What is osteonecrosis of the hip. How does it affect the hip joint. What are the risk factors for developing osteonecrosis. What symptoms does osteonecrosis cause. How is osteonecrosis diagnosed and treated. What lifestyle changes can help manage osteonecrosis.

Understanding Osteonecrosis of the Hip

Osteonecrosis of the hip, also known as avascular necrosis (AVN) or aseptic necrosis, is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. This lack of blood flow causes bone cells to die, leading to the gradual collapse of the femoral head and potentially severe arthritis in the hip joint.

Each year, over 20,000 people in the United States are hospitalized for treatment of hip osteonecrosis. The condition most commonly affects adults between 20-65 years old, with men developing it more frequently than women. In many cases, both hips are affected simultaneously.

How Osteonecrosis Impacts the Hip Joint

The hip is a ball-and-socket joint consisting of:

• The acetabulum (socket) – part of the pelvis bone
• The femoral head (ball) – upper end of the femur
• Articular cartilage – smooth tissue covering joint surfaces

In osteonecrosis, the femoral head gradually collapses as bone tissue dies due to inadequate blood supply. This leads to breakdown of the protective articular cartilage and can result in debilitating arthritis of the hip over time.

Risk Factors for Developing Osteonecrosis

While the exact cause is not always known, several risk factors have been identified that may increase one’s chances of developing osteonecrosis:

• Corticosteroid use
• Excessive alcohol consumption
• Lupus
• Severe trauma or injury to the hip
• Blood disorders like sickle cell anemia
• HIV infection
• Decompression sickness (“the bends”)
• Radiation therapy
• Organ transplantation

Can osteonecrosis be prevented? While not all cases can be avoided, reducing corticosteroid doses when possible, avoiding heavy alcohol use, and quitting smoking may help lower one’s risk. For those who must take corticosteroids, using the lowest effective dose for the shortest necessary duration is recommended.

Recognizing the Symptoms of Hip Osteonecrosis

Early detection of osteonecrosis is crucial for optimal treatment outcomes. Common signs and symptoms include:

• Localized pain in the affected hip or groin area
• Pain that worsens with weight-bearing activities or walking
• Reduced range of motion in the hip joint
• Development of osteoarthritis in nearby joints

Is hip osteonecrosis always painful? In the early stages, some individuals may not experience significant pain. However, as the condition progresses, pain typically increases, especially during weight-bearing activities.

Diagnostic Approaches for Osteonecrosis

Accurate diagnosis of osteonecrosis involves a combination of clinical evaluation and imaging studies:

1. Physical examination
2. X-rays of the affected area
3. Bone scans
4. Magnetic Resonance Imaging (MRI)

Why is MRI particularly useful in diagnosing osteonecrosis? MRI can detect early stages of osteonecrosis before changes are visible on X-rays, allowing for earlier intervention and potentially better outcomes.

Stages of Osteonecrosis

Osteonecrosis progresses through several stages:

1. Stage 1: No visible changes on X-ray, but MRI shows bone damage
2. Stage 2: X-rays show evidence of bone damage, but no collapse
3. Stage 3: Early collapse of the femoral head (subchondral fracture)
4. Stage 4: Further collapse and flattening of the femoral head
5. Stage 5: Narrowing of the joint space and advanced arthritis

Treatment Options for Hip Osteonecrosis

Treatment for osteonecrosis varies depending on the stage of the disease and severity of symptoms. Options include:

Conservative Treatments

• Pain medications
• Activity modification to reduce weight-bearing on affected joints
• Use of assistive devices like canes or crutches
• Physical therapy to maintain joint mobility and strength

Surgical Interventions

• Core decompression: Removing bone from the affected area to restore blood flow
• Osteotomy: Repositioning the bone to improve weight distribution
• Bone grafting: Replacing dead bone with healthy bone to restore blood supply
• Total hip replacement: For advanced cases with significant joint damage

How effective is core decompression for early-stage osteonecrosis? Core decompression can be highly effective in early stages, potentially halting disease progression and relieving pain. Success rates vary, but many patients experience significant improvement.

