Practice Essentials

Mucous cysts are ganglions of the distal interphalangeal joint (DIP) of the hand or of the toes.^[1]They have had several other names, including mucoid cysts, synovial cysts, myxoid cysts, and myxomatous cutaneous cysts.

Apart from the cosmetic deformity, patients with mucous cysts may note chronic drainage, infection,^[2]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.^{[3, 4]}

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.

Pathophysiology

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.^{[5, 6, 7]}

Etiology

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

Epidemiology

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.

Prognosis

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 nodes.^[8] 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 (ROM).

Fan et al studied the results of osteophyte excision and joint debridement in the treatment of mucous cysts of the DIP joint (N = 15; 19 finger sites).^[9] Of the 15 patients, 14 recovered well, and one had partial skin necrosis that healed after dressing changes. In all affected fingers, the postoperative visual analogue scale (VAS) scores were lower than the preoperative scores. In one patient, the ROM of the affected finger decreased; the postoperative activity of the other fingers increased in varying degrees.

Clinical Presentation

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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

Practice Essentials

Pathophysiology

Etiology

Epidemiology

Prognosis

References

Tables

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