Ganglion disease. What is a ganglion? Ganglia – reflex centers

GANGLIA (ganglia nerve ganglia) - clusters of nerve cells surrounded by connective tissue and glial cells, located along the course of peripheral nerves.

G. is distinguished between the autonomic and somatic nervous systems. The cells of the autonomic nervous system are divided into sympathetic and parasympathetic and contain the bodies of postganglionic neurons. The glands of the somatic nervous system are represented by the spinal ganglia and the glands of the sensory and mixed cranial nerves, which contain the bodies of sensory neurons and give rise to the sensitive portions of the spinal and cranial nerves.

Embryology

The rudiment of the spinal and vegetative nodes is the ganglion plate. It is formed in the embryo in those parts of the neural tube that border the ectoderm. In the human embryo, on the 14-16th day of development, the ganglion plate is located along the dorsal surface of the closed neural tube. Then it splits along its entire length, both halves move ventrally and, in the form of neural folds, lie between the neural tube and the superficial ectoderm. Subsequently, according to the segments of the dorsal side of the embryo, foci of proliferation of cellular elements appear in the neural folds; these areas thicken, become isolated and turn into spinal nodes. Sensitive ganglia of the U, VII-X pairs of cranial nerves, similar to the spinal ganglia, also develop from the ganglion plate. The germinal nerve cells, neuroblasts that form the spinal ganglia, are bipolar cells, that is, they have two processes extending from opposite poles of the cell. The bipolar form of sensory neurons in adult mammals and humans is preserved only in the sensory cells of the vestibulocochlear nerve, vestibular and spiral ganglia. In the rest, both spinal and cranial sensory nodes, the processes of bipolar nerve cells in the process of their growth and development come closer and merge in most cases into one common process (processus communis). On this basis, sensitive neurocytes (neurons) are called pseudounipolar (neurocytus pseudounipolaris), less often protoneurons, emphasizing the antiquity of their origin. Spinal nodes and nodes c. n. With. differ in the nature of the development and structure of neurons. Development and morphology of the autonomic ganglia - see Autonomic nervous system.

Anatomy

Basic information about G.'s anatomy is given in the table.

Histology

The spinal ganglia are covered on the outside with a connective tissue membrane, which passes into the membrane of the dorsal roots. The stroma of the nodes is formed by connective tissue with blood and lymph vessels. Each nerve cell (neurocytus ganglii spinalis) is separated from the surrounding connective tissue by a capsule shell; Much less often, one capsule contains a colony of nerve cells tightly adjacent to each other. The outer layer of the capsule is formed by fibrous connective tissue containing reticulin and precollagen fibers. The inner surface of the capsule is lined with flat endothelial cells. Between the capsule and the body of the nerve cell there are small stellate or spindle-shaped cellular elements called gliocytes (gliocytus ganglii spinalis) or satellites, trabants, mantle cells. They are elements of neuroglia, similar to lemmocytes (Schwann cells) of peripheral nerves or oligodendrogliocytes c. n. With. A common process extends from the mature cell body, starting with an axon tubercle (colliculus axonis); then it forms several curls (glomerulus processus subcapsularis), located near the cell body under the capsule and called the initial glomerulus. In different neurons (large, medium and small), the glomerulus has different structural complexity, expressed in an unequal number of curls. Upon exiting the capsule, the axon is covered with a pulpy membrane and, at a certain distance from the cell body, divides into two branches, forming a T- or Y-shaped figure at the site of division. One of these branches leaves the peripheral nerve and is a sensory fiber that forms a receptor in the corresponding organ, while the other enters through the dorsal root into the spinal cord. The body of the sensory neuron - the pyrenophore (part of the cytoplasm containing the nucleus) - has a spherical, oval or pear-shaped shape. There are large neurons ranging in size from 52 to 110 nm, medium ones - from 32 to 50 nm, small ones - from 12 to 30 nm. Medium-sized neurons make up 40-45% of all cells, small ones - 35-40%, and large ones - 15-20%. Neurons in the ganglia of different spinal nerves vary in size. Thus, in the cervical and lumbar nodes the neurons are larger than in others. There is an opinion that the size of the cell body depends on the length of the peripheral process and the area of ​​the area innervated by it; There is also a certain correspondence between the size of the body surface of animals and the size of sensory neurons. For example, among fish, the largest neurons were found in the sunfish (Mola mola), which has a large body surface. In addition, atypical neurons are found in the spinal ganglia of humans and mammals. These include “fenestrate” cells of Cajal, characterized by the presence of loop-like structures on the periphery of the cell body and axon (Fig. 1), in the loops of which there is always a significant number of satellites; “hairy” cells [S. Ramon y Cajal, de Castro (F. de Castro), etc.], equipped with additional short processes extending from the cell body and ending under the capsule; cells with long processes equipped with flask-shaped thickenings. The listed forms of neurons and their numerous varieties are not typical for healthy young people.

