Gigroma – the osumkovanny opukholevidny education filled serous or serous and mucous liquid. Represents a benign cystous tumor. Settles down near joints or tendinous vaginas, most often – in a luchezapyastny joint, on a brush, in the field of foot and an ankle joint. The development reasons are up to the end not studied, however hereditary predisposition and communication with a repeated travmatization is traced. Small gigroma usually do not cause any inconveniences, except esthetic. At their increase or an arrangement near nerves pains develop; sensitivity violation is in certain cases possible. Gigroma never ozlokachestvlyatsya and do not pose hazard to life of the patient. Conservative therapy is ineffective, surgical treatment – removal of a gigroma is recommended.
Gigroma (from Greek hygros – liquid, oma – a tumor) – the benign cystous tumor consisting of the dense wall formed by connecting fabric and viscous contents. Contents by the form remind transparent or yellowish jelly, and on character represent serous liquid with impurity of slime or fibrin. Gigroma are connected with joints or tendinous vaginas and settle down near them. Depending on localization can be or soft, elastic, or firm, on density reminding a bone or a cartilage.
Develop at young women more often. Make about 50% of all benign tumors of a luchezapyastny joint. The forecast at gigroma favorable, however, risk of development of a recurrence is rather high in comparison with other types of benign tumors.
The point of view is widespread that the gigroma represents usual protrusion of not changed articulate capsule or a tendinous vagina with the subsequent infringement of an isthmus and formation of separately located opukholevidny education. It is not absolutely right.
Gigroma are really connected with joints and tendinous vaginas, and their capsule consists of connecting fabric. But there are also distinctions: cages of the capsule of a gigroma are degenerately changed. It is supposed that the prime cause of development of such cyst is the metaplaziya (regeneration) of cells of connecting fabric. At the same time there are two types of cages: one (spindle-shaped) form the capsule, other (spherical) are filled with liquid which then is emptied in intercellular space.
For this reason conservative treatment of a gigroma does not provide desirable result, and after operations rather high percent of a recurrence is observed. If in the field of defeat there is at least a small site of degenerately changed fabric, its cages begin to breed, and the disease recurs.
The reasons of development of a gigroma are up to the end not found out. In traumatology it is supposed that it arises under the influence of several factors. It is established that such educations appear at blood relatives more often, that is, hereditary predisposition takes place. A little more, than in 30% of cases, emergence of a gigroma is preceded by a single trauma. Many researchers consider that there is a communication between development of a gigroma and a repeated travmatization or constant high load of a joint or a sinew.
At women of a gigroma are observed almost three times more often than at men. At the same time an overwhelming part of cases of their emergence are the share of young age – from 20 to 30 years. At children and elderly people of a gigroma develop rather seldom.
Theoretically the gigroma can appear in any place where there is a connecting fabric. However in practice of a gigroma usually arise in the field of disteel departments of extremities. First place on prevalence is won by gigroma in the back surface of a luchezapyastny joint. Less often gigroma on the palmar surface of a luchezapyastny joint, on a brush and fingers, and also on foot and an ankle joint meet.
In the beginning in a joint or a tendinous vagina there is a small localized tumor, as a rule, accurately noticeable under skin. Usually gigroma happen single, but simultaneous or almost simultaneous emergence several gigry is in some cases observed.
Meet as absolutely soft, elastic, and firm opukholevidny educations. In all cases of a gigrom it is accurately delimited. Its basis is densely connected with the subject fabrics, and other surfaces are mobile and are not soldered to skin and hypodermic cellulose. Skin over gigromy is freely displaced.
With a pressure upon area of a gigroma there is an acute pain. For lack of pressure symptoms can differ and depend on the size of a tumor and its arrangement (for example, the neighbourhoods with nerves). The constant dull aches irradiating the pains or pains developing only after intensive loading are possible. Approximately in 35% of cases of a gigrom proceeds asymptomatically.
Rather seldom, when the gigroma is located under a sheaf, it can remain long time unnoticed. In such cases patients see a doctor because of pains and unpleasant feelings during the bending of a brush or attempt to clasp with a hand some subject.
Skin over gigromy can both remain not changed, and to grow coarse, get a reddish shade and to be shelled. After active movements of a gigrom can increase a little, and then at rest to decrease again.
It is possible as the slow, almost imperceptible growth, and bystry increase. Usually the size of a tumor does not exceed 3 cm, however in some cases gigroma have 6 cm a diameter. The independent rassasyvaniye or spontaneous opening is impossible. At the same time gigroma never regenerate in cancer, the forecast at them favorable.
Separate types gigry
Gigroma in a luchezapyastny joint usually arise on the back, on a side or forward surface, in a back cross ligament. As a rule, they are well noticeable under skin. At an arrangement under a sheaf opukholevidny education sometimes becomes visible only at strong bending of a brush. The majority such gigry proceeds asymptomatically and only some patients have an insignificant pain or unpleasant feelings at the movements.
