Tendon sheath cysts are the most common soft tissue tumor-like lesions of the hand. The etiology is unclear, but most believe that the disease is associated with deformation of the connective tissue surrounding the joints and tendon sheaths. It is most commonly seen in middle-aged and young adults, and is more common in women.
Clinical manifestations.
I. Site of onset.
1.Radial side of the back of the wrist, between the extensor tendon of the index finger and the extensor tendon of the long thumb, where it is most common.
2, the radial side of the wrist palm, between the radial wrist flexor tendon and the brachioradialis tendon, adjacent to the radial artery.
3.It is in the synovial bursa and originates from the flexor tendon sheath. Located on the metacarpophalangeal joint and the metacarpal tendon sheath of the proximal phalanges of the fingers, generally only the size of rice grains to green beans, hard texture, often considered as osteophytes.
II. Typical symptoms.
Cystic masses appearing in the above-mentioned areas, local pain after exertion, pressure pain, weakness of movement and sometimes numbness. The cyst on the palmar side can cause numbness in the hand by compressing the nerve. Cysts on the flexor tendon sheath of the proximal segment of the finger on the palmar side may cause pressure pain when holding an object.
Diagnosis and Differentiation.
Sometimes it has to be differentiated from tendon sheath giant cell tumor, epidermoid cyst, lipoma, and fibroma.
Treatment.
Tendon sheath cysts are benign masses and sometimes disappear spontaneously; therefore, when symptoms are not obvious, they can be observed.
1. Non-surgical treatment.
Mechanical pressure to break, aspiration of the contents followed by injection of drugs, subcutaneous puncture.
2.Surgical indications.
(1) Large masses causing local pain and discomfort.
(2) If it is located on the palm side of the finger and affects the patient’s ability to hold things.
(3) Those located in special areas causing nerve compression syndrome.
(4) Those who have not healed or recurred with non-surgical treatment.
After surgical removal of the cyst, there is still a recurrence rate of 0.9% and 25%.