Age and previous diseases affect the structure of the spinal ganglia - a significantly larger number of different atypical neurons appear in them than in healthy ones, especially with additional processes equipped with flask-shaped thickenings, as, for example, in rheumatic heart disease (Fig. 2), angina pectoris, etc. Clinical observations, as well as experimental studies on animals, have shown that sensory neurons of the spinal nodes respond much faster with intensive growth of additional processes to various endogenous and exogenous harms than motor somatic or autonomic neurons. This ability of sensory neurons is sometimes significantly expressed. In cases of hron, irritation, the newly formed processes can wrap around (in the form of a winding) around the body of its own or neighboring neuron, resembling a cocoon. Sensory neurons of the spinal ganglia, like other types of nerve cells, have a nucleus, various organelles and inclusions in the cytoplasm (see Nerve cell). Thus, a distinctive property of sensory neurons of the spinal and cranial nerve nodes is their bright morphology, reactivity, expressed in the variability of their structural components. This is ensured by a high level of synthesis of proteins and various active substances and indicates their functional mobility.

Physiology

In physiology, the term “ganglia” is used to designate several types of functionally different nerve formations.

In invertebrates, g. play the same role as c. n. With. in vertebrates, being the highest centers for coordination of somatic and autonomic functions. In the evolutionary series from worms to cephalopods and arthropods, glands that process all information about the state of the environment and internal environment reach a high degree of organization. This circumstance, as well as the simplicity of anatomical preparation, the relatively large size of nerve cell bodies, and the possibility of introducing several microelectrodes simultaneously into the soma of neurons under direct visual control have made G. invertebrates a common object of neurophysiological experiments. On neurons of roundworms, octapods, decapods, gastropods and cephalopods, studies of the mechanisms of potential generation and the process of synaptic transmission of excitation and inhibition are carried out using electrophoresis, direct measurement of ion activity and voltage clamping, which is often impossible to do on most mammalian neurons. Despite the evolutionary differences, the basic electrophysiol, constants and neurophysiol, the mechanisms of neuronal operation are largely the same in invertebrates and higher vertebrates. Therefore, studies of G. and invertebrates have general physiology. meaning.

In vertebrates, somatosensory cranial and spinal glands are functionally the same type. They contain the bodies and proximal parts of the processes of afferent neurons that transmit impulses from peripheral receptors to the central nervous system. n. With. In somatosensory neurons there are no synaptic switches, efferent neurons or fibers. Thus, the neurons of the spinal cord in the toad are characterized by the following basic electrophysiological parameters: specific resistance - 2.25 kOhm/cm 2 for depolarizing and 4.03 kOhm/cm 2 for hyperpolarizing current and specific capacitance 1.07 μF/cm 2 . The total input resistance of somatosensory neurons is significantly lower than the corresponding parameter of the axons; therefore, with high-frequency afferent impulses (up to 100 impulses per second), the conduction of excitation can be blocked at the level of the cell body. In this case, action potentials, although not recorded from the cell body, continue to be conducted from the peripheral nerve to the dorsal root and persist even after extirpation of the nerve cell bodies, provided that the T-shaped axonal branches are intact. Consequently, excitation of the soma of somatosensory neurons is not necessary for the transmission of impulses from peripheral receptors to the spinal cord. This feature first appears in the evolutionary series in tailless amphibians.

