Mucous Cyst 

  • Author: Divya Singh, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Apr 8, 2010
 

Background

Mucous cysts, as seen in the image below, are ganglions of the distal interphalangeal joint (DIP) of the hand or of the toes. They have had several names, including mucoid cysts, synovial cysts, myxoid cysts, and myxomatous cutaneous cysts.[1, 2, 3, 4, 5, 6, 7, 8, 9]

Mucous cyst, lateral to the midline, with thinned Mucous cyst, lateral to the midline, with thinned skin. One possible surgical incision is indicated.
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History of the Procedure

Treatment options in the past have included aspiration, electrocautery, chemical cautery, steroid injection, and various types of surgical excision. Surgery currently is considered the definitive treatment for mucous cysts.

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Problem

Apart from the cosmetic deformity, patients with mucous cysts may note chronic drainage, infection,[10] and pain. The pain may be secondary to the arthritic joint, as well as to the cyst itself.

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Epidemiology

Frequency

Mucous cysts are most common in the fifth through seventh decades of life. Mucous cysts are more common in women, who constitute roughly 70% of the patients.

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Etiology

The precise etiology of mucous cysts is unclear; theories include synovial herniation, extensor retinacular metaplasia, myxomatous degeneration, and excess hyaluronic production by fibroblasts.

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Pathophysiology

In 60-80% of cases, mucous cysts are associated with degenerative joint disease of the DIP joint as seen in the image below. Studies have shown a pedicle between the cyst and the DIP joint capsule.[11, 12, 13]

Degenerative changes at the distal interphalangealDegenerative changes at the distal interphalangeal joint.
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Presentation

On physical examination, the cyst is located between the DIP extensor crease and the eponychium, lateral to the midline, measuring up to 15 mm (averaging 7 mm). The overlying skin can be thick or thin, and the patient may report sporadic drainage of the viscous fluid. Some erythema may surround the ganglion. Eventually, the cyst may result in a grooved deformity of the nailbed, or a nail groove may be present before the cyst is visible. Patients present to their physicians because of the deformity, although some may complain of discomfort.[14, 15, 16, 11, 13, 17]

Differential diagnoses include Heberden nodes or rheumatoid nodules, epidermoid inclusion cyst, Dupuytren knuckle pad, xanthoma, giant cell tumor of the tendon sheath, and gout.

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Indications

Surgical excision is indicated in the presence of active infection, drainage, or pain. Patients also may complain of nailbed deformity or extensor lag.

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Relevant Anatomy

See Surgical therapy.

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Contraindications

There are few contraindications to surgery. Even if the patient has medical comorbidities with concomitant risks with anesthesia, surgery can be performed with a digital block.

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Contributor Information and Disclosures
Author

Divya Singh, MD  Hand and Orthopedic Surgeon, Department of Orthopedic Surgery, Group Health Permanente

Divya Singh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

A Lee Osterman, MD  Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel A Schmitz, MD  Consulting Surgeon, Department of Orthopedics, Klamath Orthopedic and Sports Medicine Clinic

Miguel A Schmitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and North American Spine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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Mucous cyst, lateral to the midline, with thinned skin. One possible surgical incision is indicated.
Degenerative changes at the distal interphalangeal joint.
Dorsal osteophyte seen at the distal interphalangeal joint.
 
 
 
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