Emerging Therapies

Recent studies have shown promise for additional treatments:

• Bisphosphonate therapy: May slow or prevent bone collapse in some cases
• Stem cell therapy: Experimental treatment aimed at regenerating bone tissue
• Growth factor injections: To stimulate bone healing and blood vessel formation

Living with Osteonecrosis: Lifestyle Modifications and Management

While medical treatments are crucial, lifestyle changes can significantly impact the course of osteonecrosis:

• Weight management: Reducing excess body weight to decrease stress on affected joints
• Low-impact exercise: Maintaining fitness without excessive joint stress
• Nutritional support: Ensuring adequate intake of calcium, vitamin D, and other bone-supporting nutrients
• Smoking cessation: Improving overall bone health and circulation
• Alcohol moderation: Limiting alcohol intake to reduce further bone damage

Can lifestyle changes reverse osteonecrosis? While lifestyle modifications alone cannot reverse established osteonecrosis, they can help slow disease progression, reduce pain, and improve overall joint health.

Prognosis and Long-term Outlook for Hip Osteonecrosis

The prognosis for individuals with hip osteonecrosis varies depending on several factors:

• Stage of the disease at diagnosis
• Extent of bone damage
• Underlying cause of osteonecrosis
• Patient’s age and overall health
• Adherence to treatment plans

Early diagnosis and intervention generally lead to better outcomes. With appropriate treatment, many patients can maintain joint function and delay or avoid the need for total hip replacement.

Long-term Management Strategies

Effective long-term management of hip osteonecrosis typically involves:

• Regular follow-up appointments with orthopedic specialists
• Ongoing physical therapy to maintain joint function
• Periodic imaging studies to monitor disease progression
• Adjustment of treatment plans as needed
• Management of underlying conditions contributing to osteonecrosis

Is hip osteonecrosis a lifelong condition? While osteonecrosis itself is not reversible, proper management can significantly slow its progression and maintain quality of life. Some patients may achieve long-term stability with appropriate treatment.

Research and Future Directions in Osteonecrosis Treatment

Ongoing research in the field of osteonecrosis is focused on several promising areas:

• Advanced imaging techniques for earlier detection
• Novel drug therapies to promote bone regeneration
• Improved surgical techniques for joint preservation
• Gene therapy approaches to address underlying genetic factors
• Tissue engineering for cartilage and bone repair

These advances hold the potential to dramatically improve outcomes for patients with hip osteonecrosis in the coming years.

Participating in Clinical Trials

Patients interested in contributing to osteonecrosis research may consider participating in clinical trials. These studies offer access to cutting-edge treatments while advancing scientific understanding of the condition.

How can patients find information about osteonecrosis clinical trials? The National Institutes of Health maintains a database of ongoing clinical trials at ClinicalTrials.gov, where patients can search for studies relevant to their condition.

Support and Resources for Individuals with Hip Osteonecrosis

Living with hip osteonecrosis can be challenging, but various resources are available to provide support and information:

• Patient support groups
• Online forums and communities
• Educational materials from reputable medical organizations
• Rehabilitation and pain management programs
• Occupational therapy for adaptive strategies in daily living

These resources can help patients better understand their condition, connect with others facing similar challenges, and develop effective coping strategies.

Working with Healthcare Providers

Effective management of hip osteonecrosis often requires a multidisciplinary approach involving:

• Orthopedic surgeons
• Rheumatologists
• Physical therapists
• Pain management specialists
• Nutritionists

Open communication with healthcare providers is crucial for developing a personalized treatment plan and addressing any concerns that arise during the course of treatment.

By combining medical interventions, lifestyle modifications, and ongoing support, many individuals with hip osteonecrosis can maintain active, fulfilling lives while effectively managing their condition. As research continues to advance our understanding of osteonecrosis, new treatment options and improved outcomes are on the horizon, offering hope for those affected by this challenging condition.