In functional terms, the vegetative glands of vertebrates are usually divided into sympathetic and parasympathetic. In all autonomic neurons, synaptic switching occurs from preganglionic fibers to postganglionic neurons. In the vast majority of cases, synaptic transmission is carried out chemically. by using acetylcholine (see Mediators). In the parasympathetic ciliary gland of birds, electrical transmission of impulses has been discovered using the so-called. connection potentials, or communication potentials. Electrical transmission of excitation through the same synapse is possible in two directions; in the process of ontogenesis, it is formed later than the chemical one. The functional significance of the electrical transmission is not yet clear. In sympathetic G. amphibians, a small number of synapses with chemicals have been identified. transmission of noncholinergic nature. In response to a strong single stimulation of the preganglionic fibers of the sympathetic nerve, an early negative wave (O-wave) primarily appears in the postganglionic nerve, caused by excitatory postsynaptic potentials (EPSPs) upon activation of n-cholinergic receptors of postganglionic neurons. The inhibitory postsynaptic potential (IPSP), which arises in postganglionic neurons under the influence of catecholamines secreted by chromaffin cells in response to the activation of their m-cholinergic receptors, forms a positive wave (P-wave) following the 0-wave. The late negative wave (LP wave) reflects the EPSP of postganglionic neurons upon activation of their m-cholinergic receptors. The process is completed by a long late negative wave (LNE wave), which arises as a result of the summation of EPSPs of a noncholinergic nature in postganglionic neurons. Under normal conditions, at the height of the O-wave, when the EPSP reaches a value of 8-25 mV, a propagating excitation potential appears with an amplitude of 55-96 mV, a duration of 1.5-3.0 ms, accompanied by a wave of trace hyperpolarization. The latter significantly masks waves P and PO. At the height of trace hyperpolarization, excitability decreases (refractory period), so usually the frequency of discharges of postganglionic neurons does not exceed 20-30 impulses per 1 second. According to basic electrophysiol. the characteristics of vegetative neurons are identical to most neurons of c. n. With. Neurophysiol. A feature of autonomic neurons is the absence of true spontaneous activity during deafferentation. Among the pre- and postganglionic neurons, neurons of groups B and C predominate according to the Gasser-Erlanger classification, based on electrophysiological characteristics of nerve fibers (see. ). Preganglionic fibers branch extensively, so stimulation of one preganglionic branch leads to the appearance of EPSPs in many neurons of several neurons (multiplication phenomenon). In turn, each postganglionic neuron ends with the terminals of many preganglionic neurons, differing in the threshold of stimulation and conduction speed (convergence phenomenon). Conventionally, a measure of convergence can be considered the ratio of the number of postganglionic neurons to the number of preganglionic nerve fibers. In all vegetative G. it is greater than one (with the exception of the ciliary ganglion of birds). In the evolutionary series, this ratio increases, reaching a value of 100:1 in human sympathetic genes. Animation and convergence, which provide spatial summation of nerve impulses, in combination with temporal summation, are the basis of the integrating function of G. in the processing of centrifugal and peripheral impulses. Afferent pathways pass through all vegetative G., the bodies of neurons of which lie in the spinal G. For the inferior mesenteric G., the celiac plexus, and some intramural parasympathetic G., the existence of true peripheral reflexes has been proven. Afferent fibers that conduct excitation at a low speed (approx. 0.3 m/sec) enter the nerve as part of the postganglionic nerves and end on postganglionic neurons. In vegetative G. the endings of afferent fibers are found. The latter inform the c. n. With. about what is happening in G. functional-chemical. changes.

Pathology

In wedges, practice, ganglionitis (see), also called sympatho-ganglionitis, is the most common disease associated with damage to the ganglia of the sympathetic trunk. The defeat of several nodes is defined as polyganglionitis, or truncite (see).

The spinal ganglia are often involved in the pathological process in radiculitis (see).