Less often gigroma appear on the palmar surface of a luchezapyastny joint, almost in the center, is slightly closer to the beam party (side of a thumb).
On a gigroma consistence in a luchezapyastny joint can be soft or plotnoelastichny.
On the back of fingers of a gigroma usually arise in the basis of a disteel phalanx or interphalanx joint. Skin over them stretches and becomes thinner. Under skin small dense, roundish, painless education is defined. Pains develop only in some cases (for example, at a bruise).
On palmar side of fingers of a gigroma are formed of tendinous vaginas of sgibatel. They larger gigry, located on the back, and quite often occupy one or two phalanxes. In process of growth of a gigrom begins to press on numerous nervous fibers in fabrics of a palmar surface of a finger and the nerves located on its side surfaces therefore at such localization the severe pains in character reminding neuralgia are often observed. Sometimes at a palpation of a gigroma fluctuation comes to light.
Less often gigroma arise at the basis of fingers. In this department they small, size about a pin head, painful when pressing.
In disteel (remote from the center) parts of a palm of a gigroma also arise from tendinous vaginas of sgibatel. They differ in the small size and high density therefore at survey they are confused sometimes to cartilaginous or bone educations. At rest are usually painless. Pain develops in attempt to strong clasp a firm subject that can prevent professional activity and give an inconvenience in life.
On the lower extremity of a gigroma usually appear in the field of foot (on the back surface of an instep or fingers) or on the front and external surface of an ankle joint. As a rule, they are painless. Pains and an inflammation can arise when rubbing a gigroma footwear. In some cases the pain syndrome appears from behind the gigroma pressure upon the nerve located nearby.
Usually the diagnosis is exposed on the basis of the anamnesis and characteristic clinical manifestations. For an exception of bone and articulate pathology the X-ray analysis can be appointed. In doubtful cases carry out ultrasonography, a magnetic and resonant tomography or a puncture of a gigroma.
Ultrasonography gives the chance not only to see a cyst, but also to estimate its structure (uniform or filled with liquid), to define whether there are in a gigroma wall blood vessels etc. Advantages of ultrasonography are simplicity, availability, informational content and low cost.
At suspicion on nodal educations of the patient can direct to a magnetic and resonant tomography. This research allows to define precisely structure of a wall of a tumor and its contents. A lack of a technique is its high cost.
Differential diagnostics of a gigroma is carried out with other benign tumors and opukholevidny formations of soft fabrics (lipomas, ateroma, epitelialny traumatic cysts etc.) taking into account the characteristic location, a consistence of a tumor and complaints of the patient. Gigroma in a palm sometimes it is necessary to differentiate with bone and cartilaginous tumors.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Surgeons, traumatologists and orthopedists are engaged in treatment of a gigroma. In the past to gigry tried to treat crush or a razminaniye. A number of doctors practiced punctures, sometimes – with simultaneous introduction of enzymes or skleroziruyushchy medicines to a gigroma cavity. Also physiotreatment, therapeutic muds, bandages with various ointments and so forth was applied. Some clinics use the listed techniques still, however it is impossible to call efficiency of such therapy satisfactory.
The percent of a recurrence after conservative treatment reaches 80-90% while after expeditious removal of a gigroma recur in only 8-20% of cases. Proceeding from the presented statistics, the only effective method of treatment is surgery today.
Indications for surgical treatment:
- Pain at the movements or at rest.
- Restriction of volume of movements in a joint.
- Not esthetic appearance.
- Education rapid growth.
Surgical intervention at rapid growth of a gigroma as excision of large education is accompanied by a number of difficulties is especially recommended. Gigroma quite often settle down near nerves, vessels and sheaves. Because of growth of a tumor these educations begin to be displaced, and its allocation becomes more labor-consuming. Sometimes surgical intervention is carried out in out-patient conditions. However during operation opening of a tendinous vagina or joint therefore it is better to hospitalize patients is possible.
Operation is usually performed under local anesthesia. An extremity exsanguinate, imposing a rubber plait above a section. Bleeding and introduction of anesthetic to soft fabrics around a gigroma allows to designate more accurately border between opukholevidny education and healthy fabrics. At difficult localization of a gigroma and formations of the big size use of an anesthesia or conduction anesthesia is possible. In the course of operation it is very important to allocate and excise gigry so that in the field of a section there is no small site left of the changed fabric even. Otherwise the gigroma can recur.
Opukholevidny education is excised, paying special attention to its basis. Attentively examine surrounding fabrics, at detection allocate and delete small cysts. The cavity is washed out, taken in and drain a wound the rubber graduate. Apply the pressing bandage area of a wound. The extremity is usually fixed plaster longety. The immobilization is especially shown at big gigroma in joints, and also at gigroma in fingers and a brush. The graduate delete in 1-2 days from the moment of operation. Seams are removed for 7-10 days.
In recent years along with a classical surgical technique of excision of a gigroma many clinics practice its endoscopic removal. Advantages of this way of treatment are the small section, a smaller travmatization of fabrics and more bystry restoration after operation.