- See:
Hand Tumors
- Discussion:
- cystic lesion (actually a ganglion) over dorsum of finger near DIP & fingernail;
- it is associated w/ degenerative lesions and spur formation (Heberden's nodes) over DIP joint;
- ganglion may or may not be connected to DIP joint by a synovial stalk;
- there may be associated with grooving of fingernail distal to the cyst;
- the nodule is usually flesh colored and is compressible;
- definitative dx may be made by transillumination or aspiration of synovial fluid;
- Exam:
- need to document ROM of DIP and whether nail deformities are present;
- Radiographs:
- need to look for associated osteophytosis and arthrosis of DIP joint;
- Non Operative Treatment Considerations:
- if mucous cyst ruptures & become infected, a septic joint may result;
- cysts which do not have a connecting stalk may be amenable to aspiration and injection of steroid;
-
steroid injection:
- use 0.1-0.2 cc of
triamcinolone 5mg/ml;
- Surgical Treatment Considerations:
- associated Heberdens's nodes, osteophytes should be removed at surgery;
- removal of the bony hump, which has attenuated the extensor tendon, may cause a mallet deformity;
- excision of the bony spur may initiate an arthritic flare up that can lead to a spontaneous joint fusion;
- ganglia of the distal joint area require complete excision, osteophyte resection, and skin reconstruction;
- of patients w/ preoperative nail bed deformities, only half can expect resolution of their nail bed deformity;
- Treatment: Removal of Osteophyte:
- if an osteophyte is present, it may be removed w/o disturbing the cyst;
- this minimizes the chances for nail matrix injury;
- this technique, however, may be associated w/ higher chance of recurrence;
- Technique of Cyst Removal:
- cysts is approached thru an L shaped incision and any attenuated skin is elliptically excised;
- cyst is mobilized, traced to the joint capsule, and excised w/ joint capsule;
- care is taken not to disturb the insertion of the extensore tendon or nail matrix;
- w/ the joint extended and the tendon dorsally retracted, the opposite side is explored and occult cysts are excised;
- Treatment: En Bloc Excision of Nail Fold:
- the entire proximal nail fold (full thickness) is excised to a point just proximal to the cyst;
- insert the freer elevator under the nail fold upto the most proximal edge of the nail bed;
- this will protect the underlying nail, matrix, and extensor tendon;
- healing will occur by secondary intention over 6 weeks;
- Complications:
- residual loss of extension: 17 %
- pyarthrosis of DIP joint: 2-3 %
- nail deformities: 7 %
- recurrence of deformity 3 %
Outcome of surgically treated mucous cysts of the hand.
Complications Following Mucous Cyst Excision.
Fritz, GR, Stern PJ, and Dickey M.
J. of Hand Surg. 22-B; 2: 222-223. 1997.
Finger Nail Deformities Secondary to Ganglions of the DIP Joint (Mucous Cysts).
Brown RE, Zook EG, Rssell RC, Kucan JO, Smoot EC.
Plastic and Reconstructive Surgery, 87: 718-725. 1991.
Mucous Cysts of the DIP Joint: Treatment by Simple Excision or Excision and Rotation Flap.
Crawford RJ, Gupta A, Risitano G, Burke FD.
J. Hand Surg. 15-B: 113-114. 1990.
Treatment of fingernail deformities secondary to ganglions of the distal phalangeal joint.
MK Gingrass et al.
J. Hand Surgery.
Vol 20-A. 1995. p 502-505.
Treatment of mucous cysts of the fingers: Review of 134 cases with minimum 2-year follow-up evaluation