Brief anatomical characteristics of the nerve ganglia (nodes)

Bibliography Brodsky V. Ya. Cell trophism, M., 1966, bibliogr.; Dogel A. S. Structure of spinal nodes and cells in mammals, Notes of the imp. Academician Sciences, vol. 5, no. 4, p. 1, 1897; Milokhin A. A. Sensitive innervation of autonomic neurons, new ideas about the structural organization of the autonomic ganglion, L., 1967; bibliography; Roskin G.I., Zhirnova A.A. and Shornikova M.V. Comparative histochemistry of sensory cells of the spinal ganglia and motor cells of the spinal cord, Dokl. USSR Academy of Sciences, new, ser., vol. 96, JSfc 4, p. 821, 1953; Skok V.I. Physiology of the autonomic ganglia, L., 1970, bibliogr.; Sokolov B. M. General gangliology, Perm, 1943, bibliogr.; Yarygin H. E. and Yarygin V. N. Pathological and adaptive changes in the neuron, M., 1973; de Castro F. Sensory ganglia of the cranial and spinal nerves, normal and pathological, in the book: Cytol a. cell. path, of the nervous system, ed. by W. Penfield, v. 1, p. 91, N.Y., 1932, bibliogr.; Clara M. Das Nervensystem des Menschen, Lpz., 1959.

E. A. Vorobyova, E. P. Kononova; A. V. Kibyakov, V. N. Uranov (physics), E. K. Plechkova (embr., hist.).

A tendon ganglion is a benign neoplasm that occurs in the articular area or tendon sheaths. In medical language, this disease is called hygroma or degenerative synovial cyst. The tendon ganglion is mainly located on the back of the hand, on the knee joint or near the finger joint. The good news is that such a pathology never develops into a malignant tumor.

The cause of hygroma is similar to the formation of tumors in general. The tendon sheath is a kind of isolated cavity filled with fluid. In normal condition, this one presses on the walls with some force. But with a significant load on the joint, the size of the joint cavity decreases significantly, while the fluid remains in the same amount. As a result of such a destructive process, the wall of the tendon sheath is damaged and fluid flows out. As a result, a small bubble filled with liquid is formed.

A similar pathology can occur due to strong sudden movement; athletes are often susceptible to this. However, tendon ganglion also occurs as a result of constant monotonous load on the joint. For example, pianists, laundresses, seamstresses will be at risk. Constant use of a computer mouse leads to the formation of a ganglion of the wrist joint. The occurrence of hygroma near other joints is facilitated by wearing tight, uncomfortable shoes and hereditary connective tissue diseases. Quite often, patients self-medicate pathologies such as arthrosis or arthritis. These actions can lead to the formation of a ganglion.

Symptoms

This disease usually does not cause obvious pain. But still, patients can easily diagnose tendon ganglion on their own based on a number of characteristic signs:

• to the touch the ganglion feels like a round soft formation with clear boundaries;
• the skin at the site of ganglion formation may peel off;
• with active load on the joint, aching pain may occur;
• As the lump grows, the vessels become pinched, which leads to pain.

Although tendon ganglion itself is not dangerous, it can cause more serious health problems. For example, in advanced forms of the disease, compression of blood vessels occurs, leading to stagnation of venous blood. Therefore, it is extremely important to diagnose the disease in time and begin treatment.

Types of disease

The tendon ganglion always contains a multilayer capsule consisting of connective tissue. The capsule cavity is filled with synovial fluid.

Based on their structure, the following types of tendon ganglion are distinguished:

• Isolated hygroma. The neoplasm is located in a confined space, separate from the maternal shell, connected by the base of the capsule.
• Anastomosis. The fluid has the ability to overflow from the hygroma into the joint or tendon sheath.
• Valve. A valve is formed from the joint to the cavity with fluid, which prevents.

Depending on the location of the tumor, there are:

• hygroma of the wrist joint;
• tendon ganglion of the foot;
• popliteal hygroma;
• tumor on the finger.

According to the structure of the ganglion:

• single-chamber;
• multi-chamber.

Sometimes a ganglion appears on the sole of the foot due to wearing tight shoes or even being overweight. In such situations, patients quite often confuse the ganglion with another disease called bursitis. But it should be borne in mind that bursitis does not form under the influence of external signs, it is a serious pathology of the joint capsule that occurs due to inflammation inside it; there is an infection in the body. Therefore, before starting any treatment, it is necessary to diagnose the disease.

