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Removal of Swellings of Hand

Removal of Swellings of Hand

The human hand is a complex structure made up of bones, joints, tendons, ligaments, nerves, and blood vessels. Because of its constant use in daily activities and its intricate anatomy, the hand is prone to developing swellings. These swellings can arise from a wide range of causes including benign tumors, cysts, infections, inflammatory conditions, or traumatic injuries. While some swellings may be harmless and only require observation, others may cause pain, deformity, restricted movement, or cosmetic concerns, making surgical removal necessary.

Causes of Hand Swellings

Hand swellings may result from different underlying conditions, such as:

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1. Ganglion Cysts:

  • The most common swellings of the hand.
  • Fluid-filled sacs arising from joints or tendon sheaths.
  • Usually appear on the back of the wrist, palm, or around finger joints.

2. Giant Cell Tumor of Tendon Sheath (GCTTS):

  • A benign solid tumor arising from the tendon sheath.
  • Firm, slow-growing, and often painless.

3. Epidermoid Inclusion Cysts:

  • Result from implantation of skin cells into deeper tissues, often after injury.
  • Appear as small, round lumps under the skin.

4. Lipomas:

  • Benign tumors made of fatty tissue.
  • Soft, mobile, and usually painless.

5. Infective Swellings (Abscesses):

  • Caused by bacterial infection.
  • Painful, red, swollen, and may discharge pus.

6. Other Rare Causes:

  • Vascular malformations, nerve sheath tumors (schwannomas), or bony swellings like exostosis.

Indications for Surgical Removal

Not all hand swellings require surgery. Some may be observed if they are small, painless, and not interfering with hand function. However, surgical removal of hand swellings is recommended when:

  • The swelling causes pain or discomfort.
  • There is restriction of finger or wrist movement.
  • The lump is rapidly growing or suspicious for malignancy.
  • Recurrent infections are present (as in abscesses or infected cysts).
  • Cosmetic concerns affect the patient’s confidence.
  • Diagnostic uncertainty exists and a biopsy is required.

Preoperative Evaluation

Before removal, the swelling is carefully examined by a hand surgeon. The evaluation usually includes:

  • Clinical Examination: Location, size, mobility, tenderness, consistency, and relationship with surrounding structures.
  • X-rays for bony swellings.
  • Ultrasound for cysts and soft tissue lumps.
  • MRI for deep or complex swellings to see involvement of tendons, vessels, or nerves.
  • Blood Tests: If infection is suspected.
  • Fine Needle Aspiration / Biopsy: In select cases, to confirm the diagnosis.

Surgical Techniques

The method of removal depends on the type and location of the swelling:

1. Ganglion Cyst Removal (Excision):

  • Performed under local or regional anesthesia.
  • The cyst is carefully dissected and removed along with its stalk to reduce recurrence risk.
  • Can be done as an open procedure or minimally invasive arthroscopic surgery.

2. Excision of Solid Tumors (GCTTS, Lipoma, Epidermoid Cyst):

  • Requires precise dissection to remove the swelling completely.
  • Care is taken to protect nerves, blood vessels, and tendons.
  • Tumor is sent for histopathology to confirm the diagnosis.

3. Abscess Drainage:

  • An incision is made to release pus and relieve pain.
  • The cavity is cleaned and sometimes left open with a dressing to allow drainage.
  • Antibiotics are prescribed to control infection.

4. Removal of Rare Lesions:

  • Vascular swellings may require ligation or laser treatment.
  • Nerve-related tumors are excised with meticulous care to preserve nerve function.

Postoperative Care

Recovery after hand swelling removal depends on the type of swelling and surgical method. General care includes:

  • Wound Care: Keep the dressing dry and clean. Stitches are removed after 7–14 days.
  • Pain Management: Painkillers and anti-inflammatory medicines are given.
  • Antibiotics: If infection was present or suspected.
  • Physiotherapy: Gentle exercises to prevent stiffness and restore full range of motion.
  • Follow-up Visits: To check healing and review biopsy reports if needed.

Risks and Complications

Although removal of hand swellings is generally safe, possible risks include:

  • Infection at the surgical site.
  • Recurrence, especially in ganglion cysts and GCTTS.
  • Injury to nearby nerves or tendons, leading to temporary or rarely permanent weakness or numbness.
  • Stiffness or scar formation.
  • Rarely, unexpected malignant diagnosis requiring further treatment.

Importance of Timely Removal

Delaying treatment of suspicious or symptomatic swellings can lead to:

  • Persistent pain and reduced hand function.
  • Progression of infection in abscesses, risking spread to deeper tissues.
  • Increased difficulty in surgical removal if the swelling grows larger.
  • Rare but serious consequences if a malignant tumor is left untreated.

Conclusion

Removal of swellings of the hand is a common surgical procedure performed for a variety of conditions ranging from benign cysts and tumors to infections. While many swellings are harmless, those causing pain, functional limitation, rapid growth, or cosmetic concerns require surgical excision. A proper clinical assessment, supported by imaging and histopathological studies, helps in accurate diagnosis and safe removal. Advances in surgical techniques allow most procedures to be performed with minimal scarring and quick recovery. Ultimately, removal of hand swellings not only relieves symptoms and restores function but also provides peace of mind to patients by confirming the nature of the condition.

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