TUMOURS AND SWELLINGS
This category of disorders includes anything deep to the skin that swells up or enlarges producing a lump of tissue. In the hand it is rare for a swelling to be serious for the majority of swellings are not cancerous.
Specific skin disorders are not considered under hand surgery, being more suited to diagnosis and treatment by a Dermatologist.
Enlargement of a lump, with or without discomfort or pain, perhaps with associated impairment of activity are frequent symptoms. There may be pain on minor trauma, gripping, at night, at work etc. and the pattern may be characteristic of a particular tumour.
Certain features are typical of certain tumours: varies in size, on the back of the wrist – ganglion: solid, on the side of the finger – synovioma: severe shooting pain on pressure – glomus, haemangioma.
Non tumour causes of a swelling must be considered: rheumatoid arthritis [inflammatory disease]: gout [metabolic/chemical disease]: joint deformity from arthritis, and others.
Much can be said about a swelling based upon its site, size, surface, consistency and attachments. Other simple tests such as ‘transillumination’ can demonstrate liquid or fat content, and tapping to produce tingling may indicate a nerve tumour.
Careful consideration of the history and examination findings will lead to a diagnosis in most cases, but sometimes special radiography and other tests are needed.
This will depend on the diagnosis. Some swellings need to be removed because they are known to grow progressively, even though they may not be serious e.g. synovioma. Others, like ganglion, are known to vary in size and may recur after surgery. Here removal may be useful at certain sites but less so at others. Each case is judged on it’s merits. Sometimes surgical removal is needed to establish the identity of a swelling.
Some cases need to be performed under general or arm block anaesthetic but others, particularly those in the fingers, can be done under local anaesthetic as a ‘day-case’. Pain on insertion of the anaesthetic injection is modest, and the surgical procedure will be painless.
After surgery pain is modest. Light use and movement exercise are performed from the day of surgery, allowing essential functions to continue. Discomfort and weakness is usual following surgery but reduces progressively, quickly at first, and often continuing for a few months to a minor degree.
The swelling will be examined by a Consultant Histopathologist to report on the nature and prognosis. This process usually takes one to two weeks.