Diagnostics

If you notice a lump or swelling near a joint, you should consult your doctor. If upon examination and palpation of the formation the diagnosis remains unspecified, then additional tests and studies are prescribed. During the analysis, fluid is taken from the cyst for a sample. Also, the tendon ganglion is successfully detected by diagnostic methods: MRI and ultrasound.

Treatment methods

In some cases, when the patient stops loading the joint, the hygroma may disappear on its own. But if a person is bothered by pain in the area of ​​the lump, or there is limited movement of the joint, he needs to consult a specialist to prescribe effective therapy. Also, the tendon ganglion often looks unaesthetic, which also motivates patients to seek help from a doctor.

Treatment involves removing the fluid that caused the tumor to form.

Conservative

This type of treatment is carried out on an outpatient basis, without special preparation on the part of the patient. It should be noted that with such treatment there is a high probability of a relapse of the disease.

Types of conservative treatment:

• By crushing. An extremely painful and ineffective procedure. It involves pressing on the lump, while the contents remain under the skin. This technique is considered outdated and is practically not used.
• Puncture. The liquid is pumped out from the tendon ganglion, then the cleaned cavity is filled with a drug to glue the walls of the ganglion capsule. Next, the diseased area is fixed with a bandage and plaster to immobilize the limb for a period of 1 week.

Surgical

If conservative methods of therapy are ineffective, doctors resort to surgical interventions, which boil down to removing the tendon ganglion.

Surgical treatment is performed under general or local anesthesia. After the procedure is completed, the limb is firmly fixed to limit movement in the joint. The patient is advised to remain absolutely at rest to reduce the formation of synovial fluid.

Surgical treatment methods:

• Bursectomy is a surgical operation to remove the tendon ganglion with a scalpel;
• laser excision of the ganglion.

Folk remedies

If you do not want to undergo surgery, you can use traditional medicine, which is also represented by a huge selection of treatment methods at home.

Treatment of tendon ganglion with folk remedies will look like this:

• Using a cabbage leaf. Attach 2-3 clean cabbage leaves to the affected area for several hours.
• With the help of celandine. Squeeze the juice from the celandine herb, strain, and apply a bandage moistened with the juice to the seal. Wrap the top with a plastic bag and a warm towel.
• Using hot baths with sea salt solution. Immerse your hands or feet in the bath for half an hour. Then lubricate the swollen area with honey and wrap it with a warm towel. Repeat the procedure every day before bed until the hygroma resolves.
• Alcohol compress. The cotton wool is moistened with medical alcohol and applied to the sore area, wrapped in a plastic bag on top. The procedure lasts several hours.
• Compress made of honey and aloe. Prepare a paste of honey, aloe pulp and rye flour. Apply the resulting mixture to the site of the tumor overnight, wrap it in a plastic bag and insulate it.
• Blue clay compress. Mix blue clay with water, form a cake and apply to the sore spot for 3 hours. Wrap the top with plastic wrap.
• Wormwood juice. Crush fresh wormwood until juice forms. Apply the resulting juice to the sore spot and leave overnight.

It is important to remember that when self-medicating, you should never puncture a hygroma yourself. This is fraught with infection in the blood and subsequent sepsis.

The ganglion in most cases (50-70%) is the cause of soft tissue swelling in the hand and wrist area. They can appear throughout life. There are two types of the disease.

The first type occurs in young people, usually between the ages of 20 and 40. There is no association with osteoarthritis, but they may be associated with general joint laxity.

The second type occurs after age fifty and usually appears in the context of existing osteoarthritis.

Ganglia may appear suddenly, but usually develop gradually. They are fixed to the underlying joint or tendon sheath. Only in some cases is a causal relationship with injury identified (for example, forced flexion of the wrist), indicating a traumatic origin.

Pathology

Ganglia can be single or multi-chambered with walls containing collagen. They do not have an epithelial or synovial lining. The pedicle contains several clefts, which represent a tortuous duct connecting the cyst to the underlying joint. Histological examination does not reveal any inflammatory reaction. The cyst contains an extremely viscous gel-like mucin containing glucose-min, proteins and hyaluronic acid. The pathogenesis is unclear, but there appears to be a “microscopic bulging” of mucin-producing cells through the fibers of the joint capsule, with the formation of ducts and mucin aggregates visible on histological sections of the pedicle. When they merge, they form a noticeable subcutaneous cyst.