Osteonecrosis

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Osteonecrosis is a painful condition that involves the death of bone cells due to decreased blood flow. It is also called avascular necrosis (AVN) or aseptic necrosis. It is a painful condition most commonly occurring in the hips or knees and is often more symptomatic with any weight-bearing activities, such as walking. In some cases, the bone at the hip (femoral head) may collapse. Shoulders, hands, and feet are less often affected. Rarely, osteonecrosis affects the jaw (see separate chapter for details on osteonecrosis of the jaw). Osteonecrosis usually occurs between the ages of 20 and 50 years. Bones and bone marrow need steady blood supply to stay healthy. Decreased blood flow causes bone cells to die. Corticosteroid use, heavy drinking, lupus and severe trauma or injury may cause osteonecrosis. Rarer causes of osteonecrosis include HIV, decompression disease (“the bends”), blood disorders such as sickle cell anemia, radiation therapy, and organ transplant.

What Are the Signs/Symptoms?

An early sign of osteonecrosis is local pain in the affected bone or joint. Hip osteonecrosis may cause pain in the groin. Pain from hip or knee osteonecrosis may be worse during weight-bearing or walking. Nearby joints may develop osteoarthritis. Diagnosis of osteonecrosis begins with an x-ray of the painful area. Other imaging tests such as bone scans or magnetic resonance imaging (MRI) may be needed. MRI is effective for early osteonecrosis detection, particularly when the x-rays do not reveal change.

What Are Common Treatments?

Treatment of early osteonecrosis includes pain medications and modifying activity to reduce weightbearing on affected joints. Patients with worsening osteonecrosis may have core decompression surgery to remove bone from the affected area and restore blood flow. In more advanced cases of osteonecrosis, osteotomy surgery may remove dead bone and reposition bone to support the weight-bearing joint. Patients with bone collapse may need total joint replacement of the hip or knee. Another option is bone grafting surgery, where dead bone is removed and replaced with healthy bone from another part of the body to restore blood flow. Some studies show short-term bisphosphonate treatment may slow, improve, or prevent bone collapse in the hip or knee.

Living with Osteonecrosis

Steps to prevent osteonecrosis include reducing corticosteroid doses and avoiding heavy drinking and the use of tobacco. If patients must take corticosteroids, they should take the smallest possible dose for the shortest time necessary. Smoking and alcohol consumption raise the risk of osteonecrosis and are adjustable risk factors to lower risk.

Updated February 2023 by Karmela Chan, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

Osteonecrosis of the Hip – OrthoInfo

Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis.

Osteonecrosis is also called avascular necrosis (AVN) or aseptic necrosis. Although it can occur in any bone, osteonecrosis most commonly affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. 

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The surface of the ball and socket is covered with articular cartilage, a smooth, slippery substance that protects the bones and enables them to glide easily across each other.  

Osteonecrosis of the hip occurs in the femoral head, which is the ball of ball-and-socket hip joint.

Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis.

Osteonecrosis can affect anyone, but is more common in people between the ages of 40 and 65. Men develop osteonecrosis of the hip more often than women.

In osteonecrosis, the bone in the head of the femur slowly dies.

Risk Factors

It is not always known what causes the lack of blood supply, but doctors have identified a number of risk factors that can make someone more likely to develop osteonecrosis:

• Injury. Hip dislocations, hip fractures, and other injuries to the hip can damage the blood vessels and impair circulation to the femoral head.
• Excessive alcohol use. Overconsumption of alcohol over time can cause fatty deposits to form in the blood vessels and can elevate cortisone levels, resulting in a decreased blood supply to the bone.
• Corticosteroid medicines. Many diseases, including asthma, rheumatoid arthritis, and systemic lupus erythematosus, are treated with steroid medications. Although it is not known exactly why these medications can lead to osteonecrosis, research shows that there is a connection between the disease and long-term corticosteroid use.
• Medical conditions. Osteonecrosis is associated with other diseases, including Caisson disease (diver’s disease, or “the bends”), sickle cell disease, myeloproliferative disorders, Gaucher’s disease, systemic lupus erythematosus, Crohn’s disease, arterial embolism, thrombosis, and vasculitis. 

