Mucous Cyst

Mucous Cyst

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

Apart from the cosmetic deformity, patients with mucous cysts may note chronic drainage, infection, [10]  and pain. Infections that develop from a ruptured cyst communicate with the underlying joint and can become septic arthritis and osteomyelitis. The pain may be secondary to the arthritic joint, as well as to the cyst itself. Additionally, the cyst may weaken the terminal extensor tendon with a resultant mallet finger. [11, 12]

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.

In 60-80% of cases, mucous cysts are associated with degenerative joint disease of the DIP joint. Studies have shown a pedicle between the cyst and the DIP joint capsule. [13, 14, 15]

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

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

The recurrence rate with both cyst and osteophyte excision is 3-12%, compared with a 25-50% recurrence rate with cyst excision alone.

Lee et al conducted a retrospective review of the medical records of 37 patients (42 cases) who had mucous cysts combined with Heberden’s node. [16]  Osteophyte excision without cyst excision was performed. In all cases except one, the cyst regressed without recurrence or a skin complication after osteophyte excision; eight patients experienced postoperative pain and loss of range of motion.

ARNER O, LINDHOLM A, ROMANUS R. Mucous cysts of the fingers; report of 26 cases. Acta Chir Scand. 1956 Oct 8. 111 (4):314-21. [Medline].

BOURNS HK, SANERKIN NG. MUCOID LESIONS (‘MUCOID CYSTS’) OF THE FINGERS AND TOES CLINICAL FEATURES AND PATHOGENESIS. Br J Surg. 1963 Sep. 50:860-6. [Medline].

Constant E, Royer JR, Pollard RJ, Larsen RD, Posch JL. Mucous cysts of the fingers. Plast Reconstr Surg. 1969 Mar. 43 (3):241-6. [Medline].

KING ES. Mucous cysts of the fingers. Aust N Z J Surg. 1951 Nov. 21 (2):121-9. [Medline].

Nelson CL, Sawmiller S, Phalen GS. Ganglions of the wrist and hand. J Bone Joint Surg Am. 1972 Oct. 54 (7):1459-64. [Medline].

Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999 Jul-Aug. 7 (4):231-8. [Medline].

Kivanc-Altunay I, Kumbasar E, Gokdemir G, Koslu A, Tekkesin M, Basak T. Unusual localization of multiple myxoid (mucous) cysts of toes. Dermatol Online J. 2004 Jul 15. 10 (1):23. [Medline].

Schmoeckel C, von Mallinckrodt G, Risch M. [Dorsal mucoid cyst–ganglion-like pseudocyst of the joint space]. Hautarzt. 2000 Sep. 51 (9):682-4. [Medline].

Budoff JE. Mucous cysts. J Hand Surg Am. 2010 May. 35 (5):828-30; quiz 830. [Medline].

Rangarathnam CS, Linscheid RL. Infected mucous cyst of the finger. J Hand Surg Am. 1984 Mar. 9 (2):245-7. [Medline].

Budoff JE. Mucous cysts. J Hand Surg Am. 2010 May. 35 (5):828-30; quiz 830. [Medline].

Kasdan ML. Mucous cysts. J Hand Surg Am. 2010 Oct. 35 (10):1720; author reply 1720. [Medline].

Loder RT, Robinson JH, Jackson WT, Allen DJ. A surface ultrastructure study of ganglia and digital mucous cysts. J Hand Surg Am. 1988 Sep. 13 (5):758-62. [Medline].

Newmeyer WL, Kilgore ES Jr, Graham WP 3rd. Mucous cysts: the dorsal distal interphalangeal joint ganglion. Plast Reconstr Surg. 1974 Mar. 53 (3):313-5. [Medline].

Psaila JV, Mansel RE. The surface ultrastructure of ganglia. J Bone Joint Surg Br. 1978 May. 60-B (2):228-33. [Medline].

Lee HJ, Kim PT, Jeon IH, Kyung HS, Ra IH, Kim TK. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur Vol. 2014 Mar. 39 (3):258-61. [Medline].

Barth J, Heinisch G. Multiple black nodules on the thumb. Dorsal mucoid cysts of the finger. Arch Dermatol. 1993 May. 129 (5):633-4, 637. [Medline].

Brown RE, Zook EG, Russell RC, Kucan JO, Smoot EC. Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts). Plast Reconstr Surg. 1991 Apr. 87 (4):718-25. [Medline].

JOHNSON WC, GRAHAM JH, HELWIG EB. CUTANEOUS MYXOID CYST. A CLINICOPATHOLOGICAL AND HISTOCHEMICAL STUDY. JAMA. 1965 Jan 4. 191:15-20. [Medline].

SMITH EB, SKIPWORTH GB, VAN DER PLOEG DE. LONGITUDINAL GROOVING OF NAILS DUE TO SYNOVIAL CYSTS. Arch Dermatol. 1964 Mar. 89:364-6. [Medline].