Carpal ganglion

Rear

The most common localization of the ganglion (two thirds of all ganglia of the wrist). Typically arises from the capsule above the scapholunate ligament and lunatecapitate ligament.

Hidden ganglion

This is a small ganglion, non-palpable or palpable only with extreme flexion of the wrist. Complaints of local pain, especially with forced extension with a load; On examination, local tenderness is revealed over the area of ​​fusion of the scaphoid lunate and capitate bones. Differential diagnosis is made with dorsal synovial impingement, with similar symptoms.

Dorsal synovitis

Patients with arthrosis of the radioscaphoid joint, usually men over 60 years of age, experience diffuse swelling along the dorsal radial surface of the joint. This is not a ganglion, but a thickening of the synovial membrane associated with arthrosis. A confirming sign is painful limitation of radial deviation and palmar flexion. For diagnosis, radiography is performed.

Tenosynovitis

Synovitis in the extensor carpi radialis brevis and longus tendons or extensor digitorum communis tendons may mimic a ganglion. A thorough examination will reveal pathology.

Extensor tendon ganglion

Fixed to the extensor tendon, small and dense, moves with the tendon.

Palmar

One third of the carpal ganglia are palmar. They can originate from the radiocarpal or scaphotrapezius-trapezius joint, sometimes from the pisiform-triquetral joint. Possible proximity to the branches of the radial artery and accompanying veins or to the sheath of the flexor radialis, which complicates surgical isolation.

Diagnosis of ganglion

Clinical

The diagnosis can usually be made by examining and palpating the cyst. In case of doubt, transillumination will help (light the wrist area with a flashlight in a dark room). The ganglion gel allows light to pass through, unlike solid tissue formation.

Visualization

• Ultrasound: specific for differentiating a solid mass from a fluid-containing cyst.
• MRI: very sensitive. An asymptomatic small ganglion is often visible. As always, MRI findings should be consistent with the clinical picture.

Rare diseases for which differential diagnosis of carpal ganglion is carried out

• Inflammation (rheumatoid nodules, gouty tophi)
• Infection (bacterial, fungal)
• Neoplasms (soft tissue and bone)
• Vascular malformations (aneurysm, arteriovenous malformations)
• Muscle abnormalities

Treatment of carpal ganglion

Unless clearly indicated, treatment is not required. In most cases, the ganglion disappears over time. The following treatments have been used with varying results.

Large needle aspiration

In some cases it is successful. The volume of aspirated material is usually replenished within a few days. However, demonstrating that the tumor has subsided can sometimes have a therapeutic effect, eliminating the fear of cancer.

Aspiration + injection

Various agents, including steroids, hyaluronidase, and sclerosing agents, have been used with moderate success. Recurrence usually occurs, and infection can be a rare but dangerous complication.

Operation

This is the only adequate treatment method. For dorsal ganglion, removal can be done openly or arthroscopically. It is important to follow the ganglion pedicle to the joint and excise the joint capsule sleeve around the pedicle.

Surgical technique for dorsal ganglion

The ganglion is accessed through a transverse incision along a skin fold. The dorsal retinaculum extensor ligament is incised and the tendons are pulled apart. The ganglion is bluntly isolated, freed from surrounding tissues, and the pedicle is traced to the joint capsule. It is necessary to excise the joint capsule sleeve around the ganglion stalk to reduce the risk of recurrence. The capsule is left unsutured. It is important to guide the scalpel blade in a plane above the scapholunate ligament (i.e., tangent to it) to ensure that the integrity of the ligament is not compromised. The accompanying ganglia are also excised.

Other types of ganglia

Flexor tendon sheath ganglion (vesicle ganglion)

The third most common ganglion in the hand and wrist. Originates from a weak spot between the annular ligaments A1 and A2. Painful when grabbed.

Diagnostics: a dense and painful formation is palpated, which does not move when the finger is flexed/extended.

Treatment: Needle aspiration helps in 50-60% of cases. In case of relapse - surgical treatment.