Osteonecrosis develops in stages. Hip pain is typically the first symptom. This may lead to a dull ache or throbbing pain in the groin or buttock area. As the disease progresses, it becomes more difficult to stand and put weight on the affected hip, and moving the hip joint is painful.

It may take from several months to over a year for the disease to progress. It is important to diagnose osteonecrosis early, because some studies show that early treatment is associated with better outcomes. 

The four stages of osteonecrosis. The disease can progress from a normal, healthy hip (Stage I) to the collapse of the femoral head and severe osteoarthritis (Stage IV).  

Reproduced and adapted from Beaule PE, Amstutz, HC: Management of ficat stage III and IV osteonecrosis of the hip. J Amer Acad Orthop Surg 2004; 12: 96-105.

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After discussing your symptoms and medical history, your doctor will examine your hip to discover which specific motions cause your pain.

Patients with osteonecrosis often have severe pain in the hip joint but relatively good range of motion. This is because only the femoral head is involved in the earlier stages of the disease. Later, as the surface of the femoral head collapses, the entire joint becomes arthritic. Loss of motion and stiffness can then develop.

During the exam, the doctor will move your hip in different ways to learn more about your pain. 

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Imaging Tests

Imaging studies will help your doctor confirm the diagnosis.

X-rays. X-rays provide images of dense structures, such as bone. X-rays are used to determine whether the bone in the femoral head has collapsed and to what degree. 

(Left) An X-ray of a healthy hip joint. (Right)  In this X-ray, the osteonecrosis has progressed to collapse of the femoral head.

Osteonecrosis is typically seen as a wedge-shaped area with a dense whitish sclerotic (hardened) border in the superior lateral portion of the femoral head. On the lateral view, a line called a “crescent sign” can often be seen just below the surface of the femoral head. 

(Left) This X-ray shows osteonecrosis of the hip. (Right) When viewed close up, the X-ray reveals the “crescent sign” that is typically seen before collapse of the femoral head. 

Magnetic resonance imaging (MRI) scans. Early changes in the bone that may not show up on an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is affected by the disease. An MRI may also show early osteonecrosis that has yet to cause symptoms (for example — osteonecrosis that may be developing in the opposite hip joint). 

This MRI scan shows osteonecrosis in a patient’s right hip (white arrow). The dark line (red arrows) denotes the border between dead bone and living bone. The patient’s left hip is normal.

Although nonsurgical treatment options — such as anti-inflammatory medications, activity changes, and using crutches  — can help relieve pain and slow the progression of the disease, the most successful treatment options are surgical. Patients with osteonecrosis that is caught in the very early stages (before the femoral head collapses) are potential candidates for hip-preserving procedures.

There are several different surgical procedures used to treat osteonecrosis of the hip.

Core Decompression and Grafting

This procedure involves drilling one large hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip.

When osteonecrosis of the hip is diagnosed early, core decompression is sometimes successful in preventing collapse of the femoral head and the development of arthritis. 

(Left) Illustration of core decompression. (Right) In this X-ray, the drill lines show the pathway of the small drill holes used in the procedure. 

Core decompression is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint. A bone graft is healthy bone tissue that is transplanted to an area of the body where it is needed. The tissue may be taken from a donor (allograft) or from another bone in your body (autograft).

There are also several synthetic bone grafts available today. Sometimes, your own bone marrow cells may be mixed together with the graft substitute to help in the bone regeneration process. It is importat to speak with your surgeon about the available options that may be used for your procedure.

Vascularized Fibula Graft

Another surgical option is a vascularized fibula graft. In this procedure, a segment of bone is taken from the small bone in your leg (fibula) along with its blood supply (an artery and vein). This graft is transplanted into a hole created in the femoral neck and head, and the artery and vein are reattached to help heal the area of osteonecrosis. 

