They are called ganglia. Tendon ganglion. Characteristic manifestations at different stages of pathology

Ganglia, or nerve ganglia, are the simplest elements of the macrostructure of the nervous system. It is from them that the “double” is built, and it is they, when merging, that form the head of the insect. In addition, ganglia that are not part of the nerve chain form the sympathetic one, which controls the functioning of many internal organs, primarily the endocrine system.

The brain (or suprapharyngeal ganglion) contains three pairs of nerve ganglia; they are fused into a single mass, so it is impossible to “recognize” them separately - at least visually. The subpharyngeal ganglion, located just behind the brain, is also usually fused together.

The number of ganglia in the nervous system of different insects is not the same; their number may be reduced, because the nerve ganglia often merge with each other. When nodes unite, the newly formed mass is called synganglium. At the same time, as a result of unification, the “posterior” nodes are shifted anteriorly and become part of the anterior nodes, which shortens the nerve chain.

In exceptional cases it turns out to be very short. For example, in some flies the entire central nervous system is represented by two synanglia: the brain and the nerve “lump” located in the department. They do not have elements of the nerve chain; they only have peripheral nerves.

Structure of the ganglion. Innervation

If we understand the structure of the ganglion in more detail, we can say that it consists of different types of nerve cells and their processes. Using the example of a typical abdominal ganglion, the relationships between the structural elements of the nerve ganglion can be represented as follows.

The ganglion includes processes of sensory nerve cells (their axons) that carry information from receptors. Inside the node they come into contact with the fibers of the motor and interneurons located there. Motor neurons transmit impulses to muscles or glands and provide a motor response to a stimulus. At the same time, intercalary ones are carried to neighboring ganglia and the head

Dorsal ganglion of a seven-day-old chick embryo grown in an artificial environment. Axons diverging from the ganglion are visible.

Vertebrate ganglia

In vertebrates, ganglia are usually called clusters of nerve cells that lie outside the central nervous system. Sometimes they speak of the "basal ganglia" of the brain, but more often the term "nuclei" is used for the clusters of neuron cell bodies within the central nervous system. The ganglion system performs a connecting function between various structures of the nervous system, provides intermediate processing of nerve impulses and controls some functions of internal organs.

There are two large groups of ganglia: dorsal ganglia and autonomic ganglia. The former contain the bodies of sensory (afferent) neurons, the latter - the bodies of neurons of the autonomic nervous system. In modern medicine, several concepts of ganglion are distinguished. Let's look at some of them.

The basal ganglion is a formation consisting of subcortical neurons (neural ganglia) located in the center of the white matter, in the cerebral hemispheres (caudate nucleus, globus pallidus, putamen, etc.). Neurons regulate the autonomic and motor functions of the body and participate in various processes (for example, integrative) of the nervous system.

The autonomic ganglion is a nerve ganglion, which is one of the inseparable parts of the autonomic nervous system. The autonomic ganglia are located along the spine in two chains. They are small in size - from a fraction of a millimeter to the size of a pea. Autonomic ganglia regulate the functioning of all internal organs, perform the function of supplying and distributing nerve impulses passing through them.

At the moment, the cervical superior nerve ganglion, located at the base of the skull, is the best studied by medicine.

In the medical literature, the term “plexus” is used instead of the term “ganglion”. However, it should be remembered that the ganglion is the place where the synaptic contacts are connected, and the plexus is the specific [ ] the number of ganglia connected in an anatomically closed region.

Other meanings

Also called ganglia are cystic formations that can be located around the tendon sheath (see.

Autonomic ganglia can be divided, depending on their location, into three groups:

• vertebrates (vertebral),
• prevertebral (prevertebral),
• intra-organ.

Vertebral ganglia belong to the sympathetic nervous system. They are located on both sides of the spine, forming two border trunks (they are also called sympathetic chains). The vertebral ganglia are connected to the spinal cord by fibers that form white and gray connecting branches. Along the white connecting branches - rami comroimicantes albi - preganglionic fibers of the sympathetic nervous system go to the nodes.

The fibers of post-ganglionic sympathetic neurons are sent from the nodes to the peripheral organs either along independent nerve pathways or as part of somatic nerves. In the latter case, they go from the nodes of the border trunks to the somatic nerves in the form of thin gray connecting branches - rami commiinicantes grisei (their gray color depends on the fact that postganglionic sympathetic fibers do not have pulpy membranes). The course of these fibers can be seen in rice. 258.

In the ganglia of the border trunk, most of the sympathetic preganglionic nerve fibers are interrupted; a smaller part of them passes through the border trunk without interruption and is interrupted in the precertebral ganglia.

Prevertebral ganglia are located at a greater distance from the spine than the ganglia of the border trunk; at the same time, they are located at some distance from the organs they innervate. The prevertebral ganglia include the ciliary ganglion, the upper and middle cervical sympathetic nodes, the solar plexus, the upper and lower 6th mesenteric ganglia. In all of them, with the exception of the ciliary ganglion, sympathetic preganglionic fibers are interrupted, passing through the nodes of the border trunk without interruption. In the ciliary ganglion, the parasympathetic preganglionic fibers innervating the eye muscles are interrupted.

TO intraorgan ganglia These include plexuses rich in nerve cells located in the internal organs. Such plexuses (intramural plexuses) are found in the muscular walls of many internal organs, for example the heart, bronchi, middle and lower third of the esophagus, stomach, intestines, gallbladder, bladder, as well as in the glands of external and internal secretion. On the cells of these nerve plexuses, as shown by histological studies by B.I. Lavrentyev and others, parasympathetic fibers are interrupted.