Surgical treatment of vesicular ganglion

The A1 annular ligament is accessed through an oblique or volar incision according to the Bruner type. The neurovascular bundles are retracted. The ganglion is removed, including a strip of surrounding intact tissue (ligaments). The integrity of the A2 ligament must be preserved.

Mucous cyst (nail bed cyst) (distal interphalangeal joint)

Typical for the older age group. Early manifestations include striation of the nail plate due to pressure on the germinal matrix. Later, the cyst weakens the overlying tissue and may rupture and drain - the opened cyst is susceptible to infection, which can spread to the distal interphalangeal joint. Haberden tubercles are often present. If necessary, the cyst is excised.

Technique for surgical treatment of mucosal cyst

Access to the cyst in its relatively proximal position is made through a Y-shaped incision along the lateral surface of the distal interphalangeal joint. When the cyst is localized under the nail fold, a longitudinal incision is made on it with the nail fold moved to the side. The cyst is traced to its base, usually a small osteophyte at the dorsal angle of the distal interphalangeal joint. The acute osteophyte and cyst capsule are excised to reduce the likelihood of recurrence. If the condition of the skin is poor, plastic surgery with a displaced flap may be required.

Ganglion associated with the carpometacarpal joints (carpal prominence)

A ganglion may appear with periarticular osteochondroma of the carpometacarpal joint. If surgical treatment is resorted to, it should be excised along with the underlying osteochondoma (exostosis).

Proximal interphalangeal joint/extensor tendon

The ganglion may appear on the extensor tendon, as well as in the area of ​​the distal interphalangeal joint. Treatment can be by aspiration or excision to remove part of the dorsal capsule of the joint.

First dorsal carpal tunnel

A ganglion may arise on the surface of the first dorsal carpal tunnel, usually in patients with de Quervain's disease. Upon examination, a dense, painful, immobile formation is palpated. Injection of steroids under the ligament in the area of ​​the first canal can have a therapeutic effect on de Quervain's disease and ganglion. In chronic cases, dissection of the dorsal carpal ligament in the area of ​​the first canal and excision of the ganglion are required.

Ulnar (Guyon) canal

The ganglion arises from the pisiform-triquetral or triquetral-uncinate joint. May manifest as low ulnar nerve palsy (see Chapter 11). The diagnosis is confirmed by ultrasound or MRI. Treatment: opening of the Guyon canal and excision of the ganglion.

Ganglion I Ganglion (Greek ganglion, tumor-like formation)

cystic formation in tissues adjacent to tendon sheaths, articular capsules, less often to the periosteum or nerve trunks. G.'s occurrence is associated with constant mechanical irritation. As a professional, G. is found among pianists, typists, and laundresses. Most often, G. is formed in the area of ​​the rear of the wrist joint. Less commonly, it occurs on the palmar surface of the hand, the inner surface of the forearm, in the area of ​​the ankle and knee joints, etc.

The ganglion can be single-chambered or multi-chambered. Contains gelatinous liquid with a large amount of mucin. dense, slightly elastic, with developed fibrous fibers. Multichamber G. have lateral branches that spread into the perisynovial tissue. Often G.'s cavity communicates with the cavity of the tendon sheath or joint.

Characterized by aching pain in the G. area, which intensifies with physical activity. Upon examination, a round tumor-like formation measuring 0.5 to 5-6 is detected cm in diameter. On palpation, it has a dense consistency, slightly painful or painless, and sometimes fluctuates. G.'s contours are clear, mobility is weak. The surrounding tissues are without signs of inflammation, the G. is not changed. the joint is not broken. G.'s increase occurs slowly and is not accompanied by a deterioration in the general condition or dysfunction of the limb. ganglion inflammation is observed very rarely.

To clarify the diagnosis, sometimes they resort to G.'s puncture, during which the gelatinous fluid is evacuated. In a number of patients, G. can be eliminated by several sequential punctures with evacuation of the contents and tight bandaging or the introduction of sclerosing substances into the G.’s cavity. Radical cure occurs with complete excision of the ganglion. In the postoperative period, the limb is immobilized with a plaster splint for 2-3 weeks. favorable.