History and Physical Examination

On physical examination, the cyst is located between the distal interphalangeal (DIP) extensor crease and the eponychium, lateral to the midline, measuring up to 15 mm (average, 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 typically present to their physicians because of the deformity, though some may complain of discomfort.^{[10, 11, 12, 5, 7, 13]}

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

Workup

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Media Gallery

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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Mucous Cyst Clinical Presentation

History and Physical Examination

References

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