Overview
Tendon sheath cyst, also known as “synovial cyst”, is a cystic swelling that occurs near the joint or tendon sheath and contains a thick jelly-like mucus that is colorless and transparent or slightly white and yellowish. The ancient name for the cyst is “wrist tendon tumor”, “wrist tendon knot”, and “tendon gathering”. The site of onset is usually on the back of the wrist. It can occur at any age, but is more common in women than men. In Chinese medicine, it is believed to be caused by trauma to the tendons and membranes, and is caused by poor transportation and fluid accumulation in the bones and meridians. Mostly due to excessive activities of the affected joints, repeated weight-bearing, etc., strain the tendons, resulting in poor flow of Qi and fluid and stagnation of the tendons.
Tendon sheath cysts are hemispherical cystic and elastic masses that occur around the joint or tendon sheath. There are three reasons for the formation of cysts: first, the cystic symptom of the synovial sheath of the joint capsule and extensor tendon protruding outward; second, the mucus-like degeneration of the joint capsule or tendon sheath; third, the cystic degeneration of connective tissue unrelated to the synovial sheath of the joint or tendon, and the outer layer of the cyst is composed of dense fibrous tissue, and the inner layer is covered by a smooth white membrane. Therefore, prolonged and excessive wrist strain is the main cause of the development. Some occupations that require long-term repetitive strain on the joints, such as typists, cargo handling, or industries that require long hours of computer operation, can trigger or aggravate this disease.
Western medicine diagnosis
The growth of cysts is mostly slow, but they are also found suddenly. A few of them can disappear naturally and can grow again later. They are most commonly found on the dorsal side of the wrist, starting from the dorsal side of the navicular and lunate joints of the hand, and located between the thumb extensor and finger extensor tendons; secondly, they are commonly found on the radial side of the palmar surface of the wrist, between the radial wrist flexor tendon and the thumb extensor tendon. It is soft and pushable, with smooth surface, clear border and fluctuating sensation, no obvious conscious symptoms or slight pain; when the bursa is filled with fluid, the wall becomes hard and local pressure is painful. When touching, the subcutaneous is full and has fluctuating cyst-like feeling, accompanied by wrist weakness, discomfort or pain, mostly soreness or radiating pain, and may have certain functional disorders.
Basic treatment
I. Manipulation treatment
For those with thin cyst wall, finger pressure method can be used to break the cyst wall. If the cyst is in the wrist, the wrist should be flexed as much as possible to make the cyst as high and fixed as possible, and the operator should squeeze it with two thumbs and increase the pressure to break the cyst wall, and then use massage to disperse the swelling and activate the blood, so that the fluid inside the cyst can flow out fully and gradually reduce or disappear. After the operation, the local swelling and pain relief cream or Wanying cream can be applied externally to further dissipate and absorb the swelling and exudate.
Acupuncture treatment
The modern acupuncture treatment for this disease was first seen in 1958, when moxibustion with ginger was used to achieve better results. Since the 1980s, there have been many reports on various acupoint stimulation methods for this disease, and on the basis of the inheritance of the previous methods, fire needling, pointer, acupuncture plus jar and acupoint injection have been added. In order to prevent recurrence, local pressure after acupuncture is generally advocated. From the existing experience, acupuncture is indeed one of the better conservative treatments for this disease.
1.Acupuncture method
First, the skin around the cyst is routinely disinfected, and if the cyst is small, it is directly needled; if the cyst is large, a syringe can be used to aspirate the contents of the cyst first and then needled. There are two types of acupuncture methods: ① direct acupuncture, 1 needle in the middle, symmetrically stabbing into the cyst from all around the cyst to the center, using the diarrhea method; ② point acupuncture, 1.5 inch milli-needle with 28 gauge, direct acupuncture against the top of the cyst. After the tip of the needle pierces the wall of the cyst and reaches the middle of the cyst, the needle is punctured back and forth at 45 degrees and 75 degrees respectively, and the depth of the needle is measured by piercing the wall of the cyst around. Retain the needle for 20-30 minutes. After starting the needle, squeeze the cyst forcefully to make it rupture. Some patients use moxa rolls to moxibustion the needle handle, the hotter the better, but to avoid burns; also after starting the needle for rotary moxibustion or use TDP lamp for 15 minutes. After taking the needle, it is appropriate to make local pressure bandage, once a day, 10 times for a course of treatment.