Chae JB, Ohn J, Mun JH. Dermoscopic features of digital mucous cysts: A study of 23 cases. J Dermatol. 2017 Nov. 44 (11):1309-1312. [Medline].

Weinheimer K, Patrick N, Darowish M. Treatment of Distal Interphalangeal Ganglion Cysts by Volar Corticosteroid Injection. Hand (N Y). 2017 Dec 1. 1558944717744336. [Medline].

Fisher RH. Conservative treatment of mucous cysts. Clin Orthop Relat Res. 1974. (103):88. [Medline].

Gingrass MK, Brown RE, Zook EG. Treatment of fingernail deformities secondary to ganglions of the distal interphalangeal joint. J Hand Surg Am. 1995 May. 20 (3):502-5. [Medline].

Jacox HW, Freedman LJ. The roentgen treatment of myxomatous cutaneous cysts. Radiology. 1941. 36:695-699.

Kleinert HE, Kutz JE, Fishman JH, McCraw LH. Etiology and treatment of the so-called mucous cyst of the finger. J Bone Joint Surg Am. 1972 Oct. 54 (7):1455-8. [Medline].

Korman J, Pearl R, Hentz VR. Efficacy of immobilization following aspiration of carpal and digital ganglions. J Hand Surg Am. 1992 Nov. 17 (6):1097-9. [Medline].

Richman JA, Gelberman RH, Engber WD, Salamon PB, Bean DJ. Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture. J Hand Surg Am. 1987 Nov. 12 (6):1041-3. [Medline].

Gümüş N. A new sclerotherapy technique for the wrist ganglion: transcutaneous electrocauterization. Ann Plast Surg. 2009 Jul. 63 (1):42-4. [Medline].

Hojo J, Omokawa S, Shigematsu K, Onishi T, Murata K, Tanaka Y. Patient-based outcomes following surgical debridement and flap coverage of digital mucous cysts. J Plast Surg Hand Surg. 2016. 50 (2):111-4. [Medline].

Chen WS, Lin CC. Mucous cyst of the distal interphalangeal joint: treatment by simple excision or excision and rotation flap. J Hand Surg Br. 1991 Feb. 16 (1):118-9. [Medline].

Crawford RJ, Gupta A, Risitano G, Burke FD. Mucous cyst of the distal interphalangeal joint: treatment by simple excision or excision and rotation flap. J Hand Surg Br. 1990 Feb. 15 (1):113-4. [Medline].

Eaton RG, Dobranski AI, Littler JW. Marginal osteophyte excision in treatment of mucous cysts. J Bone Joint Surg Am. 1973 Apr. 55 (3):570-4. [Medline].

Kasdan ML, Stallings SP, Leis VM, Wolens D. Outcome of surgically treated mucous cysts of the hand. J Hand Surg Am. 1994 May. 19 (3):504-7. [Medline].

Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am. 2009 Mar. 34 (3):395-400. [Medline].

Jager T, Vogels J, Dautel G. The Zitelli design for bilobed flap applied on skin defects after digital mucous cyst excision. A review of 9 cases. Tech Hand Up Extrem Surg. 2012 Sep. 16 (3):124-6. [Medline].

Jiménez I, Delgado PJ, Kaempf de Oliveira R. The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases. J Hand Surg Am. 2017 Jul. 42 (7):506-510. [Medline].

Jamnadas-Khoda B, Agarwal R, Harper R, Page RE. Use of Wolfe graft for the treatment of mucous cysts. J Hand Surg Eur Vol. 2009 Aug. 34 (4):519-21. [Medline].

Kawakatsu M, Ishikawa K. Dorsal digital perforator flap for reconstruction of distal dorsal finger defects. J Plast Reconstr Aesthet Surg. 2010 Jan. 63 (1):e46-50. [Medline].

Imran D, Koukkou C, Bainbridge LC. The rhomboid flap: a simple technique to cover the skin defect produced by excision of a mucous cyst of a digit. J Bone Joint Surg Br. 2003 Aug. 85 (6):860-2. [Medline].

Shin EK, Jupiter JB. Flap advancement coverage after excision of large mucous cysts. Tech Hand Up Extrem Surg. 2007 Jun. 11 (2):159-62. [Medline].

Blume PA, Moore JC, Novicki DC. Digital mucoid cyst excision by using the bilobed flap technique and arthroplastic resection. J Foot Ankle Surg. 2005 Jan-Feb. 44 (1):44-8. [Medline].

Fritz GR, Stern PJ, Dickey M. Complications following mucous cyst excision. J Hand Surg Br. 1997 Apr. 22 (2):222-5. [Medline].

Divya Singh, MD Hand Surgeon, Department of Orthopedic Surgery, The Polyclinic

Divya Singh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern 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, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Mucous Cyst

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