1. Tendon sheath cyst is a cyst formed by mucinous degeneration of connective tissue of hand-foot joint or tendon sheath.
The etiology is unknown, which may be related to trauma and chronic strain. Clinically, it can be divided into single room type and multi-room type. Single room type is the most common, and a few are multi-room type. The outer wall of the capsule is composed of dense fibrous tissue, and the inner wall is composed of synovial cells to form a smooth white membrane. The capsule is colorless and transparent colloidal mucus, and it is still controversial whether it communicates with the joint cavity or synovial cavity of tendon sheath.
Tendon sheath cysts are more common in young and middle-aged women, mainly in the dorsum of wrist and foot, as well as tendons and aponeurosis near knee joint and elbow joint. The main symptom is a lump with little pain. Tumors grow slowly, are round, have different sizes, generally less than 2cm, are soft, have a smooth surface, do not adhere to the skin, and have a fixed base. When the cyst occurs in carpal tunnel or thenar, it can compress the median nerve or ulnar nerve, causing sensory disturbance or muscle atrophy. If the cyst occurs on the back of the wrist, bend the wrist to the palm, the mass will be more prominent, the tension will increase, and there may be pain locally; On the contrary, when the wrist joint is extended backward, the tension of the mass decreases and the fluctuation can be touched.
A few cysts can disappear on their own, and most cysts persist or enlarge and need treatment. Small cysts can be squeezed by fingers to make them rupture and absorb; Or inject hyaluronidase or hydrocortisone into the capsule after pumping the liquid with a thick needle, and then press and wrap it. The curative effect is good, but sometimes it is easy to relapse. Cystectomy is feasible for large cysts, symptomatic cysts, or cysts that recur after finger squeezing after conservative treatment is ineffective. During the operation, the whole cyst should be removed together with the surrounding normal tendon sheath and aponeurosis to avoid recurrence.
2. Each hand has 28 bones, 24 long tendons from the forearm, and 18 small muscles in the hand, which are connected into a whole by ligaments, joints and skin. Some tendons in the hand are covered with a layer of fibrous tissue called tendon sheath. It has the function of maintaining normal finger flexion and extension and tendon sliding. When the hand is fixed in a certain position and repeatedly moves excessively, friction often occurs between tendon and tendon sheath, resulting in edema and fibrosis, causing lumen stenosis. Because the tendon moves in the tendon sheath, its path is narrow, which leads to pain and dyskinesia. This is tenosynovitis, also known as stenosing tenosynovitis.
Tenosynovitis is a common disease. The common tendon sheath of extensor pollicis longus and extensor pollicis brevis and the tendon sheath of flexor pollicis longus of the first metacarpal are most common among female workers, packers and bookbinding workers in cigarette factories. Sewing workers, calligraphers, housewives, painters, etc. There are two common tenosynovitis.
(1) The onset of stenosing tenosynovitis of styloid process of radius is slow, and it is getting worse gradually. It is characterized by pain of the bony process (styloid process of radius) on one side of wrist and around thumb, obstruction of thumb movement, tenderness and friction of styloid process of radius, and sometimes there are slight pea-sized nodules on styloid process of radius. If you hold your thumb tightly with the other four fingers and bend your wrist to the inside of your wrist (ulnar side), severe pain will occur at the styloid process of the radius. There may be swelling locally in the acute stage. When the swollen tendon passes through the narrow tendon sheath, the thumb will make a noise when it flexes, which is also called "snapping fingers".
(2) Tenosynovitis of flexor tendon mostly occurs in thumb and middle finger. Finger flexion and extension dysfunction is particularly obvious when you wake up in the morning, and it can be alleviated or disappeared after the activity. Pain sometimes radiates to the wrist. The flexion of metacarpophalangeal joints may be tender, and sometimes thickened tendon sheaths and pea-sized nodules may be touched. When bending the affected finger, it suddenly stays in the semi-bending position, and the finger can neither be straightened nor bent, which is as unbearable as being suddenly "stuck". After being pulled with the other hand, the finger can move again, producing action and snapping sound similar to the trigger of a gun, so it is also called "trigger finger" or "snapping finger".
The treatment of tenosynovitis includes: reducing finger movement early to make the local rest; Massage and acupuncture have certain curative effects; Injecting hydrocortisone acetate, triamcinolone acetonide acetate or prednisolone acetate (0.25 ml) into the tendon sheath for local blocking has a good effect. For the authors with a long course of disease and recurrent diseases, the narrow tendon sheath can be cut in parallel and partially removed, so that the tendon sheath will no longer squeeze the tendon, which can achieve the goal of radical cure.
But after the final diagnosis, I still have to go to a regular hospital to avoid delaying my illness. I wish you a speedy recovery.