. Autonomic ganglia play a significant role in the distribution and propagation of nerve impulses passing through them. The number of nerve cells in the ganglia is several times greater (in the superior cervical spmpathic ganglion 32 times, in the ciliary ganglion 2 times) greater than the number of preganglionic fibers coming to the ganglion. Each of these fibers forms synapses on many ganglion cells.

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.

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Ganglion from lat. “knot” - in normal anatomy, it refers to nervous tissue containing neurons and their processes - axons and dendrites.

But according to the international classification of diseases of the World Health Organization, the code “ganglion” in ICD-10 hides any degenerative-dystrophic disease of the wrist joint.

Also in the literature you can find the names “ganglion”, “cyst”, “”, “”. All these are names of the same pathology - ganglion.

Tendon ganglion is a degenerative-dystrophic cyst-like damage to the articular apparatus of the hand or other joints, caused by constant mechanical irritation.

That is, it is a benign tumor-like process that is formed due to the proliferation of synovial tissue. Differs from hygroma in smaller size.

In 80-90% of cases, all benign lesions of the hand are hygromas. This pathology especially often affects young girls and women (frequency about 60%).

Externally, it is a tumor-like formation on the palm or the back of it, the wrist. The consistency can be dense or more elastic. Elongated and usually painful.

What are the reasons for the violation?

Reasons that may lead to the development of education:

The mechanism of pathology development

The joint capsule consists of connective tissue. The inside is lined with fibrous litter.

Articular fluid enters the joint through the valves from the joint space. This movement occurs in one direction, that is, only from the periarticular bursa into the joint cavity. There is no return outflow. This fluid persists in the joint cavity and is partially processed by the cells of the same fibrous connective tissue.

After or exposure to another etiological factor, degenerative-dystrophic processes occur in the tissue, that is, the death of the cells that make up this tissue.

Therefore, it becomes impossible to process excess synovial fluid; it thickens, thickens and resembles jelly in consistency.

Over time, this fluid can become overgrown with connective tissue, forming a cyst. Often adheres tightly to underlying tissues. Over time, calcium may be deposited on the capsule that delimits the defect. E

This will lead to calcification, that is, if previously the consistency of the defect was elastic, now it gradually becomes hard.

Types of formations

Based on the number of chambers that are formed, the following ganglions are distinguished:

• single-chamber;
• multi-chamber.

Where can it be located?

Depending on location, the following may be affected:

• articular phalanges;
• wrist joints;
• wrist joints.

On foot:

• phalangeal joints;
• metatarsal joints;
• tarsal joints;
• ankle joint;
• knee.

Leg damage is more common among athletes who heavily overload their joints with excessive loads. The joints of the hands are affected in people who perform monotonous, repetitive work. For example, seamstress, violinist, stenographer, etc.

Characteristic manifestations at different stages of pathology

At the initial stages of the development of the process, it is usually asymptomatic.

She’s still small, she’s not even particularly visible. But as the process grows, pain, discomfort, friction, and tension inside the joint arise.

It becomes impossible to perform usual work, especially if fine motor skills are involved in the process.

Numbness and tingling sensations may also occur.

The main complaint of patients is not even pain, but a cosmetic defect. Such formations look very unaesthetic.

Establishing diagnosis

The diagnosis is made based on the clinical picture, life history, and medical history. A general and biochemical blood test is performed.

The general analysis takes into account signs of acute inflammation, the so-called acute phase indicators.

These include leukocytosis with a shift to the left, increased erythrocyte sedimentation rate, and the presence of C-reactive protein and fibrin in the blood.

In a biochemical blood test, they look at the concentration of minerals - calcium, phosphorus, as well as creatinine, urea, etc. This is necessary, first of all, for the differential diagnosis of pathology from other types of joint disease.

To differentiate the process from malignant neoplasms, the doctor may prescribe a puncture of the joint fluid. That is, a small content is taken from the joint and its contents, mainly cells and chemical composition, are examined under a microscope.

Based on the totality of this data, a clinical diagnosis is made, after which treatment begins.

How to get rid of the problem?

It is possible to use several methods of treating ganglion:

Laser removal is an effective innovation

Now there is a modern method for removing ginglion using laser technology.

A laser makes a pinpoint incision of the skin and subsequent layers, removal of the formation and suturing. After the operation, 2-3 points remain, which almost completely disappear over time, which is more aesthetic.

The popularity of this method is also due to the fact that healthy tissue is practically not affected. And the occurrence of relapses is reduced to zero.

All types of surgery are performed under anesthesia, usually general. Therefore, you should not be afraid that you will be hurt. The rehabilitation period is also not very long, only about 10 days.

Possible complications

Such great importance is attached to these seemingly trivial processes because of the high number of complications.

Like any process of neoplasm, even benign, it can undergo malignancy - a transition from a benign form to a malignant one.

Also, excessive growth of the ganglion often leads to immobilization of the joint - loss of movement and performance.

Preventive measures

Prevention of ganglion development is the dosage of physical activity. It is necessary to protect joints from permanent mechanical trauma.

At all times, a person's age has been determined by the condition of his hands. If the hands were well-groomed, neat and beautiful, it was believed that this person was beautiful.

So take care of the beauty and health of your hands, do not allow any illness to disrupt your usual lifestyle and affect your happiness. Don’t delay in seeing a doctor; it’s better to make sure once again that everything is fine than to regret later what you didn’t do. Be always healthy and beautiful!