Two different X-ray views showing osteonecrosis of the hip.

Two X-ray views of the hip after treatment with a vascularized fibular graft.

Total Hip Replacement

In total hip replacement, both the head of the femur and the socket are replaced with an artificial device.

If osteonecrosis has advanced to the point where the femoral head has already collapsed, the most successful treatment is total hip replacement. In this procedure, your doctor removes the damaged bone and cartilage, then positions new metal or plastic joint surfaces to restore the function of your hip.  

Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases. This depends upon the stage and size of the osteonecrosis at the time of the procedure.

Core decompression achieves the best results when osteonecrosis is diagnosed in its early stages, before the bone collapses. In some of these cases, the bone heals and regains its blood supply after core decompression. It takes a few months for the bone to heal and, during this time, you will need to use a walker or crutches to avoid putting stress on the damaged bone.

Patients with successful core decompression procedures typically return to walking unassisted in about 3 months and may have complete pain relief.

Vascularized fibular grafting is an invasive procedure that requires several months of healing. Typically, you are non-weightbearing for the first several weeks; you will then gradually start weightbearing with an ambulatory assistive device (walker or cane). If a vascularized fibular graft is performed prior to femoral head collapse, the clinical outcomes are usually favorable.

When osteonecrosis is diagnosed after collapse of the bone, core decompression is not usually successful in preventing further collapse. In this situation, the patient is best treated with a total hip replacement. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis. 

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Bone” on the foot. Causes, prevention and treatment

Bones on the legs is one of the most common foot deformities with a pronounced cosmetic defect . …

According to statistics, 98% of those suffering from this disease are women and only 2% are men. Is it possible to slow down the growth of the bone, how to relieve pain and is it possible to get rid of the lump once and for all?

The medical name for “bones” sounds threatening: hallux valgus deformity of the first toe, or Hallux Valgus. The disease develops due to a violation of the tendon-muscle balance with flat feet. Bumps on the legs are often confused with gout. However, gout is a disease associated with impaired metabolism of uric acid, the salts of which are deposited in different joints (including the joints of the feet). This disease mainly occurs in men.

Why does the deformation occur?

First, a little theory: there are two arches in the foot – longitudinal and transverse. The purpose of both is cushioning and maintaining balance while walking. The heads of the metatarsal bones are in the transverse arch, forming the shape of an arch.

The deformity occurs due to the deviation of the head of the first metatarsal bone inward, and the phalanges of the thumb outward. In this case, the load of the foot is redistributed. The heads of the middle metatarsal bones are overloaded and gradually lower, fixing in the wrong position. In this regard, the appearance of corns on the soles of the feet is an alarming bell, because “corns” are an external sign of prolonged pressure of the lowered heads of the metatarsal bones on soft tissues, as a result of which the layer of subcutaneous fatty tissue decreases, the depreciation properties of the foot decrease.

Thus, the deviation of the thumb is a consequence of deviations of the metatarsal bone.

Physiotherapy and pain relief

The review of folk remedies and solutions on this topic is replete with abundance: these are all kinds of compresses, and the application of cabbage leaves, and wrapping with burdock, and iodine nets. Of course, with the help of these procedures it is impossible to eliminate the deformity of the toe. Roughly speaking, lotions do not act on bone structures.

Physiotherapy is recommended in the early stages of Hallux Valgus. As a complex treatment for the removal of inflammatory processes and pain, courses of a magnet, laser and other procedures are prescribed. At home, baths with sea salt are suitable for this purpose (with the expectation of 1 liter of water 1 tablespoon of sea salt), while it is important to observe the temperature regime – no more than 36–36.8 degrees. The first 20 days of the bath are done every day, and then – 3 times a week. Patients with the first and second degree of valgus deformity of the big toe are also recommended exercise therapy, special exercises for the foot (elementary walking on toes, on the heels, on the outside and on the inside of the foot), massage.

