surrounding tissues. If the hygroma develops in a deeply located synovial bag, its walls do not reach a significant thickness and are not welded to surrounding tissues.

In the serous inflammation phase, the appearance of lymphoid and lymphocytic infiltrates( clusters of cellular elements of lymphoid and macrophage systems) in tissue, as well as separate proliferation of connective tissue in the inner layer of the synovial sac wall. In addition, sometimes there are foci of hemorrhages and necrosis( necrosis) in which lime deposits occur.

In the phase of proliferative inflammation of granulation( a juicy tissue of bright red color with a granular surface that develops during the healing of wounds and foci of inflammation) begin to lining the inner surface of the synovial bag and form villous growths, thereby forming strings, lintels and pockets that separate the bag cavityon isolated cameras.

Small hygromas, as a rule, contain a dense mass inside, and large ones contain a serous fluid with an admixture of blood and its clots, as well as crystals of cholesterol and so-called rice bodies.

Causes of hygroma occurrence

Hygromes appear due to chronic bursitis( inflammation of the mucous bags mainly in the joint region) or chronic tendovaginitis( inflammation of the tendon sheath - connective tissue membranes surrounding the tendon), provided that the inflammatory process is accompanied by profuse sweating from the small blood vessels of a protein-rich fluid. As a rule, hygromas can develop on areas of the body that are constantly subjected to regular traumatization or prolonged pressure that occurs in individuals of certain professions or as a result of wearing inadequately fitted shoes, prostheses, etc. In this connection, hygromas are observed mainly in synovial bags, located superficially and, therefore, more susceptible to mechanical action, for example, on the back surface of the wrist joint and on the back side of the foot. So, often enough wrist hygroma occurs in women after childbirth, which is due to the fact that they begin to regularly take the child in his arms, thereby burdening his wrists. However, more often hygromes are found in men.

Symptoms of hygroma

The clinical picture depends largely on the size of the hygroma. Patients with small hygromas, as a rule, do not complain. As the size of the hygroma increases, there is a dull pain in the area of ​​the corresponding synovial bag, due to its stretching and increasing with physical activity. In the case of compression of the hygroma of the neurovascular bundles, hyperesthesia( increased skin sensitivity) and paresthesia( sensation of numbness of the skin, crawling of the goose and the other in diseases of the nervous system, peripheral vessels), neuralgic pains and venous congestion are attached.

When examined, the skin above the hygroma is smooth and mobile, and with hygromes arising on the soil due to the professional activities of chronic trauma, the skin is often thickened and rough to the touch. In the absence of inflammation in the wall of the synovial bag during palpation( feeling), the hygroma is defined as a morbidly boundedly displaced, round-shaped formation having a smooth surface and a soft-elastic consistency. In the case of hyperkeratosis( excessive thickening of the stratum corneum due to prolonged pressure, friction) and proliferative changes in the wall of the synovial bag, the hygroma can become dense and sedentary. In some cases, it is possible to determine the presence of transfer waves on one side when applying light, abrupt blows with the other hand on the opposite side of the hygroma wall( the phenomenon of fluctuation).

Appearance of hygroma of wrist joint

Complications of hygroma

When the hygroma is opened or if it is opened as a result of an external traumatic effect, the hygroma contents are continuously distributed through the hole formed.

In some cases, with accidental or intentional injury, the hygroma opens its synovial membrane outward, and the fluid is forced into the joint cavity;It is possible to rupture the membrane of the hygroma with the emptying of its contents into surrounding tissues. After such a crushing of the hygroma, its membrane eventually regains its integrity and becomes tight, this leads to the fact that the hygroma is again filled with a liquid, sometimes several hybrids can appear in the place of one crushed hygroma.

In case of unfavorable development of events in the area that has been injured by the hygroma, an inflammatory reaction may occur, up to the development of suppuration when infection is attached. In this case, the clinical picture is characterized by classical local and general signs of inflammation.

Survey and laboratory diagnosis of hygroma

If the hygroma has a typical localization and is superficial, its diagnosis is usually not difficult.

Differentiate the hygroma with the ganglion, the abscess, the aneurysm of the artery, the benign and malignant neoplasms( tumors).

Laboratory examination in uncomplicated gigroma does not have an independent diagnostic value. If necessary, hospitalization for the purpose of conducting a routine surgical intervention for a hygroma is assigned a general clinical examination( general blood test( UAC), general urine analysis( OAM), blood glucose, biochemical blood test( BAC), hepatitis, syphilis, HIV test).necessary to exclude contraindications to surgical intervention.

Treatment of hygroma

At the onset of the disease, it is possible to use conservative methods of treatment, the appointment of which is possible only under the condition of prolonged release from physical labor associated with permanent traumatization of the affected synovial bag. Conservative treatment is reduced to the use of heat, paraffin and mud applications, X-ray therapy and ultraviolet irradiation. It is possible to use repeated punctures of the hygroma with aspiration( suction) of its contents, as well as the introduction of glucocorticosteroids into the lumen, after which it is necessary to apply a compression bandage.

Conservative treatment methods in a large number of patients are ineffective, since, despite temporary success, recurrences of hygroma often occur.

The most effective method of treating hygroma is surgery( bursectomy), the indications to which are:

1. Pain syndrome, especially when moving in the joint;
2. Restrictions on flexion of the joint and loads on it;
3. Rapid increase in the size of hygroma;
4. Cosmetic defect( unaesthetic appearance).

Surgery is performed under regional anesthesia on an outpatient basis and takes about 30 minutes to complete. In the course of the operation, the hygroma capsule is allocated up to the place where its leg with the joint is communicated and is completely removed along with the contents. Seams are applied, which are removed on the 7-10th day after the operation. With a large size of the hygroma and complicated localization, the operation is performed under general anesthesia under conditions of a surgical hospital.

Stage of surgical intervention to remove hygroma: allocation of hygroma capsule

Prevention of hygroma

Prevention of hygroma is reduced to the implementation of measures that allow regular injuries of joints during labor activity, as well as to treatment of diseases that can lead to the appearance of gigrom( chronic bursitis, chronic tendovaginitis).

Doctor surgeon Kletkin ME