2.Pick treatment method
The patient’s wrist joint is flexed to the palm side first, so that the cyst is exposed obviously, and the operator presses a sterilized cotton ball with the left thumb and index finger to the left and right of the cyst, presses and squeezes it tightly, so that the cyst is fixed, and then fully disinfects it with 2% iodine and 75% alcohol. The right hand holds the sterilized trigeminal needle to puncture the highest point of the cyst quickly, pay attention not to pass through the lower layer of the cyst, then pull out the needle quickly and pinch the cyst with the left hand that pinches the cyst (pulling out the needle and pinching the cyst should be done at the same time), and for larger cysts, squeeze the cyst from around the cyst to the center with both thumbs to make sure that all the gelatinous mucus (transparent burnt material) inside the cyst is discharged from the needle hole. If the cyst site is large and long, the mucus is not discharged and the needle hole is blocked, the sterilized trigeminal needle can be used to stab again at the original needle hole and gently poke several times in the cyst until the mucus is discharged. Then, a cotton pad with a diameter of about 2 cm and a thickness of 5 mm is applied to the wall of the cyst and tied tightly with a bandage (not too tight, so as not to affect local blood circulation), and the patient is instructed not to get wet and not to use excessive wrist force, and the bandage and cotton pad are removed after three days. If there is a recurrence, the same method of treatment can be used.
3.Fire needle method
Use No. 2 fire needle or ordinary small trigeminal needle (can also be replaced by large-headed needle), held with hemostatic forceps, burned red on the alcohol lamp, left thumb and index finger squeeze the cyst, push the contents to one side, avoiding the blood vessels, so that the cyst protrudes. The red-burning needle is aimed at the cyst and quickly stabbed into the deep part (to reach the base of the cyst) and quickly removed, depending on the size of the cyst, 2 to 3 stitches can be stabbed. Then, dry cotton balls in both hands are squeezed around the needle holes to release the gelatinous liquid, squeezed cleanly, wiped dry and disinfected with alcohol cotton balls, and compressed with sterilized dry cotton balls to wrap the area without water for 3 days, and the dressing is removed after 4 days. If 1 time is not healed, can be interval 5 to 7 days and then perform needle 1 time.
4.Acupuncture plus acupoint injection
Firstly, press the local area for 5 minutes to make local flushing and softening of the cyst. Local routine sterilization, with a trigeminal needle in the edge of the cyst equal to the central rapid needle, stab to the center of the cyst that is to withdraw the needle. When withdrawing the needle, use one thumb to press the side opposite to the eye of the needle, squeeze in the direction of the eye of the needle, squeeze while withdrawing the needle, the contents of the cyst will overflow with the needle, until the overflow is exhausted. Then enter the needle from the original eye and inject 12.5-25mg of prednisone and 2ml of 1% lidocaine, and after injecting the liquid, then to the multiple directions
puncture the wall of the capsule. After the needle is removed, slight pressure is applied and pressure bandage is applied. If there is still residual cyst or recurrence after a week, the above method can be repeated.
5.Warm needle plus cupping
The cyst is localized with No. 26 or No. 28 1-inch milli-needle, and one needle is stabbed directly into the cyst and one needle is stabbed into each side. After the needle is burned out, a miniature glass jar is used to suck and cupping for 3 to 5 minutes to extract the yellow mucous-like liquid. If it does not heal once, it should be re-needled at intervals of 2 to 3 days.
Three, drug treatment
External medicine The cyst wall has been broken, the cyst becomes smaller, the local is still more hypertrophic, can be external rubbing fennel wine, saffron oil, etc., so that the lump further dissipation.
IV. Surgical treatment
Cyst removal is a reliable method commonly used, that is, under the use of balloon tourniquet, local infiltration anesthesia is used. A transverse incision slightly longer than the cyst is made along the skin line at the most prominent part of the cyst, and the subcutaneous tissue is separated longitudinally after the skin is cut to reveal the cyst. The cyst is separated along the perimeter of the cyst to the tip, and the cyst is removed completely. If the cyst is connected to the joint, the joint capsule should be closed with fine sutures, and then the two layers of tissue under the fascia should be overlapped and sutured, and the area should be wrapped with slight pressure after surgery.
Prevention
Prevention and care]
Tendon sheath cysts are common in females and adolescents, and are most likely to occur near the joint or tendon sheath, with the highest incidence in the dorsal wrist, the flexor wrist tendon on the palmar side of the wrist and the dorsal foot. Chronic injury increases synovial fluid in the synovial cavity and forms cystic herniation or connective tissue mucosal degeneration is an important cause of morbidity. People who have been dealing with computers for a long time, holding the mouse for too long, or incorrect posture, can lead to injury to the synovial cavity of the hand joint and cause the disease.
Remind everyone not to use the computer for a long time, if you need to surf the Internet for a long time, you should also take a break every hour for 5 to 10 minutes, and do indoor exercises, soft exercises or local massage, stretching and muscle training for the shoulders and neck, upper limbs and wrists to increase flexibility and muscle strength.