Surgical treatment

In the third and fourth degree of foot deformity, there is a need for surgical treatment. The choice of surgical correction depends on the severity of the deformity: from operations on soft tissues (mainly on tendons) to operations on bone structures or a combined operation. Whatever technique is chosen, its goal is the most accurate reconstruction of the anatomy of the foot.

Varus deviation of the foot, valgus deviation of the foot, bronation (supination) – the terms are different, the essence of the disease is the same: “bones”. This is a very complex disease that includes many concepts. The foot has 3 sections: anterior, middle and posterior. Deformations can be in any of the departments, and, as a rule, are found in all. Therefore, the foot must be perceived as a whole as a whole. In addition, you must understand that the foot is the support of the body. When the foot is deformed, the load on the knee and hip joints, and on the spine increases.

If you suspect hallux valgus, you should contact an orthopedist as soon as possible, who will diagnose the stage of the disease and, depending on this, prescribe treatment. When a callus appears on the foot, you don’t have to run to the beautician and start cleaning the calluses, but you need to understand the reason for the appearance of these calluses.

Diseases of the musculoskeletal system cannot be cured without surgical intervention, but they can and should be treated. On average, once every six months, you need to come to the orthopedist and check the state of the disease. Physiotherapy is prescribed not for a certain period, but for a lifetime.

The panacea for hallux valgus is surgery. Such operations have been carried out for a long time. There are about 300 varieties of them, but, of course, not all of them are effective and many have a bunch of complications. There are a large number of joints in the foot; during surgery, a change in one ray pulls changes in all other rays (there are 5 in total). Nevertheless, when referring to an adequate specialist – not to a surgeon, but to an orthopedist – you will not only get rid of bumps, but also of flat feet as the main reason for their appearance. Your posture and gait will change.

Science is developing very quickly, and there is no need to be afraid of the operation. Today, immobilization in plaster is not always used; special orthopedic shoes (Baruka boots) are used, which create conditions for walking without load on the forefoot. The recovery period is 6-8 weeks.

Comfortable shoes are the best prevention

If you have calluses and corns, this is the first wake-up call. So, it’s time to take on your wardrobe so that only those shoes that are pleasant and useful for the foot remain in it. To choose one, you must follow certain rules:

Shoes should be wide with rounded toes so as not to impede the normal rolling of the foot while walking.

With or without a heel? Orthopedic doctor about correct shoes and treatment of flat feet

Heels – preferably up to 4 cm . At the same time, shoes without heels can also cause the arches of the foot to droop and disrupt their cushioning function. So find a balance!

The hallmark of a good shoe is arch support for longitudinal flat feet. Thanks to the compensation of this arch, the leg gets tired less.

The problem of transverse arch compensation can be solved by individual orthopedic insoles, which are made according to the cast of the foot.

If you wear individual insoles regularly, calluses will go away, the rate of deterioration will decrease. The service life is about a year, then it is necessary to make new ones.

In the trauma departments of our hospital, surgical treatment is carried out using modern methods: distal osteotomies (shevron osteotomy), diaphyseal osteotomies (scarf osteotomy), proximal osteotomies (Logroscino osteotomy, wedge-shaped osteotomies) and other operations that are selected individually depending on the existing deformity foot and are aimed at maximum correction of changes in the forefoot.

causes of development, diagnosis, treatment – Omega-Kiev reference book

Synovial cyst of the wrist or GI thunder – a benign formation with a gel-like or liquid content. It looks like a round-shaped lump ranging in size from 1-2 to 5-6 cm. At the initial stage, it does not hurt and does not interfere, causing only aesthetic discomfort. As the tumor grows, it can press on numerous nerve fibers in the tissues of the hand, causing pain. Soreness and ugly appearance encourages the patient to get rid of the annoying defect. Why hygroma appears, how to treat it, and in the future to avoid relapse – read about this in our article.

