The lump on the back of my hand was crushed by me, can the doctor help me?

I once received a consultation from a friend and took a photo of the back of my hand under the setting sun. The description when I sent it to me via WeChat is quite poetic:

“I have never paid attention to the back of my hand. I was driving across the bridge after get off work that day, and it was a bit blocked. I listened to the song and looked around. Suddenly I noticed that there was a bulge on the back of my hand, the setting sun It looks very obvious when you look at it. I thought it was dazzling at first, but then I looked closely and there is indeed a bulge. It’s been a few days and the bag is still there, you See what it is?”

ganglion cyst | Wikimedia Commons

Judging from the location, shape, size, and symptoms of the lump in the photo, nine times out of ten it should be a ganglion cyst. The rigorous thinking of a medical student told me: to diagnose whether the bulge on the back of a friend’s hand is a ganglion cyst, it should also be compared with infectious paraganglion cyst, subcutaneous lipoma or Other lumps are identified.

In the spirit of “no treatment without accurate assessment”, I replied to her: “It may be a ganglion cyst. It’s not a big problem. Let’s see it in person when you have time.”

That night, this friend sent me a WeChat message again: “After taking a shower at night, I felt very unsteady to touch this new friend on my body, touching, I feel The cyst burst suddenly and the bump on the back of the hand disappeared.

After that, I took a photo and sent it to me: “Look, is the back of your hand flat?” This result told me that the judgment at that time was correct. The bulge on the back of her hand was indeed a “ganglion cyst”.

What is a ganglion cyst?

Like the scabbard of a sword, a tendon sheath is a sheath that wraps around a tendon. The tendon sheath is divided into two layers, the outer layer is a fibrous sheath, and the inner layer is a synovial membrane that secretes synovial fluid. During muscle movement, synovial fluid lubricates the sliding of the tendon.

Cross-section of tendon sheath 1. Tendon fibrous sheath 2. Mesentery 3. Tenosynovial sheath parietal layer 4. Synovial cavity 5. Tenosynovial sheath visceral layer 6. Tendon | Wikipedia

ganglion cysts are made up of a cyst wall, pedicle and cyst fluid. The cyst wall is dense fibrous connective tissue, and the cyst fluid is colorless transparent peptone mucus. A ganglion cyst is like a little water-filled balloon, with an inflatable nozzle serving as its “pedicle” leading to the joint cavity.

ganglion cyst | Literature[3]

The formation of a ganglion cyst is a long-term process that is usually asymptomatic and goes unnoticed. It is not detected until it protrudes from the surface of the skin.

Its cause is still inconclusive, and the currently recognized view is that ganglion cyst is a degenerative cyst. Trauma, strain and ligament laxity can lead to a series of pathological changes of the tendon sheath: The production of synovial fluid increases, the discharge or absorption decreases, the tendon sheath bulges outwards, the synovial fluid accumulates, and cysts are formed.

ganglion cysts are more common in people with active hands

ganglion cysts generally occur in areas of high mobility, such as back of wrist, inner wrist, finger joints >andat the instep. These places are superficial and cysts are easy to spot. When a superficial ganglion cyst bulges over the skin surface, the bulge appears to be well-defined, smooth in appearance and can be pushed gently. Other ganglion cysts occur in the elbows, knees, hips, and even the temporomandibular joint.

Like tenosynovitis, ganglion cysts are more common in people who use a lot of hand movement, especially wrist flexion and extension – keyboard players, pianists, guitar players, and those who often pump and hug The new mother of the baby, if you are not careful, ganglion cysts may occur in both hands.

What should I do if a ganglion cyst occurs?

People often say, “It’s a trivial matter, just break it by yourself.” That’s not advisable!

Currently, conservative treatment remains the preferred method of treatment for ganglion cysts.

In an orthopedic or hand surgery clinic, after a ganglion cyst has been diagnosed, the doctor may easily crush the cyst. Self-compression is not recommended until a diagnosis is made. if in handThe protrusion is not a ganglion cyst but a malignant mass, and the consequences of pressing are unimaginable. The pressing of the cyst is not like pinching a bubble, and requires certain techniques and skills.

Figure | Figure Worm Creative

Furthermore, after the ganglion cyst was pinched, the cyst wall and pedicle were still there, and synovial fluid was still secreted. If the living and working habits that lead to ganglion cysts do not improve, it is easy to recur.

Sometimes ganglion cysts go away without treatment, but they are often prone to recurrence.

How to avoid recurrence?

Doctors often recommend surgical treatments, including open surgerytreatment and arthroscopic surgery. Surgery can completely remove the pedicle of the cyst, reducing the recurrence rate.

What can I do:

Adjust lifestyle and work habits that can lead to ganglion cysts.

Swipe your phone less, use a wrist rest to support your wrist when using a keyboard or mouse, or replace it with an ergonomic device.

Pay attention to posture when practicing musical instruments, and combine work and rest.

New mothers can use a feeding pillow when breastfeeding; avoid holding the baby for a long time, or use a sling, waist stool, etc.; and, choose a suitable electric breast pump.

It should be noted that not all masses are ganglion cysts. When a mass on the body surface is found, It is recommended to go to the hospital /strong>. The doctor will make a diagnosis through the evaluation of the manipulation and the judgment of the symptoms. If necessary, there will be color Doppler ultrasound, MRI, X-ray, CT and pathological examination to clarify or differentiate the diagnosis.

References

[1]. Hu Fei, Shang Xifu, Kong Rong, Fang Shiyuan, Tong Yuan, Diagnosis and surgical treatment of soft tissue masses in the wrist, [J], Chinese Journal of Orthopaedic Surgery. 2007(02 )

[2]. Jiang Liya, Zhang Jia. Treatment of ganglion cyst on the back of the wrist: history and progress [J]. Chinese Journal of Bone and Joint Surgery. 2016(06)

[3].https:https://www.mayoclinic.org/diseases-conditions/ganglion-cyst/symptoms-causes/syc-20351156

Author: Sometimes in April

Editor: Mu Yi Yang Yang, Dongfeng

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OCD people with ganglion cysts should take it easy!

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