91: Treatment of Mucous Cysts of the Distal Interphalangeal Joint

Procedure 91 Treatment of Mucous Cysts of the Distal Interphalangeal Joint



Shimpei Ono, Sandeep J. Sebastin, Kevin C. Chung



Indications




image Symptomatic mucous cyst


• Progressive cyst with impending rupture due to thinning of skin (Fig. 91-1)

• Discomfort or pain due to pressure from the cyst

• Nail deformity (see Fig. 91-1)

image Asymptomatic mucous cyst


• Aesthetic appearance

• Patient desire

image Patients should be advised that cyst excision might not provide complete pain relief in the context of an underlying arthritic joint because pain can be due to either the cyst or the underlying arthritic joint. The only treatment that can ensure a cyst will not recur is distal interphalangeal (DIP) joint arthrodesis.


image

FIGURE 91-1



Examination/Imaging



Clinical Examination




image A mucous cyst is a degenerative cyst of the DIP joint arising as a result of osteoarthritis. It usually occurs between the fifth and seventh decades of life, and patients have DIP joint osteoarthritis including Heberden nodes (Fig. 91-2).


image The cyst may present on the dorsum at the level of the DIP joint on either side between the extensor tendon and the collateral ligament or under the eponychium to cause longitudinal grooving of the nail plate (Fig. 91-3).


image

FIGURE 91-2


image

FIGURE 91-3



Imaging




image Anteroposterior and lateral view radiographs are useful in determining the location of the osteophytes and degree of osteoarthritic change (joint subluxation, deformity, and joint space narrowing) (Fig. 91-4).


image

FIGURE 91-4



Surgical Anatomy




image The mucous cyst originates from the DIP joint in relation to one of the osteophytes, and the stalk of the cyst passes between the collateral ligament and the extensor insertion to present on the dorsum of the DIP joint. Occasionally, the stalk can connect with another mucous cyst on the opposite side of the DIP joint. This cyst may not be clinically obvious (occult cyst), and the entire DIP joint should be examined during surgery.


image The terminal extensor insertion is about 1.2 mm from the proximal edge of the nail matrix (Fig. 91-5).


image

FIGURE 91-5



Positioning




image The procedure can be performed under a digital block using a forearm, arm, or digital tourniquet.

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Mar 5, 2016 | Posted by in Hand surgery | Comments Off on 91: Treatment of Mucous Cysts of the Distal Interphalangeal Joint

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