How does hygroma occur?

Synovial fluid, being in the capsule of the joint of the hand, flows from one area to another in case of excessive load. The capsule, stretching, forms a protrusion in the form of a bump. The flow of joint fluid is unidirectional – from the joint into the cavity of the neoplasm. Over time, if you continue to load the arm, the protrusion will grow and may detach from the joint capsule, forming a cyst – a closed cavity. Inside the cyst, the synthesis of synovial fluid continues, which contributes to the further growth of the neoplasm.

Synovial cyst occurrence factors

• Age, sex: young women from 20 to 40 years old are most often affected by the disease.
• Susceptibility to chronic traumatization of the hands (carrying a child in her arms, sports, professional activities).
• Increased elasticity of the connective tissue, excessive joint mobility.
• Heredity: hygromas in close relatives.

Diagnosis of hygroma

An orthopedic surgeon can diagnose hygroma based on the patient’s appearance and complaints. Most often it is a hard and elastic formation, not fixed to the skin, single or multi-chamber, which is easily displaced by 1-3 cm in any direction. Sometimes the hygroma cannot be felt. The movement of the hand, especially in extreme positions, causes pain of a dull and aching nature.

To confirm the diagnosis, instrumental methods are used:

• Ultrasound of the soft tissues of the hand is the most accessible and informative type of diagnosis. Well visualizes the cyst, allows you to determine the homogeneity of its structure, fullness of fluid, the presence of blood vessels in the walls of the tumor.
• Radiography – to exclude osteoarticular pathologies (arthrosis, exostosis).
• MRI – to detect very small hygromas, for differential diagnosis with Kienböck’s disease and in case of suspected oncological nature of the tumor.
• Puncture of a cyst with subsequent analysis of its contents.

Is hygroma dangerous?

Hygroma (if it really is) is not life-threatening, it is a completely benign formation without the risk of rebirth. Malignant tumors with localization on the hand are rare. They are more painful, quickly increase in size and fuse with the skin (the skin can neither be lifted nor moved over the tumor).

Treatment of hygroma

In 40%, the cyst ruptures with the outpouring of its contents into the joint cavity – and the hygroma disappears without any intervention (self-healing). True, cases of its repeated formation (relapse) are not uncommon.

If the bump itself does not resolve, there are three options for treating hygroma:

• Conservative, with the help of medicines (tablets, ointments – anti-inflammatory, analgesic, absorbable), physiotherapy. It is used for small tumors (up to 1-2 cm), not complicated by purulent processes. With the help of non-surgical treatment, you can slow down the growth of hygroma, reduce its size.
• Mechanical crushing (the method is used for small formations). The hygroma is pressed into the joint cavity, the cyst shell bursts, and the contents spread over the surrounding tissues. After the manipulation, anti-inflammatory drugs and wearing an orthosis are prescribed. Among the disadvantages: the procedure is accompanied by rather strong pain, besides, there is a high probability of recurrence – from 20 to 60%, as well as the development of complications in the form of traumatic inflammation, microbes entering tissues, and even sepsis.
• Puncture: the contents of the lump under local anesthesia are pumped out with a syringe, followed by the introduction of medications (hormonal agents, sclerosing drugs, antibiotic solutions). You can also make a simple aspiration of the hygroma, without the introduction of drugs. The recurrence rate is 15-50%.
• Surgery (excision with a scalpel or laser beam) is the most effective way to get rid of the hygroma. During the operation, the hygroma capsule is completely removed along with the contents, and the excised tissues are sent for analysis for histology. Relapses happen, but only in 10-20% of cases.

Prevention

• Exclusion of injury to the wrist and hand.
• Timely treatment of inflammatory processes in the joints (bursitis, tendovaginitis).
• When playing sports: to minimize stress on the hands and wrists, strengthen the muscles of the shoulder girdle and monitor posture during arm exercises. To avoid recurrence after removal of the hygroma, a bandage should be worn for training.